Seminar on Aids And Nutrition, Mozambique

April 21, 2005- Mozambican rural households, who live essentially from agriculture, are losing the capacity to generate foodstuffs, because of the impact of HIV/AIDS, according to Ana Taju, of the Food and Nutritional Security Technical Secretariat (SETSAN) in the Agriculture Ministry. She was speaking at a planning meeting on nutrition and AIDS organised by SETSAN and the National Council for the Fight against AIDS (CNCS), with support from the UN Food and Agriculture Organisation (FAO).

There is a vicious circle involved when HIV infection hits farming households. On the one hand food security and good nutrition are essential conditions for fighting against AIDS, but on the other people weakened by HIV/AIDS are in no condition to produce enough food for themselves and their families.

Taju said that AIDS reduces the work force, reduces the area under cultivation, and compromises agricultural production.

Households then find themselves forced to resort to "risky activities" (such as prostitution) in order to ensure their survival.

But if food security were guaranteed, Taju said, this would help keep communities united, and would offer greater protection for the large number of orphans whose parents have died of AIDS.

She pointed out that a healthy diet can hold back the progression of HIV infection, delaying the onset of full-blown AIDS.

"Even when people have access to anti-retroviral treatment, a balanced diet is fundamental so that the drugs can be effective", she said.

Taju stressed the role of community leaders in the strategies required, which would include, among other actions, ensuring that peasant farmers know their rights under the land law, supplying seeds and other agricultural inputs, vegetable production in gardens and at schools, and breeding small livestock species.

Source: All Africa.com and Agencia de Informacao de Mocambique (Maputo), April 21, 2005

UN condemns irresponsible attack on antiretroviral therapy

Geneva, 11 May 2005 -- A recent advertising campaign is touting the benefits of vitamin therapy above antiretroviral therapy and claiming that antiretroviral therapy is toxic. These advertisements, placed in the international press, are wrong and misleading, reiterated the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) today.

WHO, UNICEF and UNAIDS have condemned the irresponsible linking of their names to claims that vitamins and nutrition therapy alone can prevent AIDS deaths.

A number of accounts published by Matthias Rath on his website and distributed as flyers and advertisements in South Africa imply that a number of United Nations bodies including WHO, UNICEF and UNAIDS endorse his approach. The three UN organizations are extremely concerned about these misrepresentations and note that the Rath Foundation has used quotes and information from UN agencies out of context.
Misrepresentations of this sort are both dangerous and unhelpful.

Over the last few years, several studies have been carried out to investigate the role of micronutrient supplements on the course of HIV/AIDS disease. The results of these studies have not been conclusive.
WHO and UNAIDS recommendations for micronutrient supplementation are therefore similar for all people whether they are infected with HIV or not.

As in the population at large, a good diet that provides the full range of essential micronutrients is important to the health of people infected with HIV and can help bolster the immune system, boost energy levels and maintain body weight and well-being. Guidelines published jointly by the Food and Agriculture Organization (FAO) and WHO in 2003 offer simple dietary suggestions for people living with HIV and AIDS .

Although they may help to meet increased nutritional requirements, nutritional supplements cannot replace eating a balanced and healthy diet. Whether a person is infected with HIV or not, WHO and UNAIDS recommend a good mixed diet, whenever possible, rather than dietary supplements. For people on antiretroviral therapy, good nutrition and clean water help treatment work more effectively.

Vitamins and nutritional supplements alone can not take the place of comprehensive treatment and care for people living with HIV/AIDS, including prophylaxis and treatment for opportunistic infections and antiretroviral therapy, where indicated, as well as a good, balanced diet. Antiretroviral therapy has been shown in numerous studies to reduce the replication of HIV in the body, reduce the incidence of opportunistic infections and AIDS-related illness and improve quality of life. In countries where it is widely available, antiretroviral therapy has turned AIDS from a 'death sentence' into a chronic but manageable disease. As with any other drugs, antiretroviral treatments do have side effects that have been documented in clinical trials.

The role of nutrition for people living with HIV/AIDS was highlighted at a recent meeting in South Africa convened by WHO in collaboration with other UN agencies. Participants at the meeting called for the integration of nutrition into the essential package of care, treatment and support for people living with HIV or AIDS.

Editors note: A fact sheet entitled 'AIDS treatment, nutrition and food supplements' is available on the internet at www.who.int/3by5/mediacentre/fsFood/en/

Source: HealthGap listserve

AIDS treatment, nutrition and food supplements: WHO Fact Sheet

[30 March 2005]

HIV progressively damages the immune system, which can make a person susceptible to a range of opportunistic infections and lead to conditions such as weight loss, fever and diarrhoea.
These HIV-related conditions can lower food intake by reducing appetite and interfering with the body's ability to absorb food. HIV also alters metabolism which can often lead to increased energy and nutrient requirements for people with HIV-infection.

People with HIV who are also suffering from hunger and/or nutritional deficits are more likely to fall ill with opportunistic infections and less likely to be able to recover from them. In addition, people who are sick with HIV-related illnesses are also less able to work normally, to earn income or to produce food, which can lead to nutritional deficits both for themselves and for their dependants.

As in the population at large, a good diet that provides the full range of essential micronutrients is important to the health of people infected with HIV and can help bolster the immune system, boost energy levels and maintain body weight and well-being. Guidelines published jointly by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) in 2003 offer simple dietary suggestions for people living with HIV and AIDS.[1]

Over the last few years, several studies have been carried out to investigate the role of micronutrient supplements on the course of HIV/AIDS disease. The results of these studies have not been conclusive.[2]WHO and UNAIDS recommendations for micronutrient supplementation are therefore the same for people whether they are infected with HIV or not.

Although they may help to meet increased nutritional requirements, nutritional supplements cannot replace eating a balanced and healthy diet. Furthermore, supplements are often not available, are expensive and may leave less money for food. Whether a person is infected with HIV or not, WHO and UNAIDS recommend a good mixed diet, whenever possible, rather than dietary supplements.

WHO and UNAIDS recommend periodic, high-dose vitamin A supplements for all children who are vitamin A deficient, including those who are HIV-infected, as these can reduce morbidity and mortality.

According to current UN feeding recommendations, infants of HIV-negative mothers and mothers who do not know their HIV status should be exclusively breastfed for the first six months of life, and thereafter should receive nutritionally adequate and safe complementary foods while breastfeeding continues up to 24 months or beyond.

However, for HIV-infected mothers, to reduce the risk of HIV transmission while minimizing the risk of other causes of morbidity and mortality, when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life and should then be discontinued as soon as the conditions for replacement feeding are in place. Women should receive counselling about the risks and benefits of the various infant-feeding options, and support for their choice.

Feeding non-breastfed infants and young children from 6 months to 24 months of life poses particular challenges, especially in countries where formula, cow's milk and animal-source foods are not readily available. Guiding principles for feeding non-breastfed children have recently been developed. [3]

Although good food and diet are important for the wellbeing of people living with HIV/AIDS, there is no evidence that food and/or dietary supplements alone will stop people who are infected with HIV from progressing to AIDS. Comprehensive care for people living with HIV and AIDS needs to include prophylaxis and treatment for opportunistic infections and antiretroviral therapy, where indicated and a healthy, balanced diet.

Antiretroviral therapy has been shown in numerous studies to reduce the replication of HIV in the body, reduce the incidence of opportunistic infections and AIDS-related illness and improve quality of life. Optimal antiretroviral treatment requires safe, clean drinking water and a balanced diet rich in energy, protein and micronutrients. Secure, good nutrition and clean water may make antiretroviral therapy easier to take and help ensure that treatment works effectively.

More research is needed to examine the micronutrient needs of people living with HIV/AIDS and the best role for micronutrient supplements in HIV/AIDS infected populations. There is no evidence that, taken alone, micronutrient supplements will prevent disease or prolong life for people living with HIV and AIDS.

Citations:
********
[1] - Living well with HIV/AIDS: A manual on nutritional care and support for people living with HIV/AIDS, World Health Organization / Food and Agriculture Organization, 2002
[2] - Nutrient requirements for people living with HIV/AIDS: report of a technical consultation, WHO, May 2003, available here
[3] - Guiding principles for feeding non-breastfed children, .WHO, in press.

[Source file here]

Training HIV/AIDS orphans in sub-Saharan Africa

Field schools fight hunger and poverty with farming know-how and life skills

9 May 2005, Rome - AIDS orphans in Africa are being helped to improve their often desperate living conditions by learning agricultural techniques in specially designed schools, FAO said today.

To date, FAO has set up 34 Junior Farmer Field and Life Schools for orphaned children in Kenya, Mozambique, Namibia and Zambia, targeting a total of around 1 000 young people. Many of these children are not able to farm because their parents could not pass on the necessary agricultural knowledge before dying of AIDS.

The AIDS crisis

Of the estimated 34 million orphans in sub-Saharan Africa, more than 11 million lost their parents to AIDS. By 2010, it is estimated that up to 20 million children could lose one or both parents to the disease. Children orphaned by AIDS and living in rural areas are particularly at risk from malnutrition, disease, abuse and sexual exploitation.

The threat of sexual exploitation is particularly high for those left alone to cope with poverty and forced to earn money to support their families. After the death of their parents, the children often become heads of household and have to search for ways to make an income, a difficult task in rural areas with few job opportunities, services and little infrastructure.

Learning by doing

FAO is working with the World Food Programme (WFP) and other UN agencies, non-governmental organizations and local institutions, to found the Junior Farmer Field and Life Schools for children and young people in response to the growing numbers of AIDS orphans.

The schools aim to share agricultural knowledge, business skills, and life skills with orphans and vulnerable children between 12 and 18 years of age. The knowledge and skills acquired by the young girls and boys should help them to develop positive values regarding gender equality and human rights.

The schools cover both traditional and modern agriculture. Children learn about field preparation, sowing and transplanting, weeding, irrigation, pest control, utilisation and conservation of available resources, utilisation and processing of food crops, harvesting, storage and marketing skills.

The field schools also help to recover or sustain traditional knowledge about indigenous crops, medicinal plants, and biodiversity.

In addition, the schools address such issues as HIV/AIDS awareness and prevention, gender sensitivity, child protection and sexual health, while offering psychological and social support, nutritional education, and business skills. The schools provide a safe social space for the students to develop their self-esteem and confidence.

"The objective of the schools is to empower the orphans through knowledge and self-esteem and to give them essential elements for their long-term food security. These training courses are an important starting point to get AIDS orphans out of hunger and poverty. They offer survival strategies in often very difficult environments," said Marcela Villarreal, Director of FAO's Gender and Population Division.

Mozambique

Mozambique is the focus of the project with a total of 28 Junior Farmer Field and Life Schools now up and running in the central provinces. So far, around 120 orphans have successfully completed their training, and 840 more students are currently learning how to work the land with hands-on lessons in farming techniques, nutrition and medicinal plants.

Lessons in dancing and singing help the children grow in confidence and develop social skills. Theatre and discussion groups are used to tackle potentially life-saving issues including the prevention of HIV/AIDS and malaria, gender equality and children's rights.

The programme is funded by Finland, Norway, FAO and WFP

Online at: http://www.fao.org/newsroom/en/news/2005/102183/index.html

A Better Way to Fight Poverty

(NY Times Editorial, 5 May 2005)

Kenya has never seemed to be able to live up to the potential of its rich farmland and staggeringly beautiful valleys. Its government is corrupt. Its capital, Nairobi, has become a haven for street thieves and muggers. Some 56 percent of the population lives below the poverty level. Malaria, which could be as treatable as strep throat, kills one in five children every year because the government grossly shortchanges its public health system. All in all, it is a classic case of how African governments can squander foreign aid.

But far from the noise, pollution and public and private crooks of Nairobi, the village of Sauri, practically smack on the equator, is an example of a better way to do things. It is one of two test cases for the United Nations' ambitious program to cut poverty in half by 2015. Sauri's story shows how direct aid can largely bypass governments, getting money and help straight into the hands of the people who not only need it the most, but also know what to do with it.

Anne Omolo, the head teacher of Sauri's sole primary school, arrived six years ago to find a student population that was listless, miserable and performing poorly in national exams. Some 500 children were enrolled, but attendance was low. She soon realized the problem. "They were hungry," she said.

So on her own, she started a food program. She went to the village parents who could afford it and asked them to bring in corn and beans. But almost half of the school's students were orphans whose parents had died of AIDS, and they couldn't afford to contribute food. So Mrs. Omolo and the 10 other teachers dug into their own pockets.

Eventually, they scraped together enough to feed about 100 students. It was a terrible choice. "Not everybody could eat," Mrs. Omolo said. So she fed the top two grades - seventh and eighth graders - because they would soon be taking national exams to move on to high school. Students from the younger classes went to the windows to watch their older schoolmates eat.The result was instantaneous. Attendance among the older children shot up to 100 percent, and their test scores followed suit. Sauri went from 68th out of 353 schools in the district in 2000 to 7th in 2004.

"This year," Mrs. Omolo says, "we will be No. 1." Part of the reason for her confidence is that this year, every schoolchild will eat. Sauri was chosen last year to be one of the United Nations' test villages - Koraro, Ethiopia, is the other - to show how poverty in Africa can be ended through programs that help villages directly. For the next five years, Sauri will receive $250,000 a year for agricultural, educational and health programs.

Much of the money will go to help farmers improve their crop yields. Farms are already looking better, thanks to people like Patrick Mutuo, a Kenyan soil expert who travels there from Kisumu four days a week to teach the farmers how to get the most out of their land. Because of Mr. Mutuo and his band of agricultural extension workers, Monica Okech's six acres of corn, ground nuts and beans are lush and green. Mrs. Okech, a fiercely independent 50-year-old whose husband left her in Sauri years ago, has planted leguminous trees and plants throughout her farm. These plants provide natural fertilizer for what was once depleted soil.

Mrs. Okech now feeds 10 villagers, and is building a chicken coop. The United Nations plan, spearheaded by the economist Jeffrey Sachs, seeks to expand the program to the entire district, and then all over Africa. But that will happen only if rich countries make good on their promise to ratchet up foreign aid to 0.7 percent of G.D.P. by 2015. Britain, France and Germany have all put out timetables for meeting the goal. The United States, the world's richest country, has yet to do so.

In the meantime, the people in Sauri work on their farms while trying to ward off killers like malaria, hunger and AIDS - some 25 percent of them are infected with HIV. But all it takes is for the villagers to look across the valley at the anemic farms and dismal test scores of their neighbors to know that they are still the lucky ones.