Comprehensive care for children with HIV: Don’t forget nutrition

By Katheryn Barrera

"Attention must be paid to making better nutrition a reality for those children on treatment."

Toronto- Throughout the International AIDS Conference there was an undercurrent of discussion about nutrition and children affected by HIV and AIDS. The issue was raised in most of the sessions on client care. A little surprising, as talking about food hand-outs has been more or less taboo for sometime.

There are still concerns about food dependency, food jealousies within communities, and how we must feed families, as you cannot just feed one person in a household. At one particular nutrition session, Dr Paul Farmer (Partners for Health) emphasised that food support is still a stop-gap measure, that in time programmes like FairTrade must get communities back to producing sufficiently for themselves.

Even with the apparent shift in the AIDS agenda back towards an emphasis on prevention, attention must be paid to making better nutrition a reality for those people on treatment. And though antiretroviral therapy (ART) for kids has started in many countries, good nutrition is still especially critical for HIV positive children.

At the session titled ‘It takes more than a village to raise a child’ all three presenters brought up food and feeding. Kathleen Okatcha of Kenya admitted that providing children at her centres with a nutritious meal helps improve their health, though they still don’t have free ARTs.

In Nigeria, HIV positive children were kept alive primarily through improved nutrition until ART arrived for them last November. After ART was begun, results were relatively poor until the communities were involved in nutrition programmes for the children. In Tanzania, income-generating projects were used to improve food supplements received from the World Food Program to assisting mothers and their children affected by HIV.

At another satellite session on food and nutrition in care and treatment the chair, again Dr Paul Farmer, urged all the participants to advocate seriously for food support in their work. Stephen Lewis, UN Special Envoy for AIDS in Africa, also reiterated this message.

The Toronto conclusion on this issue? Nutrition is a vital element in the provision of comprehensive care for HIV positive children.

Contributed by:
Katheryn Barrera

[First distributed: 16 August 2006]

Source: Children-IAC2006 eForum 2006: Children-IAC2006@eforums.healthdev.org

TANZANIA: Free food programme to complement free ARVs

DAR ES SALAAM, 8 August (PLUSNEWS) - The treatment and care of HIV-positive Tanzanians, more than half of whom live below the poverty line, must go well beyond merely providing life-prolonging medication if it is to be successful.

"Most patients are poor. The medicines become irritants when they react with the walls of the stomach, exacerbating the side effects of the drugs. Without money to buy food, they are forced to literally feed on the drugs," said Monica Joseph, an HIV/AIDS counsellor and nurse at the Shree Hindu Mandal Hospital in the coastal city of Dar es Salaam.

Most HIV/AIDS patients lived in rural areas and urban slums, and being able to afford enough food was a problem. "It is an emerging challenge that health-givers must contend with. Some patients withdraw from the programme after developing side effects, most of which are related to nutritional factors."

According to Herman Lupogo, director-general of the Tanzania Commission for AIDS (TACAIDS), "ARVs must be integrated into other national health and food security programmes. ARVs alone cannot boost the patient's immunity; provision of nutritious food must go hand in hand with the distribution of free ARVs, or else AIDS will remain a major health problem."

The government has acknowledged these concerns by announcing a programme to provide free food for HIV/AIDS patients. Although details of the scheme are yet to be made public, it has received strong political backing.

However, Joseph said the policy would be difficult to implement because nearly 55 percent of the population lived on less than a dollar a day, and she foresaw logistical and financial problems in setting up the feeding programmes countrywide. Approximately 44,000 HIV-positive people are receiving free ARVs.

Tanzania experienced a severe drought recently, and the United Nations World Food Programme estimates that some 565,000 people are facing food shortages. Mobilising enough resources to feed the growing number of AIDS patients would be extremely difficult.

Critics have warned that persistently poor harvests would force the government to import food to sustain the programme, adding to the cost.

Joseph also thought it likely that some patients would sell the food to get money for fuel and water. Some organisations had already backed out of feeding programmes because many patients, particularly women, were so poor that they would rather give the food to their children, while their own health continued to deteriorate.

Source: Pronut-HIV

PanAfrica: HIV/AIDS And the Children

July 31, 2006
East African Business Week (Kampala)

There are many strategies used in responding to the impact of HIV/AIDS on adults and children and I am going to consider a few. For our purposes, I will consider the concerns that have been inscribed in the Convention on the Rights of the Child (CRC).

First on the list is survival of children. For children who are living with HIV, it is important to ensure that they are protected diligently from any form of opportunistic infections such as malaria, cold, intestinal diseases and pneumonia among others.

Children especially in their infancy cannot be expected to understand what it means to keep clean, warm or to observe rules of hygiene unless adults around them supervise them. It is important to note here that, even children who may not be HIV positive face similar risks in their infancy and need to be protected from infection of any kind.

As caretakers of children, we need to monitor their health status regularly, especially if they are living with HIV. For the children who are HIV positive, we should ensure that they are not struggling against an unknown opportunistic infection quietly as we take care of them.
Medical check up would always ensure this.

If we can afford at some stage, we should check their CD4 count and viral load to see whether they need to be put on some form of anti-retroviral drugs. The drugs for children are still limited, but a lot of research is going on to try and deal with this imbalance.
Related to health is nutrition. There is currently a lot of work being done in the region on nutrition especially in relation to our traditional foods, which are affordable and available.
Many of the regular vegetables we get even in the poorest homes are not only nutritious, but may also be medicinal. Adults need to deliberately give children the first priority in feeding, and healthy feeding at that.

We also have to improve our knowledge of the kinds of easily available and affordable nutritional foods we have among us. If in any culture, the children feed after adults, this must be reversed; if they are given mainly starchy and watery food, this should change.
The aim should always be to have quality before quantity. Past assessments in certain parts of this East African region have shown that because of cultural feeding practices, even in the midst of plenty of food, some children have ended up becoming malnourished, often reflected in a high number of children being underweight (weight for age), wasted (weight for height) or stunted (height for age). Stunting is usually considered chronic malnutrition.

In this region according to UNICEF statistics, the percentage of moderate to severe stunting in infants (under-fives) between 1996 and 2004 in a number of countries are as follows: Burundi, 57%; DR Congo, 38%; Djibouti, 26%; Eritrea, 38%; Ethiopia, 52%; Kenya, 30%; Rwanda, 41%; Somalia, 23%; Tanzania, 38%; and Uganda, 39%. Many of the countries that do not have figures for malnourished children are found in Europe, North America and Australia. There also seems to be a close link between instability, poverty and malnutrition. For example, 54% of under-five children in Afghanistan between the years 1996 and 2004 were stunted, while the figure for Iraq was 22% for the same period compared to 15% for neighbouring Iran.

It is therefore not a big surprise that a big part of Sub-Saharan Africa has children facing chronic malnutrition.

We have to however take this with "a pinch of salt" because even in the countries that have had stability for years, we still see high levels of stunting; Kenya and Tanzania come to mind when we consider this contradiction.

If one compared the economies of Somalia and Kenya for example, it would be quite unfair to say that they are in anyway close. Probably the answer is not in whether one is poor or rich, highly developed or just developing, but rather in what kind of feeding practices we have with respect to our infants.

Source: ProNut- HIV eForum