South African experts say food no substitute for medical drugs in AIDS and TB

By, News-Medical.Net, August 22, 2007

A report by the Academy of Science of South Africa has stated that there is no evidence to support the theory that a healthy diet is a substitute for medical drugs when it comes to treating HIV/AIDS and tuberculosis (TB).

The scientists conducted a comprehensive study on the links between nutrition and treatment and found that no food has been identified as an effective alternative to appropriate medication in fighting HIV/AIDS and TB.

The South African government currently stresses that nutrition as well as drugs is important in the fight against these devastating diseases despite the fact that the country's health minister has earned herself international ridicule and the nickname "Dr Beetroot" for her views.

Dr. Tshabalala-Msimang has been criticised in the past for stressing the benefits of beetroot, garlic and potatoes in fighting HIV and under-playing the role of anti-retroviral (ARVs) drugs.

South Africa has one of the world's highest HIV infection rates and the country's researchers say that scientific evidence about conditions in South Africa was urgently needed.

The report by the country's top scientific advisory panel concludes that though nutrition is important for general health, is not sufficient to contain either the HIV/AIDS or the TB epidemic and says a well-fed population on its own will not resist HIV/AIDS without anti-retroviral (ARV) drugs.

A more comprehensive approach on the part of the government now means about 280,000 people were on ARV treatment at the end of March this year but that falls well below the estimated 800,000 who are thought to need ARVs in South Africa.

South Africa has one of the world's highest HIV infection rates with an estimated 12% of the country's 47-million population infected with the deadly virus.

South Africa's healthcare system struggles to cope because of a lack of doctors and nurses, many of whom have left the country for better pay abroad; the fight against AIDS has also been confused and hampered by the conflicting messages sent by senior government officials such as Health Minister Manto Tshabalala-Msimang.

Deputy health minister Nozizwe Madlala-Routledge was sacked this month for insubordination, provoking an outcry from AIDS activists who strongly backed her policies and critics who say she was fired for political reasons.


Source: http://www.news-medical.net/?id=28994

South Africa: New report confirms nutrition no substitute for treatment

By, IRIN PlusNews, August 22, 2007

There is no evidence that better nutrition can substitute for antiretroviral (ARV) treatment, a new report has found. These findings might seem unremarkable anywhere else in the world, but not in South Africa, where the issue of nutrition has been tainted by a damaging debate that has tended to frame it as an alternative to ARVs.

Statements by Health Minister Manto Tshabalala-Msimang, suggesting that eating garlic, beetroot and olive oil, could delay the need to take ARVs, have created widespread confusion in the country with the world's highest HIV caseload.

A multidisciplinary panel of 15 members of the Academy of Science of South Africa (ASSAf), an independent statutory body considered to be the national academy of science for the country, spent nearly two years reviewing an estimated 2,000 studies on the role of nutrition in the HIV and TB pandemics.

Drawing on literature as well as years of field experience, the panel formed a consensus on the role of nutrition and reviewed guidelines from the World Health Organisation (WHO), the South African Department of Health and the Southern African HIV/AIDS Clinicians Society to see how the guidelines matched the science.

The report concluded that no evidence exists to back claims that better nutrition alone can treat HIV or TB - let alone curb these pandemics. Such assertions have led many South Africans to question high-level commitment to ARV promotion and the national rollout.

"Neither poverty nor malnutrition is the cause of HIV/AIDS or tuberculosis," said Prof Este Vorster, director of the Africa Unit for Transdisciplinary Health Research at Northwest University and panel member. "If you've been tested for HIV and you know your status, you need to know that dietary supplements cannot compensate for healthy eating; in the same way, eating healthily cannot compensate for antiretroviral drugs."

Many studies indicated improved outcomes for patients practising better nutrition in addition to drug treatments. For instance, the intake of macronutrients, such as carbohydrates, fats and proteins, was a strong indicator as to how fast people living with HIV and on treatment would progress to AIDS, said Jimmy Volmink, a clinical researcher at the University of Stellenbosch, but such studies on the role of nutrition in HIV and TB were rare.

He noted that among the small number of studies available, most had been conducted in high-income countries, where populations tend to be better nourished and treated. Questions remained as to the applicability of these studies in lower-income settings or even more socio-economically complex settings such as South Africa.

"We might be one country, but we are not one nation yet," he said. "We need to be aware of disparities between the haves and the have-nots; we need to see what works in specific situations."

Besides identifying a lack of research on nutrition in South Africa, the report noted confusion about the role of nutrition in HIV, which was being exacerbated by a dual system of medicine regulation that subjected "Western" medicine to much more rigorous controls than complementary medicines, such as immune boosters and nutritional supplements.

"If you simply put together something, put it in a bottle and sell it for R300, it's never checked," said Wieland Gevers, ASSAf's executive officer and panel member.

Consequently, HIV-positive people, family members, caregivers and the community were not only confused about the validity of medicines and nutrition, and what roles they played, but also distrustful of medical doctors and prescription treatments, according to the report.

The duality in regulatory practice arises from the contrast between Western scientific tradition, with its enormous emphasis on rigorous testing, and traditional medicine and the politics related to tradition in South Africa, he said.

"In traditional medicine, we have a different approach: it is seen as wisdom passed on. It's simply, in a sense, experience in practice," he said. "Traditional medical practitioners say that part of the remedy is the patient's belief in the remedy itself, and it's very hard to test that in a controlled study."

"Also, there are the special conditions of the historical transitions," he said. "Nobody wants to be very heavy handed with the traditions of the majority - about 80 percent of South Africans would go to a traditional healer first; it's very hard to regulate a tradition that the majority of the population thinks is okay," Gevers said.

Although the report did not focus on the debate about the regulation of traditional versus "Western" medicines, it noted the need for better regulation of "traditional" or "alternative" medicines, and to educate the population about their uses. According to Gevers, the health department and the Medical Research Council were moving in that direction.

The report has been released at a tumultuous time for the health minister and her department. Earlier this week, claims surfaced in the South African media that Tshabalala-Msimang's heavy drinking may have prompted her liver problems and subsequent transplant, and that her position and influence had pushed her to the top of the recipient list.

Deputy Health Minister Nozizwe Madlala-Routledge, who was fired less than two weeks ago, has also been at loggerheads with the health minister over her stance on nutrition, ARVs and other health issues.

"I want to stress that this not part of any political issue; the project had a dynamic of its own," Gevers said, pointing out that the timing of ASSAf's report on nutrition was coincidental. "We saw a need for this study; in these highly controversial areas of nutrition everybody's an expert, and you have to be sure of your ground."

The WHO, the South African Health Department and the Southern African HIV/AIDS Clinicians Society, whose guidelines were reviewed, have not yet commented on the study but ASSAf said it was too soon to expect a response. Tshabalala-Msimang received an advanced copy of the report.

"The health department is likely to be preoccupied with other matters right now, but we expect to give a detailed presentation to explore how we can link our research with current interventions," Gevers said.

To read the report's findings and recommendations in full, go to http://search.sabinet.co.za/images/ejour/assaf/Study%20%20pdf%20final%20ASSAf%20HIV%20TB%20and%20Nutrition%20doc.pdf

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South Africa: Chewing Over the Research On HIV/Aids And Food

By, Barry Mendelow, Business Day (Johannesburg), August 22, 2007

There is an astonishing abundance of over-the-counter products, extracts made from food and food supplements, which claim somehow to modulate the human immune system to prevent or treat deadly infections such as HIV and tuberculosis. Such mixed messages about nutrition have been harmful from an individual level all the way up to the level of government policy and implementation. An unambiguous message has emerged from a 16-month analysis of all the relevant research, which we did, with many colleagues, under the auspices of the Academy of Science of SA: there is no evidence that better nutrition is an alternative to the correct medications at the correct times.

We are not saying nutrition is insignificant. Healthy eating habits still have a hugely important role to play in managing these infections. Eating a variety of food, including fruit and vegetables, daily is especially important in developing countries, where nutritional deficiencies are rife.

Nutritional support is helpful. But nutritional support cannot substitute for the specific combinations of drugs required to cure the TB infection or reduce the amount of HIV to undetectable levels.

Much of the previous coverage of the intersection of nutrition, HIV and tuberculosis has focused on politics and personalities. We suggest that some of the factors contributing to the uncertainty are scientific in nature.

One is the desire for a solution without the evidence to back up the claims. The academy panel has noted the startling lack of welldesigned, relevant studies in the field of nutritional intervention for people with HIV and/or TB. This absence of thorough research, before or after specific medical treatment is started, is a sad reflection in a country and continent in which hunger and micronutrient deficiencies are common.

Another factor that may be contributing to the confusion in the debate about nutrition and infections is simply the astonishing complexity of food. Plants have evolved to contain thousands of chemicals. Some affect humans. Few are well understood.

Another issue is the need for common guidelines. We need to agree on the best ways to test how malnourished a person is. We need reliable, appropriate, affordable tests. We need more sensitive ways to measure the depletion of vitamins and minerals. We need intensive research on vitamins, now known to be far more active in parts of the body that play a critical role during HIV infection.

We need much more research into whether specific kinds of nutritional support can assist in staving off the day when antiretroviral drugs are absolutely required.

And recent research showing how the gastrointestinal tract (the gut) plays a pivotal role in the speed and severity of HIV replication suggests that the intestine will be a major site of new advances against AIDS.

We have recommended to the science and technology and health departments that this absence of sound scientific research should be tackled as a priority.

We need to make it clear that we did not conduct new research ourselves. That is not the role of an academy. It is not meant to replace a university or a research council. What we can do is bring our particular skills to analyse and assess the existing research.

In this case, given the controversies, we thought it was essential that all the evidence, international and local, was thoroughly reviewed by an independent, impartial, multidisciplinary and authoritative panel.

So in 2005 the Academy of Science appointed a panel of 15 researchers with a wide variety of experience and expertise, including nutritionists, immunologists, biochemists, infectious disease physicians and paediatricians, policy experts and epidemiologists.

Many of these fields have been isolated from each other. This consensus panel was beneficial as it forced people to confront the latest news in areas outside their own specialisations. Since then, these researchers have systematically picked away at the myths, marketing hype and salesmanship that have thrived like weeds around two of the most serious diseases facing humanity.

For 16 months, we have carefully reviewed a vast amount of research. We are probably pioneers in bringing together separate medical fields that have seldom met, in what has been a very creative process. Many promising new avenues of research have opened up.

It is possible that in future, some types of foods may be confirmed in exhaustive and reputable scientific analyses as having some beneficial power to reduce the onslaught of HIV, especially if they dampen the early inflammation caused by the virus in the gut.

But there is enough evidence currently to suggest caution in any case in which exaggerated claims are made on behalf of any food, nutritional supplement or plant chemical. And under no circumstances should people be going off medically prescribed drugs in favour of a particular diet or vitamin.

Mendelow, a professor emeritus based at Wits University and the National Health Laboratory Service, chaired the panel investigation. Dr Ncayiyana, editor of the South African Medical Journal, Dr Dhansay of the Medical Research Council, and Vorster, a nutrition professor from the University of the North West, helped assess the research.

Source: http://allafrica.com/stories/200708220209.html

HIV/AIDS and food insecurity: Double jeopardy

By, Kate Harper, The International Development Research Centre

In 1989, while working at the Food and Agriculture Organization of the United Nations, Stuart Gillespie spent six months examining the connection between HIV/AIDS and food security. It quickly became clear to him that the epidemic’s long-term impacts could have a devastating effect on hunger throughout the developing world.
Seventeen years later, he continues to emphasize this connection as a senior research fellow with the International Food Policy Research Institute (IFPRI) and cofounder of the Regional Network on HIV/AIDS, Rural Livelihoods and Food Security (RENEWAL), partly funded by Canada’s International Development Research Centre (IDRC).

Reaching the MDG targets

Gillespie says that responding to the connection between HIV/AIDS and food security is now more important than ever, particularly in the context of the UN Millennium Development Goals (MDGs), drafted in 2000 and subscribed to by all 191 UN member countries. Halting or reversing the spread of HIV/AIDS, and halving the proportion of the world’s population living in extreme hunger are two of the eight MDGs to be achieved by 2015.

“There’s no way that Africa will reach the Millennium Development Goals by 2015 without addressing HIV/AIDS and food security together,” Gillespie says. “Both challenges are now so intertwined that they cannot be compartmentalized.”

To help tackle these issues, RENEWAL was launched in 2001 at a conference on HIV/AIDS, rural livelihoods and food security in Malawi as a joint project between IFPRI and the International Service for Agricultural Research (ISNAR). Currently active in Ethiopia, Kenya, Malawi, South Africa, Uganda, and Zambia, RENEWAL’s goal is to increase the “HIV-responsiveness” of agriculture, food, and nutrition policies and programs and to identify actions that could help reduce people’s exposure to HIV and lessen the impact of AIDS.

For example, research has shown that those affected by HIV and AIDS may be less likely to access a diverse mixture of crops needed for adequate nutrition, as the disease weakens their productivity. Dietary quantity and quality deteriorates, creating further health problems. RENEWAL researchers say this can be solved through more HIV-aware development policies and practices linked to improving access to information on the disease and the importance of nutritional support within prevention, care, and treatment.

After the 2001 Malawi conference, researchers began to see the advantages of working together in a network to strengthen their capacity, sharing information to inform policy.

In its first phase, launched in 2002, RENEWAL expanded into a “network of networks,” linking local researchers across sub-Saharan Africa through a series of eight studies examining HIV/AIDS and food security.

“We thought, ‘Why should we just limit this to one or two countries? Why not try and maximize that kind of interaction by going regionally as well?’” Gillespie says.

Maximizing results on a national level

In the project’s second phase, the results of these studies were compiled, and a further nine were initiated. The original studies continue to be used to inform national policies and programs. For example, in Malawi, the government met with RENEWAL researchers to draft an AIDS and agriculture strategy. Piloted in 2004 near the capital, Lilongwe, and officially launched in 2005, the strategy aims to integrate food and nutrition security interventions with HIV and AIDS prevention programs.

In the future, RENEWAL aims to encourage studies that focus on more local and regional issues. This is part of an effort to expand its influence beyond the food and nutrition community by targeting international organizations, including many that deal with health or HIV policy.

A study in Malawi, for example, found that the risk of sexually transmitted diseases increased during the “hungry season.” As local residents faced a decreasing food supply, some had little choice but to resort to high-risk transactional sex, to support themselves and their families.

Renaud De Plaen of IDRC’s EcoHealth program says that the research results from Malawi illustrate the need to examine HIV/AIDS not just from a health standpoint, but from a food and nutrition perspective as well.

“The more people are affected, the harder it becomes for them to produce enough food, and the more vulnerable they become,” De Plaen says. “As the most vulnerable are often the most at risk, it becomes a vicious spiral.”

Gillespie agrees. “People who are extremely poor or food insecure are more likely to be at risk of being exposed to the virus, and being infected,” he says. “Then later, their households are at greater risk of becoming irreversibly poorer because of this infection”

Involving key stakeholders

At the regional level, RENEWAL is supported by National Advisory Panels (NAPs) of about 10 members, which include representatives from the local agriculture and health sectors, nongovernmental organizations, and AIDS-related groups within each country of operation. Involving those closest to the issue is key to solving problems, and is an important part of the RENEWAL research process, Gillespie says.

“To have a real and sustained impact, certainly at a national level, all key stakeholders grappling with this crisis have to be fundamentally involved,” he says.

A third phase of RENEWAL, set to launch in 2007, will end in 2010, the year the UN aims to have achieved several benchmark goals for HIV/AIDS, as outlined in its 2001 Declaration of Commitment. This next phase will involve more activity throughout sub-Saharan Africa as well as in India and will increase connections with international AIDS organizations. Another goal is to eventually make the networks self-reliant, Gillespie says.

“We need to keep our focus on the bigger picture,” he says. “Our ultimate goal is to have demonstrable impact on the food and nutrition sectors, as well as the health and HIV sectors, with regard to the interaction between the two.”

Though there’s still work to be done, more people are beginning to recognize the connection between HIV/AIDS and food security, says De Plaen.

“Four years after the initial phase, there is a general recognition among the scientific community that food security and HIV/AIDS cannot be looked at separately,” he says. “It’s very clear the only way to handle the AIDS crisis is through better collaboration between the health, food production, agricultural, and education sectors.”

Kate Harper is an Ottawa-based writer.

Source: http://www.idrc.ca/en/ev-100661-201-1-DO_TOPIC.html

Lesotho: Hungry for assistance

By, IRIN Plus News, July 18, 2007

In the wake of the most severe drought in 30 years, the kingdom of Lesotho has declared a state of emergency and appealed for international assistance for over 400,000 people in need of urgent food aid.

"Food assessments conducted by local and international institutions and organisations, including the [government's] Disaster Management Authority, the [UN] Food and Agriculture Organisation (FAO) and the World Food Programme (WFP), ... all confirm a food crisis," Prime Minister Pakalitha Mosisili said in a recent statement.

According to the FAO and WFP reports, the cereal harvest, of which the largest part is maize, Lesotho's staple food, has been slashed by over 40 percent, from 126,200 metric tonnes (mt) of cereals in 2006 to 72,000mt this year. Approximately 328,000mt of cereals are required to feed the country.

The rainy season in Lesotho usually lasts from October to April. Farmers at Thuathe, a farming area near the capital, Maseru, welcomed the prime minister's call for assistance, saying that without help they would have nothing to feed their families.

In normal circumstances, Malakabane Mokoatsi, a sharecropper and mother of six, produced 40 bags of maize from the eight hectares she tends. This year the yield was a mere 12 bags, six of which went to the other shareholder.

"This means that I am literally without food, as these six bags ... at the very most, will be able to feed my family until the end of September, and from then onwards I will be forced to buy."

Food prices soar

The significant drop in cereal harvests, such as maize and sorghum, has increased prices beyond the reach of many households. Reduced harvests in South Africa, the main regional supplier, have also contributed to the price hikes.

Mokoatsi said feeding her family would be a struggle, because the family's only cash income was $130 a month, which her son earned as a taxi driver.

"Field reports indicate that the price of 12.5kg of maize meal has nearly doubled since 2006, from $3.50 in March 2006 to $5.40 in March 2007. More than half the country lives on less than US$2 a day," said the latest Southern Africa Humanitarian Update by the Regional Inter-Agency Standing Committee, a group of UN agencies and humanitarian non-governmental agencies.

The crop failure has also reduced casual labour opportunities, especially in agriculture, making it even harder for the nation's poor to survive.

A chronic problem

"These assessments point to the vicious cycle of food insecurity brought on by erratic weather, prolonged drought, poverty and the impact of HIV/AIDS in the region," the update said, warning that although immediate food and agricultural assistance was required, it would not significantly change the long-term situation of the affected people.

Mapoloko Halieo, who also farms at Thuathe, said this was the worst harvest in years of investing in field and food production, and she had only managed to reap three bags of maize from her three hectares. She said her maize cobs were short and small, with underdeveloped grains.

"There were years when I did bad, but at least I could feed my family. This maize has not returned even my planting expenses, and I do not know what I am going to do," she said. "I might have to sell my cows, though I cannot expect to get much from them either, as they are thin and will not sell for much."

Mosisili said Lesotho produced about 30 percent of its total food requirement. "Furthermore, our people are going through untold hardships because of the unrelenting impact of HIV/AIDS [official estimates put prevalence at 23.2 percent] and the number of orphans is increasing each day.

Our people are going through untold hardships because of the unrelenting impact of HIV/AIDS and the number of orphans is increasing each day
His statement noted that "analysis of prices of basic food commodities indicate a drastic upward trend ... compounded by very low purchasing power - quite a vicious circle by all accounts."

Quoting a Basotho saying, loosely translated as "help is given to those who make an effort to help themselves", Mosisili said the government viewed the declaration "of food crisis and appeal for assistance as a short-term measure to alleviate famine", and appealed "for adequate resources to eliminate our dependency on food aid in the long term".

He said the government had devised strategies to ensure national food security in the future, which included identifying agriculture as the key factor in the poverty-reduction strategy; improving agricultural productivity and food security through maximum use of arable land, with subsidised inputs; promoting drought-resistant crops, and scaling up homestead farming/gardening.

Besides food shortages, there was also a critical shortage of water for human as well as livestock consumption, and the statement pointed out that "major streams and rivers are either dry or running low".

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Source: http://www.irinnews.org/Report.aspx?ReportId=73291

BURUNDI: Food cuts for HIV-positive people worry NGOs

By, IRIN PlusNews, August 15, 2007

AIDS advocacy groups in Burundi are worried that a decision by the United Nations World Food Programme (WFP) to cut special feeding programmes next year for HIV-positive people will harm their long-term health.

Drought, crop disease, endemic poverty and more than a decade of instability mean Burundi suffers from serious food insecurity. WFP is expected to feed an estimated 874,000 Burundians by the end of 2006, including particularly vulnerable groups such as internally displaced persons, school children and HIV-positive people.

However, the agency's new policy means that feeding programmes for people infected and affected by HIV/AIDS will come to an end in December 2006 and will not be renewed.

"We have previously considered people infected and affected by HIV as a separate category of beneficiaries," Guillaume Foliot, programme manager for WFP in Burundi, told IRIN/PlusNews. "But we found that we were diverting an important tranche of our monthly food distribution to HIV patients, when the fact of being HIV positive in itself does not make one vulnerable - many people can carry on working and can purchase food, whereas people in northern Burundi [who are worst-affected by food insecurity] sometimes have literally nothing to eat."

Burundi is struggling with a 500,000-tonne food deficit, but WFP is able to provide just 70,000 tonnes in aid. "People infected and affected by HIV/AIDS have been taking up between 10 and 15 percent of our monthly distributions," Foliot said.

Local AIDS organisations dependent on WFP assistance are worried that the end of the programme could have disastrous consequences for already vulnerable people.

"We have been feeding orphans, child-headed households and our most desperate patients with WFP food, but with the programme coming to an end, we do not know what is going to happen to them," said Jeanne Gapiya Niyonzima, a leading AIDS advocate and president of the National Association to Support HIV-positive People. Gapiya's organisation has 1,700 people on life-prolonging antiretroviral (ARV) drugs, many of whom are currently receiving food aid from WFP.

Foliot said WFP would continue to provide food to people starting on ARVs for the first nine months of treatment, which Gapiya - herself HIV-positive for several years - said was insufficient.

"I have been on the drugs for years and I still need a very good diet to feel okay," she said. "We are negotiating with WFP to see if they can continue feeding the patients who really are in urgent need."

The Burundi chapter of the Society for Women Against AIDS in Africa (SWAA), which runs a programme for prisoners, said WFP's decision would also affect the health of the country's HIV-positive inmates.

"Conditions in prison are really difficult; the inmates do not get a balanced diet, which is especially dangerous for HIV-positive people," said Baselisse Ndayisaba, coordinator of SWAA Burundi.

Foliot said WFP's decision was made after consultations with the Burundian Ministry of Health and UNAIDS to allow the agency to focus on the "the worst of the worst". Apart from the programme for HIV-positive people, programmes for elderly people in institutions, street children and hospitals have also been cut.

"There are so many thousands of people in Burundi who desperately need food, and those HIV-positive people who are indeed vulnerable should still qualify for food aid under one of our other vulnerable categories," he added.

Source: http://www.irinnews.org/report.aspx?reportid=61557

A call for assistance with self-sufficient food security in Zambia

By, Bright M Mweemba, HDN key correspondent in Zambia, August 8, 2007

The food security of people living with HIV (PLHIV) in Zambia needs to be addressed as a matter of urgency. The food supplements that some people get are not a long term solution. Just as antiretroviral drugs (ARVs) are considered a lifelong necessity, so should food security.

The solution lies in finding ways of empowering PLHIV. I suggest that a policy of voluntary resettlement to productive farming areas should be put in place in Zambia. The government needs to set up a revolving fund for this purpose.

It is difficult for individuals to access institutional funding while living in areas other than where they want to settle. The financing systems currently in place only deal with cooperatives or support groups, meaning people need the support of their current community before they can finance a move elsewhere.

Many people cannot become members of their village cooperative because they plan to move on. What these people need is direct assistance to enable them to migrate and start being productive.

As a PLHIV, I have tried to access small, start-up capital from various institutions dealing with HIV and AIDS issues, but all my attempts have been in vain. My wife, who is also HIV positive, and I want to be self-sufficient and able to supply ourselves with food.

I am sure I am not the only person in this situation. I am aware that there are a lot of workshops being conducted to empower people with business skills but as long as nothing is done to actually start these people in business the money spent and the knowledge gained are going to go to waste.

Food insecurity is more of a threat to PLHIV than the actual infection with which they live.


Source: www.correspondent.org

Food security is vital for people living with HIV

By, Clementine Mumba, HDN key correspondent in Zambia, June 11, 2007

Many people living with HIV (PLHIV) are too poor to take care of their health properly. Even among those people with access to free antiretroviral (ARV) treatment, many cannot afford to maintain the balanced diet they need to compliment the drugs.

Supporting these people would require a well thought out policy, promoting the self-sufficiency of people living with disease.

In 2004, an organization that I belong to called the Network of ARV Users lodged a Project Proposal with the Zambia National AIDS Network (ZNAN) for a chicken-rearing programme that would generate income for people living with HIV. The idea was well articulated and looked good on paper so the project was approved by ZNAN and was launched in January 2005.

We bought our first batch of chickens from the Zambia Beef Company and sold them on credit for a month. We managed to collect some money and make a small profit. We did the same with the second batch but unfortunately our system started to fail, as most of our members could not resist the temptation of cooking and eating the chickens we were meant to sell.

They thought that by that time we should already have been making enough money to provide them with the soft loans they needed to improve their diets.

We hoped that after five to 12 months, we would make enough profits to reverse the situation. We wanted to have a revolving fund that would allow members who needed financial help to borrow money at low interest rates.

In the meantime, our members were starving. With no food at home for themselves or their families, the chickens ended up in their cooking pots as rations. Chicken, a useful source of protein, is considered a delicacy in many Zambian homes. Most of our members rarely received protein-rich food and the chicken became a supplement for their diets.

The cash raised from our sales could not be deposited into our account because it was given out as soft loans to some members who failed to pay it back. None of the members was harassed over their inability to pay back the money because most had no formal employment and were considered vulnerable.

Many of the members who did have jobs were also unable to pay the money back because their salaries were too low.

As I write, ZNAN is still monitoring the Network of ARV Users as a result of its failure to account for the funds raised from the income generating project. Some of our members, who have now passed away, were not able to account for the money they were responsible for.

All these problems resulted from the fact that our members living with HIV/AIDS did not have enough to eat.

Taking drugs on an empty stomach can be dangerous, especially in the case of ARVs, which are very strong. People receiving ARV treatment are advised to maintain a balanced diet but for many this is impossible. Most do not even own houses and are renting rooms in compounds without the space for a vegetable garden.

The government’s moves to ensure that people living with HIV start taking ARVs are good but more needs to be done to secure food rations for those people receiving treatment who suffer from poor nutrition.

Doctor Canisius Banda, a member of our group and a government official, was quoted in an article in Zambia’s Post newspaper in May as saying, “It is not the consumption of drugs that we must emphasize. Yes, drugs or pills have their critical role in prolonging or saving lives. Nonetheless, it is not pills that we rely on or must do for survival. It is food. Food is the fuel of life. Food keeps disease away, pills treat it.”

Food security is vital to the future of Zambians living with HIV. As long as the government fails to address this, income generating activities aimed at these people will fail. I appeal to the Zambian government to come up with a policy for the provision of food rations to people on ARV treatment.


Source: www.correspondent.org

ARVs and food security in Zambia

By, William Chilufya, HDN Key Correspondent in Zambia, June 26, 2007

For people living with HIV (PLHIV), good nutrition is essential for continued good health. Yet, for too many PLHIV in Zambia, especially in rural areas, getting enough to eat adds enormously to life’s daily challenges.

“I have no money to buy food and am on ARVs [antiretroviral drugs],” said Lillian, a mother with one child. Lillian’s husband died from AIDS-related complications three years ago.

“My son and I sometimes spend the whole day without eating anything – I feel dizzy and weak if I do not eat when I take the drugs, and then I can’t do anything.”

Despite these difficulties, Lillian has persevered with her medication; keeping in mind that if she does not she risks developing resistance to ARVs.

Chibesa, a subsistence farmer in his thirties, exemplifies the daily struggle of an HIV positive person compelled to take ARV treatment without adequate means required for the drug uptake.

Whenever he takes the drug without getting something to eat, he feels dizzy and his heart rate accelerates.

“For several hours, I cannot move but if I get something like porridge or bread it is different,” said Chibesa.

According to Emmanuel Tembo, an HIV consultant, “Taking ARVs where there is no food only worsens the sickness, because some of these drugs are toxic and, they can cause problems unless they are taken with the recommended types of food.”

Most ARVs interfere with the virus’s ability to replicate inside your body. Others block the virus from getting inside your cells. ARVs do not cure HIV, they only suppress the virus. By taking your medications as prescribed, you reduce the amount of virus in your body.

The food you eat and how you eat it is very important in keeping your immune system strong and building it up when it is low; when you are on ARVs or, indeed, other drugs, a balanced diet is recommended.

Getting a balanced diet means eating lots of different types of foods. This helps to make sure you receive all the different nutrients that your body needs. But in the absence of proper nutrition taking the drugs becomes just as bad as not taking them.

“There is a shortage of food in some parts of Zambia, especially in rural areas, where people are going for nights without meals; worse still are those who are HIV positive and on ARVs,” Tembo said.

The number of people living with HIV and going hungry has not yet been established. However, according to the 2002-2003 Living Conditions Monitoring Survey (LCMS) from the Central Statistical Office (CSO), approximately 67% of Zambian households are ‘poor’ and 46% ‘extremely poor’ (unable to afford even basic food items).

The government of the Republic of Zambia is providing free ARVs as part of its commitment to the global target of promoting universal access to treatment by 2010. Also, the government has scrapped user fees in rural health centres.

Food assistance is the number one request made by PLHIV. It is key to improving overall health and quality of life.

Good nutrition helps PLHIV manage symptoms and effectively respond to treatment. Conversely, HIV compromises the nutritional status of infected individuals. It creates additional nutritional requirements, causing symptoms that limit food intake and reducing the use of nutrients by the body. Moreover, when a hungry person living with HIV has enough food for himself and his family, he is much more likely to adhere to treatment. Food-insecure PLHIV know all too well the cruel irony of an increased appetite caused by the ARVs.

These links are particularly acute in rural communities, where households are often dependent on agriculture for both income and food. In many villages across Zambia, HIV has wreaked havoc on food production. When someone is debilitated by disease, the food security of his or her family is in jeopardy. All too often families are forced to sell livestock and other valuable assets to care for the sick or to pay funeral expenses. This then compromises any future earning potential.

For that reason, improving rural livelihoods and agricultural production can help reduce both the spread of HIV and its impact. Programmes that reduce the need for poor people to migrate to look for work (e.g., by restoring degraded land) can reduce their risk of being exposed to the virus.

With the majority of Zambian households located in rural areas, and the majority of poor households engaging in subsistence farming in these areas, what is most needed in Zambia is an agricultural revolution – in other words an explosion in agricultural output brought about by improved seed varieties, better farming and animal husbandry methods.

In Zambia agricultural development is crucial to national development: higher food production leads to higher rural incomes and lower urban food prices, both bringing about higher levels of food security; higher food production also increases resources for diversifying into other income generating activities at household level and increases overall opportunities for agro-business (e.g., producing peanut butter, cooking oil, etc.) at the national level.

Frequent droughts, cattle diseases, HIV related illnesses and deaths, etc. have decimated agricultural productivity in the country. The government has a huge responsibility to rejuvenate agricultural productivity.

Last season’s heavy rains damaged crops and infrastructure in some parts of the country and worsened the already fragile situation of food insecurity.

According to Paul Kasokomona, an HIV activist and member of Treatment Advocacy and Literacy Campaign (TALC), the food crisis in rural areas will seriously compromise life prolonging ARV treatment.

“Many persons taking ARVs tell us they are considering stopping it as without food there is no use taking the drugs,” Paul said.

HDN 2007

Source: www.correspondent.org