ACW: Food Security

SUDAN: People with HIV demand safe drinking water

2008-05-13T14:19:00.000+07:00

By, IRIN PlusNews, May 12, 2008

For years, Lole Laila Lole had to drink, cook with, and bathe in the dirty, contaminated water he fetched from the River Nile. "There was no other way," he told IRIN/PlusNews.

Lole, chairperson of an association for people living with HIV/AIDS in southern Sudan, discovered he was HIV-positive after falling ill in 2002 and travelling to the Sudanese capital, Khartoum, where the country's only HIV testing facility at the time was located.

Due to their weakened immune systems, people living with HIV are particularly susceptible to infections and diseases that can be present in untreated water. But after testing positive, Lole was forced to return to the virtually non-existent water system of Juba, the southern capital, which had been at war for close to two decades.

The conflict ended in 2005, but government leaders in the south say they lack adequate resources to redevelop the war-ravaged region and deliver services such as providing safe water.

Since the end of the war, treatment tablets have become available in the shops, and HIV-positive people who can afford them are now able to protect themselves from the outbreaks of cholera and other diarrhoeal diseases that are common in this region.

This year, non-profit organisation, Population Services International (PSI), with funding from the United States Centres for Disease Control, began including water treatment tablets in the basic care packets they distribute to people with HIV every three months.

Water Guard, the brand name of the tablets being distributed, is helping to keep people healthy in areas of the south where antiretroviral treatment is unavailable. Each care packet contains 90 tablets, and each tablet treats 25 litres of water. The packet also includes a jerry can with a tap at the bottom, water containers, condoms, two mosquito nets and educational materials on malaria and how to prevent HIV infection.

"The health indicators [in southern Sudan] are very low," said Erin Stuckey, HIV/AIDS technical advisor to PSI in southern Sudan. "If you have a high incidence of watery diarrhoea and a high incidence of malaria, the HIV-positive people would be affected the most."

The decision to include Water Guard in PSI's care packets was partly in response to pressure from people living with HIV. The fruits of this effort were visible last month, when hundreds of HIV-positive people swarmed the office of the Sudan Council of Churches in Juba. Five hundred people received packets, but more than two hundred had to be turned away.

Women in Sudan also face very high maternal health risks, which are exacerbated by the unavailability of clean water. According to the United Nations Population Fund, a Sudanese woman's lifetime risk of dying from pregnancy-related causes is estimated at 1 in 30. The risks are significantly higher for HIV-positive mothers and babies, particularly if they are unable to access safe drinking water.

"It's a major concern for us; we feel that they must have access to clean water," said Dr Angok Kuol, executive director of the Southern Sudan AIDS Commission. "If they don't have safe water, they are always prone to infections such as watery diarrhoea."

PSI's Stuckey said the programme to distribute care packets to people living with HIV would be expanded into other areas of southern Sudan in the near future. Meanwhile, several organisations, including the UN Children's Fund (UNICEF) and Solidarités, a French non-governmental organisation, are raising awareness about hygiene and sanitation, drilling boreholes and repairing existing water points across the south.

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Source: http://www.plusnews.org/Report.aspx?ReportId=78148

WHO To Launch Campaign Aimed at Improving Nutrition Among HIV-Positive People in South, Southeast Asia

2007-10-18T15:16:00.000+07:00

By, Kaisernetwork, October 17, 2007

The World Health Organization soon will launch a campaign in South and Southeast Asia aimed at making nutrition programs a central part of HIV/AIDS treatment in the region, Randa Saadeh, a scientist in WHO's Nutrition for Health and Development Department, said recently, Inter Press Service reports. Saadeh was speaking at the end of a weeklong meeting in Bangkok aimed at increasing support for the campaign and ensuring that governments in the region have measures to implement program in place by 2009.

According to Saadeh, this is the first time the region has been targeted to improve nutrition as part of its effort to fight HIV/AIDS. "We want governments to adopt strong positions on this link" between HIV/AIDS and nutrition "as a solution," she said. The campaign follows a similar WHO initiative in sub-Saharan Africa that was launched after the approval of a resolution that formally recognized the link between nutrition and HIV/AIDS at the 2006 World Health Assembly in Geneva, Switzerland, Inter Press Service reports. The resolution called on governments to "make nutrition an integral part of their response to HIV/AIDS."

According to WHO, HIV-positive adults and children need 10% more energy than HIV-negative people to maintain their weight. People who have progressed to advanced stages of the disease require 20% to 30% more energy, and HIV-positive children who are losing weight need 50% to 100% more energy to maintain their weight, WHO said. In addition, the growth of HIV-positive children who do not have access to proper nutrition is hindered and can lead to opportunistic infections that "place an additional demand" on children's energy and nutrient needs, according to WHO. HIV-positive people who are malnourished also are at an increased risk of malaria and other diseases, Nigel Rollins, a professor of maternal and child health at the University of KwaZulu-Natal in South Africa, said.

Studies conducted among the estimated four million people living with HIV/AIDS in South and Southeast Asia in 2006 found that many people had difficulty accessing proper nutrition. "High malnutrition rates persist in the region, and food is often identified as the most immediate and critical need by people living with HIV and others affected by the epidemic," WHO said.

Prasada Rao, head of the Asia-Pacific division of UNAIDS, said that HIV-positive people taking antiretroviral drugs might be unable to handle the medication without proper nutrition. He added that low-income populations without proper nutrition also might sell antiretrovirals for money to purchase food. Current "nutrition policies of governments" in the region "do not address the HIV/AIDS concerns," Rao said, adding that HIV/AIDS and nutrition "have to be addressed together, as one" (Macan-Markar, Inter Press Service, 10/14).

KENYA: Food shortages complicating ARV programme in the north

2007-09-10T10:07:00.000+07:00

By, IRIN PlusNews, September 6, 2007

Food shortages in arid, remote northern Kenya are making it impossible for HIV-positive people in the region to adhere to their antiretroviral (ARV) medication regime, relief workers say.

The life-prolonging ARV drugs have been labelled "death drugs" because of the effect they have on patients who take them without adequate food, according to Ahmed Mohamed Patel, a volunteer with the Kenya Red Cross in Isiolo, in Kenya's Eastern Province, which borders Ethiopia in the far north of the country.

"The safety and effectiveness of the drugs depends on the food intake ... unfortunately, most of the victims are poor and cannot afford a simple bite of food," he told IRIN/PlusNews. "The expected relief and intended assistance will never be achieved unless the problem is addressed."

Health workers said many HIV-positive people were opting to stay off the drugs rather than suffer the side effects of taking them on an empty stomach. The government has initiated a free food programme to assist families of people infected and affected by HIV in Isiolo but, so far, only 30 families have been benefiting.

"The food assistance programme is a big relief to the poor and their families; we know there are many deserving cases, but cannot assist all of them," said Isiolo district commissioner Evans Ogonkwo. "We are planning to expand and help more people."

Galma Aliof, of Isiolo Youth against AIDS and Poverty, a non-governmental support group, alleged that corrupt officials affiliated to the organisations providing free food have been selling the food supplements rather than giving them to needy families.

"Some of the officials heading these organisations are using this sad situation to make money ... they sell food openly," he said. "The other day an HIV-positive person died at Kulamawe village [near Isiolo], and yet a food store next to his house was filled with food."

Health workers have also complained that ARVs have not been reaching all those who need them. Although the government has been distributing free ARVs nationally for more than a year, many areas in the north, other than the main towns, are not served by a road network and have no access to the life-prolonging drugs.

Need to decentralise HIV services

"Infected persons have to travel to the district headquarters in case they need the drugs; it is expensive and many would rather not make the trip," said Sofia Shano, an HIV/AIDS counsellor in Isiolo.

Even where health facilities existed in remote areas, there was no electricity to store drugs that needed refrigeration. "Health centres in remote areas must be equipped with solar panels [to generate electricity for refrigeration] to help store the drugs," Shano said.

Margaret Leshore, patron of the Samburu East Women's Empowerment Programme, a non-governmental organisation advocating women's rights, told IRIN/PlusNews that all HIV programming, including testing, advocacy and treatment, needed to be taken to "the grazing fields, livestock market and watering points", where the region's mainly pastoralist communities could easily be found.

Although northern Kenya has some of the country's lowest HIV-prevalence rates, the region also has very low levels of awareness, and the nomadic lifestyle of its inhabitants means HIV service providers must find innovative ways of reaching all the area's resident with their messages.

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Source: http://www.plusnews.org/Report.aspx?ReportId=74162

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

2007-08-24T11:30:00.000+07:00

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

2007-08-23T10:11:00.000+07:00

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

2007-08-23T10:07:00.000+07:00

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

2007-08-16T10:04:00.000+07:00

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

2007-08-15T13:28:00.000+07:00

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

2007-08-15T10:41:00.000+07:00

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

2007-08-08T16:10:00.000+07:00

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

2007-08-08T15:41:00.000+07:00

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

2007-08-08T15:37:00.000+07:00

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

Right foods 'may help drugs work'

2007-07-19T16:31:00.000+07:00

By, BBC News, July 17, 2007

Combining medicines with the right food could improve the effectiveness of drugs and reduce the costs of treating patients, experts say.
The comments come after research showed taking a breast cancer drug with fatty food, rather than on an empty stomach, boosted absorption of the drug.

This means patients could take lower doses, which would reduce costs.

The comments were made by oncologists from the University of Chicago in a Journal of Clinical Oncology editorial.

Previously experts have warned of the potential dangers of interactions between food and drugs - they could lead to drugs becoming toxic, or less effective.

But professors Mark Ratain and Ezra Cohen said recent findings about the interactions between foods and anti-cancer drugs could be exploited to help decrease costs and increase the benefits from such drugs.

Researchers have found that taking the breast cancer drug lapatinib (TYKERB) with food, rather than on an empty stomach as suggested on the label, increased the availability of the drug in the body by 167%, meaning the drug could work more effectively.

And taking it with a meal rich in fat boosted levels by 325%.

Professor Ratain said: "Simply by changing the timing, taking this medication with a meal instead of on an empty stomach, we could potentially use 40% of the drug."

He said drinking grapefruit juice, which is known to increase the rate at which some drugs enter the blood stream, at the same time could increase these savings even further.

And eating such "value meals" at the same time as taking drugs could have other benefits too.

More research

For example, a major toxicity associated with lapatinib is diarrhoea, which is thought to be caused by unabsorbed drug, so taking lower doses with food to boost its absorption should help reduce this side-effects.

But the authors warned patients against trying their own experiments, calling instead for more research to assess the effects of drug-combinations on patients.

They are currently conducting such a study of their own, testing effect of combining a drug with grapefruit juice, and have called for more such studies to be carried out.

Professor Cohen said: "If we understood the relationship between, say, grapefruit juice and common drugs, such as the statins, which are taken daily by millions of people to prevent heart disease, we could save a fortune in drug costs," Cohen said.

Dr Joanne Lunn, a nutrition scientist at the British Nutrition Foundation, agreed that more research was needed, because diet and prescription drugs can interfere with each other in many ways.

She said: "More research is vital to help us to understand exactly how drugs interact with our diet so we can ensure that the drugs work effectively, but also that by taking the drugs we do not compromise our nutritional status.

"In the meantime, it is always very important to read the label on any medication and to speak to your GP if there is anything you are unsure about."

A spokesperson for the Medicines and Healthcare Products Regulatory Agency, said any new recommendations about drug dosages would need to be backed up by evidence and full testing through clinical trials.

Source: http://news.bbc.co.uk/2/hi/health/6900805.stm

Food Security Is Vital for People Living with HIV

2007-06-13T13:32:00.000+07:00

By, Clementine Mumba, The Correspondent, June 12, 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.

Clementine Mumba is a Key Correspondent in Zambia, and can be contacted at: info@thecorrespondent.org , website: www.TheCorrespondent.org

Put food at the heart of the fight against HIV and Aids or fail, warn leading aid agencies

2007-05-28T11:08:00.000+07:00

By, Care International, May 25, 2007

Food has to be at the heart of the global fight against HIV and AIDS or we will fail to stop its spread, three leading aid agencies are warning today.

CARE International UK, Concern Worldwide (UK) and Overseas Development Institute (ODI) are challenging more than 25 of the world's leading international development organisations at a meeting in London today to put food first in their HIV and AIDS programmes.

People with HIV and AIDS need good food to survive. HIV positive adults need up to one third more food than healthy adults, and children with the disease can need 50 to 100 per cent more food than healthy children, according to the World Health Organisation.

Nearly 40 million people who live with HIV, and most live in poor countries - many are hungry and malnourished. The fight against HIV and AIDS and combating hunger are clearly inextricably linked. This link, however, is too often overlooked.

Good nutrition plays a crucial role in maintaining a healthy immune system for people living with HIV.

Imaya Ephraim, CARE's HIV and AIDS advisor, said: "If people's immune systems are strengthened they live longer and are more likely to survive. It also delays the onset of AIDS," said. "Our experience shows that women and girls who have food are less vulnerable to HIV infection."

Mr Ephraim, who is opening the conference, continued: "Unless we address the issue of food in communities affected by HIV and AIDS, we are likely to see a greater number of infections and an increase in fatalities. Without putting food first, millions of people's lives at risk, and HIV will continue to spread at an alarming rate."

ODI Research Fellow, Fiona Samuels, says "it's pointless to think about Universal Access to treatment, prevention and care without also taking into account food security issues and wider livelihood and vulnerability issues."

For more information or to arrange an interview with Imaya or Fiona, please contact:

Rebecca Coutts-Buys, CARE International, 020 7934 9417, 079 5021 1700 or coutts-buys@careinternational.org

Anna Tublin, Overseas Development Institute, 0207 922 0419 or a.tublin@odi.org.uk or Kirsty Cockburn, 0207 922 0423 or k.cockburn@odi.org.uk

Sarah Molloy, Concern Worldwide (UK), 0207 863 3073, 077 7556 2647 or sarah.molloy@concern.net ABOUT CARE International:

CARE is a leading humanitarian organisation fighting global poverty. CARE works to prevent HIV and AIDS and to provide care, treatment and support to vulnerable communities impacted by the disease in 38 countries in Asia, Africa, Latin America and the Caribbean. We run more than 150 programmes reaching 12 million people around the world to prevent HIV and help people live with the disease.

ABOUT Concern Worldwide (UK):

Concern Worldwide is an international humanitarian organisation dedicated to the reducation of suffering and working towards the ultimate elimination of poverty in the world's poorest country. The fight against HIV&AIDS is central to our work and we support 24 HIV&AIDS programmes across 13 countries, benefiting 200,000 people directly and a further 2.1 million indirectly. Our work includes education and awareness-raising about the pandemic to help halt the spread of the disease, advocacy for improved treatment and increased rights for those infected and affected, and the provision of food and support programmes for the most vulnerable.

ABOUT ODI:

ODI is Britain's leading independent think-tank on international development and humanitarian issues. Its mission is to inspire and inform policy and practice which lead to the reduction of poverty, the alleviation of suffering and the achievement of sustainable livelihoods in developing countries. Locking together high-quality applied research, practical policy advice and policy-focused dissemination and debate, ODI works with partners in the public and private sectors, in both developing and developed countries. Further details can be found on the ODI website (www.odi.org.uk).

Source: http://www.alertnet.org/thenews/fromthefield/217440/118009601674.htm

WFP resumes programs providing food to people with TB, HIV in Cambodia

2007-02-14T14:23:00.000+07:00

By, News-Medical.net, February 13, 2007

The World Food Program has resumed its programs providing people living with HIV and tuberculosis in Cambodia with access to food after receiving aid from Spain and the U.S., the agency said on Thursday, the AP/International Herald Tribune reports (AP/International Herald Tribune, 2/8).
Thomas Keusters, country director for WFP's Cambodia office, said recently that WFP had been "forced to suspend" the programs because of funding shortages.

The programs distribute food rations to 18,000 people with TB and 70,000 people with HIV.

They also ensure that HIV-positive people and people with TB needing medicine are connected with food distribution points.

"The sick need food first before taking medicines," Haidy Ear-Dupuy -- advocacy manager at the Phnom Penh, Cambodia, office of World Vision -- said, adding, "You cannot take medication on an empty stomach.

You must maintain a balance" (Macan-Markar, Inter Press Service, 2/6). WFP in a statement on Thursday said that Spain has provided about $650,000 and that the U.S. has provided 6,100 tons of legumes, as well as 2,370 tons of vegetable oil, for a period of three years.

WFP three weeks ago announced that it needed at least $10 million to run its programs in Cambodia through July (AP/International Herald Tribune, 2/8).

Source: http://www.news-medical.net/?id=21872

Zambia: Poor Nutrition Nullifies Benefit of ARV Treatment

2006-12-20T09:50:00.000+07:00

By, UN Integrated Regional Information Networks, December 18, 2006

The poor nutrition often experienced by HIV-positive Zambians on antiretroviral [ARV] drug treatment is nullifying the benefits of the medicine, health experts are warning.

"Whenever I take my ARVs without eating anything, I begin to feel dizzy and sometimes I even vomit - I generally feel very weak in my body; I have to be in bed for some time unless I took the drugs after eating," Elizabeth Mukwendi, a resident in the capital, Lusaka, one of thousands on ARVs, told IRIN/PlusNews.

"We sold all our assets, including the only car we had while my late husband was sick, to pay for his medication, and this is why I am unable to buy food at the moment. Doctors have often advised me not to be taking ARVs without food but then, there is also the problem of drugs becoming resistant if I keep skipping because of not having food," Mukwendi said.

ARVs slow down the reproduction rate of the HI virus and delays progression to AIDS, but in the absence of good nutrition, experts warn that taking the drugs becomes just as bad as not taking them.

According to Nkandu Luo, Zambia's first woman professor and a former health minister, "It is like having two evils acting together in your body. Taking ARVs where there is no food only compounds the problem, because some of these drugs are toxic and, hence, they affect the body unless they are taken with the recommended food values."

President Levy Mwanawasa's administration is rolling out ARVs as part of its commitment to the global target of promoting universal access to treatment by 2010. Of the estimated 1.6 million Zambians living with HIV/AIDS - 17 percent of the sexually active adult population - only about 75,000 have access to ARV medication.

Justine Mwinga, spokesperson for the government National AIDS Council, said the treatment programme faced an uphill battle, in that "we have continued losing a lot of skilled medical staff to other countries, and we are seriously lacking the required equipment, such as the CD4 count machines, in most government institutions." The number of CD4 cells present in an individual's blood indicates the strength of their immune system.

Government scrapped the US$10 monthly user fee for HIV/AIDS treatment in 2005, and in April 2006 lifted all medical fees at government-run hospitals and clinics in rural areas, where food insecurity and poverty go hand in hand. Medical facilities in urban areas still charge individuals in monthly medical schemes up to $2.

Luo, now an HIV/AIDS consultant, said "Lack of food has become more critical and prevalent in Zambia than it was in the past. Some families are alternating when eating, especially in rural areas. In certain homes, each family member has to skip a day before taking the next meal, regardless of whether or not they are HIV positive and on medication."

In the past few years Zambia has managed to harvest a surplus of maize, the staple food, but the World Food Programme (WFP) has been providing food aid to about 555,000 people since July 2006.

Government departments and UN agencies have yet to establish the number of people living with HIV/AIDS and going hungry, but according to the Central Statistical Office, 68 percent of the 11.7 million population live $1 or less day.

Jo Woods, public information officer at the UN's WFP in Zambia, said food shortages among households with HIV-positive people was a complex issue.

"Certainly, [food] production levels do vary from region to region, but we are now also approaching the lean season in Zambia, where people are running out of food that they have stored from the last harvest. For people living in the cities, they may not have access to land for growing food and may not have ... [jobs], so poverty is the issue - they cannot afford to buy sufficient food," Woods said.

Humanitarian agencies, including the WFP and the International Federation of Red Cross and Red Crescent Societies [IFRC], are collaborating with the health ministry to set up an intervention programme for people who are on ARV treatment but have no access to food.

The WFP is providing food packs of high-energy proteins as well as farming inputs to some 9,610 people on ARV treatment in certain parts of the country, while the Zambia Red Cross Society is supporting about 1,000 HIV/AIDS patients on treatment with a monthly food supplement and a number of income-generating ventures, like livestock rearing and fish farming.

Mukesh Kapila, a Geneva-based IFRC director of policy and planning, said during a recent two-day visit to Zambia, "What we are doing, as humanitarian agencies, is not enough in itself, because the HIV epidemic in Zambia, and Southern Africa as a whole, is a matter of life and death. We need to do much more, but we are constrained by limited funding. The best way to deal with HIV is not just treatment; treatment brings hope, but it is not the solution. People should have ready access to food and basic information on health if treatment is to be effective."

The WFP's Woods said the agency faced a serious pipeline break in the food-pack support project and needed up to $7.8 million to provide food for the programme in 2007.

[Produced in partnership with the International Federation of Red Cross and Red Crescent Societies: www.ifrc.org]

Source: http://allafrica.com/stories/200612190478.html

RWANDA: Need to incorporate nutrition into kids' HIV programmes

2006-12-08T10:41:00.001+07:00

By, IRIN PlusNews, December 7, 2006

NAIROBI - Nearly 45 percent of HIV-positive Rwandan children under five years old are severely malnourished, delegates at a recent paediatric conference on HIV/AIDS heard.

Josephine Kayumba, a nutritionist with Rwanda's Treatment and Research AIDS Centre, who attended the conference in the capital, Kigali, told IRIN/PlusNews that "the nutrition aspect is not well thought out in HIV/AIDS care and treatment. The sector does not receive the sufficient financial and political support it deserves, despite the impact its interventions can have."

She said the small central African nation suffered from "unstable" climatic conditions, which caused seasonal food insecurity in some parts of the country, leading to high rates of malnutrition.

About 23,000 children are born to HIV-positive mothers each year and about 80 percent of Rwanda's 9 million people live on US$2 or less a day.

The government runs programmes for therapeutic feeding, provides training in infant feeding options and gives food support to breastfeeding mothers; nongovernmental organisations also have feeding schemes for undernourished children, but there are very few specific programmes catering for those who are HIV-positive.

According to Girma Makonnen, information officer for the United Nations World Food Programme in Rwanda, "We do not have any special programmes for HIV-positive children, but if they are malnourished then they are eligible to receive supplementary or therapeutic feeding at our feeding centres around the country."

kr/go/he/oa

[ENDS]

BURUNDI: Food cuts for HIV-positive people worry NGOs

2006-11-15T12:00:00.000+07:00

By, Reuters Foundation, November 14, 2006

BUJUMBURA - 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 2005 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, hundreds 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.

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MOZAMBIQUE: WFP halves rations for the hungry

2006-11-14T14:25:00.000+07:00

By, IRIN PlusNews, November 10, 2006

MAPUTO, 10 November (PLUSNEWS) - A funding shortfall of more than 70 percent has forced the United Nations' World Food Programme (WFP) to halve its rations to hungry Mozambicans, ahead of the critical "lean season" between harvests, when food stocks generally run out. The cut has come at a critical time, when food is at its scarcest and most expensive.

The food aid agency urgently requires US$10 million to feed 460,000 people between now and March 2007, when the next harvest is due. WFP currently assists 292,000 vulnerable people, but a 77 percent shortfall in funding has deprived hundreds of thousands of half the ration of cereals and corn-soya blend they have been using to stave off starvation.

"We are very concerned, because we are not talking about small numbers: some 240,000 people have no food security; half of those people are living in arid areas where they cannot farm; they have nothing. And now we are about to enter into a period of emergencies, with possible cyclones and floods. We should have stockpiles of food in case of emergencies," said Paulo Zacula, Director of Mozambique's National Disaster agency (INGC).

Karin Manente, WFP Acting Country Director in Mozambique, told IRIN, "By this time, we have usually pre-positioned food stocks in areas that become inaccessible during such emergencies." She added that due to the huge shortfall, some WFP-supported activities might have to be discontinued or suspended during November unless new donations were received.

The reason for the shortfall in donor funds could be partly due to the fact that Mozambique has had a better harvest than in previous years. Preliminary results of the 2006 assessment indicate that food security and nutrition improved substantially. The country produced 2.3 million mt of cereals, including carryover stock, compared to a national requirement of 2.6 million mt.

"Although WFP scaled back its activities, we continue to focus on pockets of food insecurity. We are currently making appeals to the donor community both here and abroad," said Manente.

Teresa Antonio, 27, a resident of Beira, capital of the central province of Sofala, is among those directly affected by the cut in rations. She was close to tears as she tried to soothe the hungry baby cradled in her emaciated, rash-covered arms.

"I have no money to buy milk for my child," said Antonio, who is living with HIV and is on antiretrovirals. A representative of the local Association of People Living with HIV and AIDS, who are given WFP rations to distribute each month to members suffering food shortages, has promised to help her but warned that there are too many in her situation.

Beira has the highest HIV/AIDS prevalence rate in the country, with at least 26 percent of its adult population infected. Nationally, the prevalence rate is 16.2 percent and rising.

Christaine Rudert, Health and Nutrition officer with the United Nations Children's Fund (UNICEF), was also concerned about the impact that the cuts could have on her agency's programmes. "We could see an increase in the numbers of severely malnourished children, who will then need therapeutic feeding, which, although it is not in short supply, is much more expensive than food rations."

The disaster agency's Zacula said Mozambique had taken action to reduce its dependence on food aid. In March this year, the government approved a $40million disaster management plan covering the next 10 years, with the aim of reducing the number of people dependent on food aid by 10 percent per year. The initiatives include providing at least nine cu.m of water for drinking, and 500cu.m per family for irrigation.

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KENYA: HIV exacerbates malnutrition among infants in drought-prone Turkana

2006-11-03T11:20:00.000+07:00

By, IRIN PlusNews, November 2, 2006

LODWAR - A high incidence of HIV has worsened the condition of hungry children in drought-prone Turkana region, in northern Kenya.

Over the past month, seven of the 10 children admitted to a nutritional rehabilitation centre at the hospital in Lodwar, Turkana's largest town, were found to be HIV positive. Turkana has a high HIV prevalence rate of 11.4 percent, almost double the national rate of 6.7 percent estimated by UNAIDS.

"HIV is an increasing problem in Turkana, the rate here is high," said Seife K-Yohannes, nutrition coordinator for Merlin, a UK-based healthcare NGO. "Most of the HIV-positive children have a poor appetite, nausea and vomiting and frequent uncontrolled diarrhea, so they become very dehydrated and lose a lot of nutrients."

The problems associated with HIV start early, according to Mary Anne Macharia, a nurse at the Merlin-run rehabilitation centre. "If the mother is infected, she gives birth to a child with a weak constitution and then she struggles to provide enough milk to the already weak child".

The pastoral and farming communities of Turkana have been especially vulnerable to the severe year-long drought afflicting the Horn of Africa. A recent survey by Unicef, the UN children's agency, found that acute malnutrition rates were dangerously elevated in all parts of Turkana. It recorded a global acute malnourished rate of 20 per cent, above the World Health Organization critical point, which is 15 percent.

Severely malnourished children admitted to the centre are given Plumpy'nut, a peanut-based therapeutic food paste. The meal requires no additional preparation and leads to rapid weight gain provided there are no other health complications.

But poverty and chronic food insecurity often forces the entire family to share the supplement. For HIV-positive children, even a sufficient quantity of the Plumpy'nut supplement is not always enough. Merlin refers these children to a local church-run programme that provides paediatric ARVs.

Besides the rehabilitation centre, Merlin operates an infant feeding outpatient service that visits 100 different villages every week.

Despite the availability of treatment, fear and stigma associated with HIV means that few people in Turkana volunteer for HIV testing. Only four out of 19 mothers who were offered testing during a seven-week period at the rehabilitation centre accepted it - three of them tested positive.

The few women who know they are infected, receive drugs to lower their chances of transmitting the virus during childbirth, but lack of access to formula milk means there is still a chance their babies will become infected: "Because of the drought here, there is no supplementary feeding [to replace breast milk] and no reliable sources to get food or even water," Macharia said.

Additionally, food insecurity makes HIV infected mothers particularly vulnerable to other health problems. "Often they survive on one meal a day, this is not satisfying or balanced," said Ewoi Bengunn, the supervising clinical officer at the rehabilitation centre. "When the immunity is low, there is nothing to fight the infections. We see many respiratory infections, kala-azar [also known as leishmaniasis, a tropical infection spread by sand flies] and recently severe skin infections, measles and, of course, lots of diarrhea and vomiting."

Yakish Eyapan, the district's HIV/AIDS and sexually transmitted infections coordinator, explained that the pandemic had to compete for attention with many other pressing issues.

According to Eyapan: "The problem with Turkana is that it has many neglected issues that are more important to people than HIV... like food insecurity, water, education and poverty. If people have no water and are hungry, how can you talk to them about HIV?"

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SAO TOME AND PRINCIPE: HIV-positive mothers reject formula feeding

2006-11-01T11:24:00.000+07:00

By, IRIN PlusNews, November 1, 2006

SAO TOME - Poverty and a cultural preference for breastfeeding are driving the spread of HIV from mothers to their babies in Sao Tome and Principe.

The HIV rate among pregnant women on the tiny West African islands tripled from 0.5 percent to 1.5 percent between 2001 and 2005.

"The number of cases is growing every year," said Luis Bonfim, the UN children's fund health project officer. "We were hoping that with increased support, the rate would either stagnate or reduce. So it's clear that something isn't working."

HIV testing in Sao Tome and Principe is free and health workers say they have no problem persuading pregnant women to test for the virus, adding that most of them who discover they are HIV positive agree to take antiretroviral drugs to prevent transmission of the virus to their unborn child. Others, however, prefer to visit traditional doctors or avoid treatment altogether.

Health workers point out that at present, many women risk post-natal transmission by opting to breastfeed because they cannot afford formula milk. "We recommend that HIV positive mothers feed their babies formula milk, but in most cases this doesn't happen because of the financial difficulties they face," said Antonio Amado Vaz, medical doctor and executive director of the Sao Tome Association for Family Promotion (ASPF).

"A small tin of formula milk costs around 80,000 dobras (US$ 6) and it doesn't even last two weeks. There is no aid programme to help HIV-positive women pay for the milk and they can't afford it. This is a big problem, it is not sustainable," he said.

Sao Tome is currently trying to access financing from the Global Fund to Fight AIDS, Tuberculosis and Malaria to help support HIV-positive mothers.

Next to the financial constraints, many HIV-positive mothers decide not to feed their babies formula milk because they fear it will attract suspicion from family and friends.

"When the baby comes it is hard to convince people to use formula milk, even if they have been doing the [antiretroviral] prevention during pregnancy," said Alzira do Rosario, a medical doctor and coordinator of Sao Tome's national AIDS programme.

"The grandmother will put pressure on the mother to feed the baby breast milk and the mother doesn't want to explain why she is using formula milk," she added.

Filomena (not her real name) knows the risks of breastfeeding only too well. She believes her son contracted HIV from her breast milk, which she fed him from birth.

"I don't think he was born HIV positive. He was a fat baby; he weighed four kilos when he was born. At that time I didn't know I had HIV and so I breastfed him. Here in Sao Tome we are taught that this is the best thing you can do for your child. It was only after about six months that he stopped putting on weight and I realised something was wrong," she said.

Filomena's son is one of only a few Sao Tomean children who are known to be living with HIV, but health workers fear these figures are likely to continue rising. They say that the stigma attached to HIV/AIDS in Sao Tome is promoting behaviour that is likely to increase the incidence of mother-to-child transmission.

While most of the 170,000 people living in the twin-island nation are poor there are high hopes that crude oil exploration may lead to a brighter economic future. Sao Tome and Principe currently relies on small agricultural exports and substantial donor funding. Its external debt stands at around US$300 million.

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UGANDA: Hunger kills you faster, say HIV-positive northerners

2006-10-26T17:16:00.000+07:00

by, IRIN PlusNews, October 26, 2006

Life-prolonging antiretroviral (ARV) medication is rare enough in war-damaged northern Uganda, but the lucky few able to access treatment have the additional problem of finding enough food to go with the powerful drugs.

With the support of Catholic Relief Services and the European Union, 670 people receive ARVs from St Joseph's Hospital in the northern district of Kitgum, the largest provider of drugs in the district, but this represents just 24 percent of the hospital's HIV-positive patients who need treatment.

"For the rest, we just have to treat their opportunistic infections as they get them," said Robert Ochola, coordinator of HIV/AIDS programmes at the hospital. "For children, we are only able to treat 30 percent of those who need the ARVs, and even then we do not have [paediatric] ARVs for them - they take the same drugs as the adults in different doses."

Kitgum is one of the districts most affected by two decades of war between the rebel Lord's Resistance Army and the government. About 90 percent of Kitgum's people live in camps for the internally displaced and are almost entirely dependent on relief aid, as insecurity has prevented them from farming.

It is even worse for the region's HIV-positive people, who need a healthy diet to maintain their immune systems to fight off the HI virus.

Some of the hospital's ARV patients receive nutritional support from the United Nation's World Food Programme and the Comboni Roman Catholic Mission, but qualification is not automatic: patients complete application forms and the organisations then decide who is eligible for the limited food aid.

The rations are enough to feed a family for a month. They make a real difference to the overall health of the patients, and increase the likelihood that they will adhere to the daily ritual of taking their ARVs, which can have unpleasant side effects even on a full stomach.

Sylvia Ocan and Christine Oyela have both been on treatment for two years, but only Oyela has qualified for nutritional support. Oyela looks healthy but Ocan is visibly undernourished and suffers from a condition that has left unsightly, dry patches on her face.

"I don't know why I did not qualify for the food, but I have no money to buy food and I get sick quite often," said Ocan, whose husband died from AIDS-related complications three years ago. "I make tablecloths and mats to sell, but my two children and I sometimes can 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 even work."

Despite these difficulties, Ocan has persevered with her medication, aware that if she does not she risks developing resistance to ARVs.

"The main reason for non-adherence among our patients is the lack of food. Of our 2,000 patients, just 819 are receiving food support," said Charles Odong, coordinator of Meeting Point, a local NGO helping HIV-positive people in Kitgum.

People who default on treatment often turn to traditional healers for remedies, which can make them even sicker, he said. With the support of relief agencies like the Italian NGO, Associazione Volontari per il Servizio Internazionale, Meeting Point provides home-care kits of soap and sugar to its members, and grants of school fees for their children.

"People are so desperate for food that many are willing to sell sex and risk contracting HIV because they say the disease will take some time to kill you, while the hunger will kill you immediately," said Odong. "Finding food for people in the region should be a priority for the government and aid agencies, because it helps those who are already sick and could also help prevent new infections."

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Source: http://www.plusnews.org/webspecials/ART/56020.asp

HIV/AIDS and Malnutrition Locked in "Vicious Cycle"

2006-10-18T10:37:00.000+07:00

International community working to address hunger among people with HIV/AIDS

In many of the world’s poor regions, where HIV/AIDS has taken the worst toll, the virus and malnutrition are locked in a “vicious cycle” that worsens the impact of both.

“Insufficient intake [of calories] can enhance the progression of the virus,” said Suneetha Kadiyala, a scientist at the International Food Policy Research Institute (IFPRI) who participated in a panel on food security and HIV/AIDS at the Woodrow Wilson Center in Washington October 16.

The discussion was held in observance of World Food Day.

After six years of study, Kadiyala said, the damaging relationship between malnutrition and HIV/AIDS is becoming better understood. It can begin when a family member first begins to exhibit symptoms after HIV infection. His or her capacity to work – whether as a farmer or a wage earner – is diminished, possibly affecting household income and the availability of food for an entire family.

Already compromised by the presence of HIV, the immune system becomes even less effective at defending against infection when the body is malnourished.

As anti-retroviral drugs (ARV) become more widely available in poor regions where AIDS is taking the greatest toll, Kadiyala said, scientists also are discovering that malnutrition compromises the efficacy and increases the toxicity of medications.

“Improving the nutrition status of people is critical if ARV treatment is going to be successful,” she said.

Food insecurity also can increase individual risk for exposure to HIV, researchers have found. People who are hungry will leave their homes for food, expanding their social exposures and engaging in desperate behaviors that can make them more vulnerable to infection.

With this hard-won understanding, IFPRI is working to create expanded networks of policy-makers and health experts to raise awareness about the links among poverty, nutrition and disease in hopes of finding wider solutions.

Even though recent research is revealing more about the complexity of the interaction between HIV/AIDS and malnutrition, the need to include food assistance in a program to support those suffering from HIV/AIDS is well understood.

The U.N. World Food Programme, the sponsor of World Food Day, is feeding 9 million people infected with HIV/AIDS, according to Jordan Dey, director of the program’s U.S. relations office.

“Hunger is the greatest public health threat, and it undermines a nation’s development,” Dey said.

The United States is the largest donor of food assistance worldwide, investing more than $2.4 billion in that cause in 2005, according to a report presented to the U.S. Congress in early 2006.

The U.S. Agency for International Development and the U.S. Department of Agriculture are key players in delivering food assistance and supporting efforts under the President’s Emergency Program for AIDS Relief (PEPFAR) to reduce malnutrition among people living with HIV/AIDS and those affected by the disease.

Report on Food and Nutrition for People Living with HIV/AIDS (PLWHA), released by the Global AIDS Coordinator’s Office in May, outlines the specific objectives of PEPFAR nutrition programs:

• Improve the quantity and quality of diets among PLWHA,

• Build or replenish body stores of essential nutrients,

• Prevent or stabilize weight loss,

• Preserve and gain muscle mass,

• Prevent diarrhea and other infections that affect nutritional status, and

• Speed recuperation from HIV-related symptoms that affect food consumption and dietary intake.

Source: Charlene Porter, Washington File Staff Writer, USINFO.STATE.GOV, 16 October 2006

WHO: Integrating nutrition into the overall response to HIV/AIDS

2006-09-22T09:39:00.001+07:00

The World Health Assembly adopted a resolution requesting countries to include nutrition an integral part of the overall response to HIV/AIDS by identifying nutrition interventions for immediate integration intoHIV/AIDS programmes. Food and good nutrition are immediate and criticalneeds of people living with HIV/AIDS. The Health Assembly also supportedWHO to develop a five-year-plan to help acheive universal access toHIV/AIDS treatment by 2010.

Please see below the resolution adopted by the World Health Assembly on 27 May 2006.

The Fifty-ninth World Health Assembly,

Having considered the report on nutrition and HIV/AIDS;

Recalling resolution WHA 57.14 which urged Member States, inter alia, to pursue policies and practices that promote integration of nutrition into a comprehensive response to HIV/AIDS;

Bearing in mind WHO’s efforts to support access to antiretroviral treatment as part of the“3 by 5” initiative and to ensure a comprehensive package of care and support for people living with HIV/AIDS;

Recalling the recommendations of WHO’s technical consultation on nutrition and HIV/AIDS in Africa (Durban, South Africa, 10-13 April 2005), which were based on the main findings of a detailed review of the latest scientific evidence on the macronutrient and micronutrient needs of HIV-infected people, including pregnant and lactating women and patients on antiretroviral therapy;

Noting that food and adequate nutrition are often identified as the most immediate and critical needs by people living with, or affected by, the HIV/AIDS pandemic;

Bearing in mind that nutrition and food security require systematic and simultaneous action to meet the challenges of the pandemic;

Mindful of the complex interactions between nutrition and HIV/AIDS, and the increased risk of opportunistic infections and malnutrition;

Noting that some Member States already have policies and programmes related to nutrition and
HIV/AIDS that can be used as a basis for developing priorities and workplans;

Underlining the importance of ensuring cooperation on this question with other bodies of the United Nations system, in particular, FAO, UNICEF and WFP,

1. URGES Member States:

(1) to make nutrition an integral part of their response to HIV/AIDS by identifying nutrition interventions for immediate integration into HIV/AIDS programming, including:

(a) strengthening political commitment to nutrition and HIV/AIDS as part of their health agenda;

(b) reinforcing nutrition components in HIV/AIDS policies and programmes and incorporating HIV/AIDS issues in national nutrition policies and programmes;

(c) developing specific advocacy tools to raise decision-makers’ awareness of the urgency and steps needed to incorporate nutrition into HIV treatment and care programmes;

(d) assessing existing policies and programmes related to nutrition and HIV/AIDS and identifying gaps to be filled and further opportunities for integrating nutrition interventions;

(e) ensuring close multisectoral collaboration and coordination between agricultural, health, socioeconomic, education, financial and nutrition sectors;

(2) to strengthen, revise or establish new guidelines and assessment tools for nutrition care and support of people living with HIV and AIDS at different stages of the disease, and for sex- and age-specific approaches to providing antiretroviral therapy, including nutrition counselling and special nutritional needs of vulnerable and marginalized populations;

(3) to provide support for and expand existing interventions for improving nutrition and managing severe malnutrition in infants and young children in the context of HIV by:

(a) implementing fully the global strategy for infant and young child feeding with its approach to feeding in exceptionally difficult circumstances and the United Nations framework for priority action in HIV and infant feeding;1

(b) building the capability of hospital- and community-based health workers, mothers, family members and other caregivers in order to improve the care of severely malnourished children exposed to, or infected by, HIV/AIDS;

(c) encouraging revitalization of the Baby-friendly Hospital Initiative in the light of HIV/AIDS;

(d) accelerating training in, and expanding use of, guidelines and tools for infantfeeding programmes that provide counselling on prevention of mother-to-child transmission of HIV;

(e) ensuring that institutions training health workers review their curricula and bring them in line with current recommendations;

2. REQUESTS the Director-General:

(1) to strengthen technical guidance to Member States for incorporating HIV and AIDS issues in national nutrition policies and programmes;

(2) to provide support for the development of advocacy tools to raise decision-makers’ awareness of the urgency and the need to include nutrition and HIV/AIDS as a priority on the health agenda;

(3) to provide support, as a matter of priority, to development and dissemination of sciencebased recommendations, guidelines and tools on nutritional care and support for people living with HIV/AIDS;

(4) to contribute to incorporation of nutrition in training, including pre-service training, of health workers, in technical advice, and in training materials for community and home-based settings, and during emergencies;

(5) to continue to promote research relative to nutrition and HIV/AIDS, addressing gaps in knowledge and operational issues;

(6) to provide support for development of appropriate indicators for measuring progress towards integration of nutrition into HIV programmes and the impact of nutrition interventions;

(7) to ensure collaboration between all concerned parties in this area so that progress may be made by building on each other’s achievements;

(8) to foster establishment of guidelines for including appropriate food and nutrition interventions in funding proposals.

Adopted on Ninth plenary meeting, 27 May 2006

For copy of this document, go to http://www.who.int/gb/ebwha/pdf_files/WHA59/A59_R11-en.pdf

Source://pronut-hiv@healthnet.org

Ethiopia: WFP Scheme Sustaining Thousands Affected By HIV

2006-09-13T10:30:00.000+07:00

A UN World Food Programme (WFP) initiative is providing nutritional support to thousands of poor, HIV-affected families in Ethiopia, where hunger is still a major problem more than twenty years after famine killed an estimated one million people.

"The scaling-up and expansion of our HIV/AIDS urban programme will allow WFP to continue working towards improving the nutritional status and quality of life of many thousands of people in Ethiopia, who are either infected or affected by HIV/AIDS," said WFP acting country director Abnezer Ngowi. The scheme will run.

In terms of a US$9 million agreement, signed in August by WFP, the Addis Ababa HIV/AIDS Prevention and Control Office, and other local agencies and implementing partners, WFP will provide nutritional assistance to 110,000 people in 14 towns across the country, including 54,000 beneficiaries in the capital, Addis Ababa, until December 2007.

Two million people are living with the virus and an estimated 2.6 million children have been orphaned by the pandemic in the last decade.Urban households have been more affected than rural ones.

Dinku Shitaw, 85, who lost her daughter and son-in-law two years ago, is one of the beneficiaries. "I am taking care of these two AIDS-orphaned children with the support of an organisation that gives me wheat, edible oil and schooling materials to the children." The children help their grandmother sell firewood and charcoal to pay the $5 monthly rent for their tiny, one-roomed home.

The organisation assisting Shitaw is the Participatory Community Support Association. "We have given nutritional support worth $200,000 to over 1,000 people living with HIV/AIDS. Our association has been re-elected by WFP to continue this programme [and we] plan to increase the number of benefciaries in the coming months," said the manager, Solomon Tesfaye.

People taking antiretroviral (ARV) medication must have adequate nutrition, and households are given 45kg of wheat, three litres of oil and 9kg of a locally produced fortified blended food supplement every month, allowing caregivers, usually family members, also to benefit.

Ayalnesh Melaku, 33, lost her husband to an AIDS-related illness five years ago and has been on ARVs at Addis Ababa's government-run Black Lion Hospital for the past year. "Without the nutritional support, it would be difficult to start such a heavy medicine," she said. Since she started the ARVs, her CD-4 cell count (which measures the strength of the immune system) has increased from 100 to 408 and her weight has gone up from 40kg to 50kg.

Source: ProNut-HIV, September 08, 2006

Tanzania: Babati HIV/AIDS Victims in Dire Need of Nutritional Food Arusha Times (Arusha)

2006-09-12T10:10:00.000+07:00

Members of a group of people living with HIV/AIDS in Babati have expressed concern over their lives which they say is in danger due to poverty and lack of basic nutritional foods.

The chairperson of the Babati People Living with HIV/AIDS (PLHA+) Group, Ms. Sofia Ismail said the group with 103 member was facing the problem of getting nutritional food which is vital for people who are in poor health.

Ms Ismail was addressing a delegation of thirteen persons from Amhara Region, Ethiopia who were in an eight-day study tour of Babati District in Manyara Region.

She said that although they were getting free antiretroviral (ARV) drugs, it was also necessary that the drugs be augmented with nutritional foods.

Since their association was formed in December 2005, they have lost eleven members due to inadequate nutrition, she said. "Even getting basic food is a problem", she added.

Although some of them are skilled and are capable of doing some income generating activities they cannot be employed by neither individuals nor institutions because of what she termed "stigmatization."

Out of the 103 members, 30 are orphans and ten are children living with HIV/ADS and now on a course of ARV. She said that both victims and orphaned children do not have any assistance of basic food and school requirements.

"We have orphans in our association who need some assistance on their school fees, clothes, books and stationery. They need to be helped so as to be able to continue attending school," she said.

Narating the catalogue of problems affecting them the chairperson said that they are given ARVs free of charge but cannot afford treating opportunistic disease that are associated with the HIV/AIDs pandemic.

Source: Thomas Ratsin, ProNut-HIV September 2, 2006

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

2006-08-28T13:02:00.000+07:00

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

2006-08-10T09:56:00.000+07:00

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

2006-08-03T14:32:00.000+07:00

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

India: The HIV-hunger cycle

2006-07-30T17:20:00.000+07:00

By Sugata Mukhopadhyay, HDN Key Correspondent, India

Let me tell you a story; of a woman who got HIV from her husband. There are so many stories of poor women who are infected by their husbands that you might ask what is special about this one. In many ways my story is sadly an ordinary one. But to me it is not only shocking but can teach us a hard lesson: Hunger and HIV are inextricably linked.

Sandhya (not her real name) was in her early thirties, living with her husband and two children in one of the cities in South India. Her husband was working in the private sector and had a good income. They had a happy life.

But things did not last. Sandhya’s husband suddenly fell ill and his symptoms, in the course of time, became chronic. He experienced rapid loss of weight, swollen glands, fevers and diarrhoea. His doctor finally gave him an HIV test which came back positive.

Sadly, Sandhya’s husband died despite attempts by the doctors to prolong his life. Sandhya and her two children were forced to move to her in-laws house.

At some point Sandhya also took an HIV test and was found to be positive too. Things got worse. Her in-laws threw her and her two small children out of the house. They thought Sandhya was woman of immoral character and that she had passed the virus to her husband causing his premature death.

Sandhya literally ended up on the street. She did not find any support from her parents or other relatives, nor could she find a job. Nobody wants to give people with HIV a job.

When hunger became intolerable, with the two small children to support, Sandhya made the boldest decision of her life. She became a sex worker.

So the crux of the story is, if you are hungry and your children are hungry, you will do whatever you can to survive.

Sandhya did not do anything different from what many would do in her place. She tried to provide enough food for her children and dreamt of a better future for them. Please don’t look at Sandhya’s story through the lens of morality.

My issue is not related to morality or sex work. It is food insecurity that makes people vulnerable to HIV. Sandhya is one such vulnerable woman but throughout the world there are millions of people who do not have enough food for themselves or their children and AIDS is constantly knocking at their doors.

More than 800 million people on earth know what is like to go to bed hungry. Around 200 million children below 5 years are underweight because they don’t get enough food. One child dies every five seconds from hunger and related causes. In India, which produces enough food for all its people, there are still incidences of death from hunger, and food insecurity is common place.

Food insecurity, most of the time, is man made and inevitably leads to corruption of human integrity thus generating numerous marginalized, hungry and humiliated populations all over the world. Hunger is the natural trigger mechanism for de-humanizing events like human trafficking, prostitution, drug use, child labour and migration pushing millions of people into the vacuum of AIDS. On the other hand, those already infected by HIV are constantly restrained from producing and utilizing food, being hobbled by disability, denial and discrimination. The cycle goes on incessantly making the virus even more deadly.

This is the HIV-hunger cycle gradually taking the shape of the ultimate destroyer and silently preparing to make the final assault in the form of AIDS.

Sandhya’s story is a perfect example of the HIV-hunger cycle. Breaking this cycle is probably the toughest challenge in tackling HIV/AIDS. I strongly believe that it is not condoms, ARV drugs, microbicides nor vaccines but an uninterrupted supply of food to the hungry people of the world that can really make the difference in reversing the pandemic.

As a doctor I have no medicine for AIDS so I am prescribing ‘food’ as medicine. Fight HIV with food if you really want to hit back at AIDS.

HDN Key Correspondent Team
Email: correspondents@hdnet.org
Web: www.healthdev.org/kc
HDN 2006 - Reproduction welcomed

Adequate Food Needed for ARV Programme

2006-07-16T11:24:00.000+07:00

NAMIBIA feels the provision of Anti-Retroviral Therapy alone is not enough as there is a need for the adequate provision of food to people living with HIV if the implementation of this treatment programme is to succeed.
Speaking during the main festivity to mark World Aids Day yesterday, Prime Minister Nahas Angula said Namibia has been singled out as among the few countries in Southern Africa that have made strides in providing free Anti-Retroviral Therapy (ART) though he feels the programme is being hampered by the lack of food among those receiving treatment.
He called for the intensification of available social economic programmes to ensure those on ART have adequate food.
The event to mark World AIDS Day was attended by several MPs, diplomats and UN representatives among others.
In the past, cases have been reported that some of the HIV/AIDS sufferers in the country are unable to take their medication due to lack of food. Like most drugs, it is recommended that ARVs be taken on a full stomach.
In Namibia 13 274 people presently receive ART, making it one of the leading countries in the region with regard to provision of ART.
Since the declaration of HIV/AIDS in the country in 1986, the epidemic has shown some signs of stabilisation.
The Prime Minister announced that based on the 2004 National HIV Sentinel Survey, the prevalence rate in the past two years has decreased from 22 percent to 19,7 percent.
Windhoek, the capital and one of the most densely populated towns in Namibia, has in the past two years shown a decrease in the prevalence rate from 27 percent to 22 percent. Similarly, Oshakati reported a decline of 30 percent to 25 percent.
However, the decline does not necessarily call for celebration. The report reveals some worrisome trends in some parts of the country.
Swakopmund's prevalence rate went up from 16 percent in 2002 to 28 percent in 2004, while at Nankudu the rate increased from 16 percent to 19 percent. Looking at the critical age group of 15 to 19, there has been a decrease in the prevalence rate from 11 to 10 percent recorded at antenatal clinics. Even so, the Premier says it is very disturbing when one thinks of what this age group is doing at these places while they are supposed to be in classrooms studying to make a meaningful contribution to the economic development of the country.
"It is time to take stock of our interventions and strategies to ensure that they are appropriately targeted. It is time to see stabilisation and decline of HIV prevalence in all sites where the study is conducted," indicated Angula. This year's World AIDS Day is commemorated under the theme, "Stop AIDS, Keep the Promise".
Considering that the country does not only face the HIV/AIDS challenge but also high levels of violence against women, on this day the Prime Minister also urged men to "make a promise to stop AIDS and violence against women and children!
"For those who have already made the promise, keep the promise to stop AIDS and violence against women and children!"
The Namibian government vows to keep the promise and so have the civil society, private sector, development partners, and leaders called to "Stop AIDS, Make/Keep the Promise!"

Source: ProNut- HIV eForum

Malnourishment at time HIV treatment is started equals much poorer survival

2006-07-01T12:47:00.000+07:00

AIDSMap, Michael Carter, Thursday, June 29, 2006

Malnutrition at the time antiretroviral therapy is started is associated with significantly poorer survival, according to a study published in the July edition of HIV Medicine.

In a retrospective study conducted in Singapore, investigators found that patients who were malnourished when they initiated potent HIV therapy had a six-fold increase in the risk of death compared to patients with good nutritional status.

However, CD4 cell recovery was comparable between malnourished and well-nourished patients, and the investigators speculate that the increased mortality seen in patients with malnourishment could have been due to factors such as poorer drug absorption, inability to tolerate treatment, or lower physical functioning.

They recommend that nutritional support should be provided to malnourished patients when anti-HIV treatment is started to reducing the risk of death. An association between malnourishment and poorer prognosis in HIV-positive individuals was well described in the period before anti-HIV treatment became available.

Even in the era of potent antiretroviral therapy, the unintentional loss of just 3% of body weight is associated with poorer survival. It is possible that malnourishment at the time anti-HIV treatment is started could result in poorer recovery of immune function, meaning that patients are vulnerable to opportunistic infections for longer.

No studies have previously investigated this connection, so researchers in Singapore conducted a retrospective analysis of the medical records of 394 HIV-positive individuals who started any form of antiretroviral therapy from 1991 to 2000 with a CD4 cell count of 250 cells/mm3 or less.

Nutritional status was defined by calculating a patient’s body mass index (BMI). If an individual had a BMI below 17 kg/m2 they were defined as being malnourished. Patients were followed for a median of 2.4 years.

A total of 79 individuals died during follow-up and median duration of survival was a little over five years. Median BMI was 20kg/m2 and 16% of patients were moderately to severely malnourished when they started HIV treatment.

Three factors were identified by the investigators as being associated with poorer survival after the initiation of HIV therapy: an AIDS diagnosis (p = 0.14); taking monotherapy or dual antiretroviral therapy as opposed to potent three drug HIV treatment (p = 0.03); and, malnutrition (p = 0.004). In the period 1991 – 2000, malnourished patients had a hazard ratio of death of 2.19 compared to well nourished patients.

When the investigators restricted their analysis to the 136 individuals who took potent antiretroviral therapy, they found that patients with malnutrition had a six-fold increase of death (hazard ratio 6.14, p = 0.01) compared to patients with good nutrition.

Data on CD4 cell count six months after the initiation of HIV therapy were available for 330 patients. The median increase in CD4 cell count was 64 cells/mm3 and there was no significant difference in the increase seen in patients with or without malnutrition.

“We found that malnutrition was significantly associated with reduced survival in patients commencing antiretroviral therapy”, write the investigators, who stress, “for patients starting antiretroviral therapy with moderate to severe malnutrition, the hazard ratio of death was doubled overall.

For patients who commence HAART, the hazard ratio for those with moderate to severe malnutrition was six-fold higher than for those with normal nutritional status.”

As recovery of CD4 cell count was similar between patients with good nutritional status and malnourishment, the investigators suggest that factors such as poorer drug absorption, reduced ability to tolerate side-effects, and decreased physical function which can accompany malnourishment.

Mortality amongst individuals initiating HIV therapy could, the investigators suggest, be reduced by providing nutritional support to malnourished patients.

They call for randomised controlled trials to conducted to determine the optimum nutritional support for patients starting HIV therapy. Reference Paton NI et al.

The impact of malnutrition on survival and the CD4 cell response in HIV-infected patients starting antiretroviral therapy.

Source: AIDSMap

HIV Medicine 7: 323 – 330, 2006.

Guyana: Poor nutrition, poverty may be affecting HIV patients - govt welfare subsidy in the works

2006-06-26T17:30:00.000+07:00

Stabroek News, By Iana Seales, May 30th 2006

Guyana--In the last decade nothing has grabbed more attention as far as health issues go in Guyana than HIV/AIDS and given its far-reaching implications and devastating impact, international funding continues to come in as the fight against this epidemic endures. But there is a side of HIV/AIDS we hardly hear about.

Perhaps it pales in relevance to the successes we have had locally in making adequate treatment and drugs available free of cost, in manufacturing our own antiretroviral drugs, in commencing viral load testing and in getting more infected persons to join the treatment programme at the Genito-Urinary Medical (GUM) Clinic at the Georgetown Public Hospital.

But the story we are still to know is just how many infected persons are getting the proper nutrition they need and how many are wasting away because of inadequate meals. It is of concern because poverty is part of the lives of many infected persons, particularly those living on the streets and in run-down sections of the city, who eat perhaps one meal a day or none at all.

This is troubling since in order for the antiretroviral (ARV) therapy to be of effect, those using it must have regular meals. In fact, infected persons who are homeless and without family support and who have no access to regular meals are not offered ARV treatment.

Deficiencies of important nutrients, vitamins and minerals severely affect the body's immune function and studies have shown that this coupled with the destructive effects of HIV on the immune system, increases the risk of infected persons contracting opportunistic infections and dying.

Not on ARV treatment
There are a number of reasons why some infected persons do not qualify for ARV treatment.

Firstly, their CD4 count is above 350 in which case they are considered to be doing okay but they could be placed on treatment if they have an opportunistic infection. Then there are tuberculosis patients who are at a high risk of dying faster.

Some infected persons who default on the treatment programme, by missing doses and not taking their drugs on time also do not qualify for ARV treatment.

Dr Jadunauth Raghunauth who now heads the GUM Clinic at the Georgetown Public Hospital recently explained that it is absolutely necessary that certain requirements are met before infected persons are placed on ARV treatment because some persons run the risk of developing resistance to the treatment.

"We have to be assured that persons on treatment are taking the drugs and doing so on time when they are required to. This is important and though 95 percent adherence is somewhat acceptable, we expect patients to have 100 percent," he related.

In the years that he has worked with HIV infected persons, Dr Raghunauth said he has not known any specific case whereby persons could not be placed on ARV treatment mainly because of their nutritional status. But he admits that there may be many infected people out there who are poor and are not getting help in terms of regular meals.

Dr Emanuel Cummings, Assistant Dean within the Medical Faculty of the University of Guyana was part of a team that recently studied the nutritional status of infected persons who attend the GUM clinic.

Of the 150 patients studied, the majority, 55.17% were unemployed and 44.83% were employed. Some 59.31% said they do not earn a salary (some did not wish to disclose their income). While 10.34% earned between $10,000 and $20,000 (US$50-US$100); 8.97% earned more than $80,000 (>$US400) and 2.07% earned less than $10,000 (

On average, more than half of the participants ate beef, ham, luncheon meat, salmon, pork, shellfish, soy protein, hot dogs and sausages, pepperoni and bacon less than once per month. Of the protein group, the most common foods eaten on a fairly regular basis were fried chicken 32.39%, 1-2 times per week; eggs - 30.99%, 3-4 times per week; legumes - 37.32%, 1-2 times per week; white fish - and chicken - 32.39% - more than 5 times per week.

The study also found that 66.52% of patients thought that their nutritional intake was satisfactory; 33.10% thought that it was unsatisfactory and 69% did not know whether it was satisfactory or not and 65.52% were unable to respond to the question.

It said that 15.17% attribute their lack of proper nutrition to the lack of money; 6.90% attributed this to a lack of appetite; 4.83% attributed this to their lack of knowledge; and 3.45% attributed it to a lack of access to food.

Government subsidy programme
A street dweller who walked into Stabroek News a few months back begging for something to eat aroused much curiosity because of his deteriorating physical condition. Sickly is a mild way of describing how he looked and though he did not initially say that he was HIV positive, people who saw him concluded that almost immediately.

"I ain't gat nobody to give me food and de condition I in right now people ain't even wan give me a dollar when I beg. Is na me family alone turn from me is everybody I know in me life," the street dweller said.

He looked about ten years older than his stated age of 27 years and his physical condition was bad. When he spoke with Stabroek News he was covered in ulcers from head to toe and frothing at the mouth.

The man said he was not on ARVs because of his economic situation and though he had been treated for opportunistic infections many times he always slipped back into a deteriorating state.

Several years ago he recalled living a reckless life in Cayenne, French Guiana. He summed up his life then in three words: drinking, money and sex. In his late teens he came back to Guyana with nothing and had no place to go but on the street. He later learned that he was infected with HIV.

He said dying was not something he feared. For him, it would be "a way out of the endless days of hunger". But he said while he was waiting to "close his eyes and go wherever," it would be nice to get a plate of food each day.

What then could be done for infected persons like the street dweller who is thankful if he gets one meal a day?

Perhaps soup kitchens in the city and a few other areas that are open to anyone who is in need of a meal would be the answer. That way, there would be no stigma attached and those really in need could benefit. But even this appears too demanding an effort in the long term, which is why the idea of government offering a subsidy to infected persons is a more welcome initiative.

Minister of Health, Dr Leslie Ramsammy when contacted on this said it is something that government is planning. He said they are trying to put together funds at the moment to introduce such a programme.

"We are trying to make the resources available and if I am to project when such a programme would come on stream I would say some time in 2007 providing everything is in place," the minister added.

But in the meantime a few non-governmental organisations (NGOs) have begun providing meals to persons in need regardless of their status. These include the Network of Guyanese Living With and Affected by HIV/AIDS (G+) and Comforting Hearts, which is based in New Amsterdam, Berbice.

Free Hot Meals
Early this month, Comforting Hearts started its UNICEF-sponsored Hot Meals Programme, which has become very popular. Free meals are offered to children and adults in the area who are in need and among them are HIV/AIDS infected and affected children and adults.

Beaming boys and girls flocked the Comforting Hearts building at Coopers Lane, New Amsterdam when Stabroek News visited around midday last week, awaiting lunch. And when wafts of delicious frying fish floated on the air, one boy happily announced, "Fish today".
Shawndelle Charles-Gouveia, Project Coordinator at the NGO related that the programme was initiated for orphans and vulnerable children in the area but they are also providing meals for their shut-in clients (those who are really ill) and other adults. When it started earlier this month, she said, they were catering for around 60 persons but as word spread that number quickly climbed to 100.

She said Comforting Hearts handed out hampers in the past to persons infected and affected by HIV but it was not long before they realised that the children were not benefiting.

"We embarked on this new project after we found that the children were still in need and that many of them were not going to school because of [a lack of] meals. A lot of them could not attend school because they had nothing to eat," Charles-Gouveia said.

According to her, the programme is going well and though UNICEF funding is only for one year she is optimistic it will continue to receive support because of the impact it has already had in the Berbice area.

Comforting Hearts has already received a request from the New Amsterdam Hospital to provide meals for a few shut-in patients. They also have plans to take meals home to persons who are in need and do not want to go to the NGO.

A nutritionist has joined forces with the NGO so balanced meals are being prepared, Charles-Gouveia related. She said they had sessions with their clients before the Hot Meals Programme started and persons were educated on how to prepare healthy low-cost dishes.

Comforting Hearts also offers home-based care, counselling and voluntary counselling and testing. There are 12 full-time persons on staff, 20 mentors who work with the children and other volunteers.

Charles-Gouveia who has been a volunteer since her early teenage years has been at Comforting Hearts since 2002, four years after the organisation started operating in the Berbice area. She said bringing a smile to a child's face does a lot in terms of job satisfaction and she also loves working in a field where she is able to help people on a daily basis.

She added that the people she works with have an unwavering dedication, which makes it easier to get things done. "Sometimes we are here until eight at nights and no one ever complains because this is what we do," she said.

Dusilley Cannings, President of G+ said their nutritional programme will commence some time next month since they recently got the okay that was required. She said that they have long recognised the need for such a programme and hence its provision in their recent proposal to the Ministry of Health.

According to her, this support effort will complement what the Ministry of Health will soon implement - a welfare subsidy programme for persons living with and affected by the disease.
Cannings said G+ hopes to distribute food hampers to persons in serious need on a regular basis.

She said orphans and vulnerable children will also benefit from hampers. Since their work is also about empowering those affected with the disease, Cannings said, they will continue to provide basic needs, school materials for orphans and vulnerable children, support and home-based care as well as counselling.

Extending lives
According to the study, the nutritional status of the HIV+ patient is of utmost importance to their quality of life and relates to the ability of that person to live an extended and productive life. This is of utmost importance in Guyana as most of the persons affected by HIV/AIDS fall into the 15-44 age bracket.

"Extending the lives and the economic productiveness of these persons is crucial. Guyana has recently suffered from massive emigration, which has depleted the number of skilled and educated persons. Extending the life span of those affected by HIV/AIDS is of utmost importance in helping to maintain a steady and productive workforce and economy," it said.

Further it stated that nutrition and AIDS operate in tandem, both at the individual and at the societal level. Nutritional deficits make people with HIV more susceptible to disease and infections of all sorts. Malnutrition is one of the major clinical manifestations of HIV infection.

At the household level, HIV/AIDS and food security are closely linked: an HIV-infected household increasingly risks food security and malnutrition via declines in work, income and time available for care of younger children, together with increased expenses for health care.

Food insecurity may, in turn, further increase both the risk of being exposed to HIV and a household's vulnerability to its increasing impact as the disease progresses.

Nutrition is also linked to treatment, the study added, and as access to antiretroviral drugs improves, clean water supplies and adequate food must be made available as part of an overall treatment, care and support package.

Source: Stabroek News

ART and Nutrition in HIV and AIDS

2006-06-04T23:18:00.000+07:00

The Third Voice, by David Patient & Neil Orr May, 2006
********
For the last few years we have been following the ART (antiretroviral) medication versus nutrition debate in South Africa.

This debate is not unique in the world. What makes it unique is the scale of it, and that the government is (correctly or incorrectly) placed within the ‘alternative’ camp, with civil society (e.g., TAC) as the apparent protagonist of mainstream science and medicine. This has led to a highly polarised situation, with common sense nowhere in sight, and the victims being those infected.

How is it possible that, in a civilised society, people are being asked to choose between appropriate medication and food to keep their body healthy? Do we ask the same of those with diabetes or heart disease? Since when has there been any question that maintaining body strength through exercise and nutrition is in conflict with proper medical treatment? It defies logic, yet that is what the public is being led to believe.

Initially, the ART lobby groups stated that their opposition to promoting nutritional measures was simply to ensure that ART access was placed on the forefront of government responsibilities to those infected. This is understandable and laudable. Indeed, their efforts were essential in making ART more widely available to those infected. Many lives have been saved as a direct result of their efforts. And yes, more work is required to make ART more widely available.

In response, some of the ‘nutrition-only’ protagonists escalated their efforts and claims, telling people that ART is deadly, and that AIDS can be cured with various plants, vitamins, and minerals.

In all this heated debate, a simple fact has been overlooked: Adequate and appropriate nutrition is – and always been – a critical factor in defending against illness, and sustaining optimum health. Common sense – the missing factor in this debate – is that medication and nutrition are both important to ensuring health and warding off disease: The one fights germs, and the other strengthens the body. Where’s the conflict?

The conflict lies in the fact that most people – not only those living with HIV – are largely ignorant of the basic facts about both ART and nutrition, and also when and where those options are appropriate. To make things worse, the media is not doing a very good job of explaining how things work in HIV.

You may ask what right we have in commenting upon these issues. Yes, one author (David Patient) is living with HIV, since 1983. However, infection with the virus does not automatically imbue you with insight, wisdom or information regarding the disease, medicine, or how your body works. Instead, it is useful to note that David has been involved in HIV and AIDS activism long before ART as we know it came onto the scene.

Like many others, whenever there was a claim of some ‘miracle’ treatment or cure (e.g., Compound Q from Chinese cucumber, and AL721 from egg yolk), he was one of the first to give it a go. When AZT - the first ART available – came onto the scene, he was part of the first human clinical trials, back in 1986 at Duke University.

The fact that none of the ‘miracle cures’ cured anything, nor the fact that the doses of AZT back in 1986 were so toxic that most subjects died, is not as important as recognising that – like most people living with HIV – he wanted to live, and wanted options to do this. When second-generation ART’s became available in the early 1990’s (3TC, and D4T), both authors helped get these medications to South African AIDS patients.

We have also been part of the nutrition and HIV debate since it’s early days and in some instances, we instigated it. We spent several years poring over research documents on nutrition and viral infections, distilling these into guidelines that have become the basis for many
nutritional interventions for those living with HIV. We even published a book on it called Positive Health that currently has a circulation of over 14 million copies.

When originally published in 1999, ART was simply not available to the general public, and it was felt that people living with HIV needed to know what else they could do to sustain their health until medication was available. As access to ART improved, information on this treatment was included in the book. The point is that we have never viewed either ART or nutrition as stand-alone options. Indeed, the one supports the other.

Rarely has there been a period of time when we have not been approached to promote some or other product, herbal or otherwise, which the developers claim to ‘cure’ HIV and or AIDS. We have investigated many of these, sometimes through personal trials. And no, we have not found the cure in any of these ‘miracle cures’.

Instead, we have gained a great deal of insight into how traditional medicine and western medicine view treatments and cures quite differently. For example, traditional medicine views a cure as the alleviation of symptoms, whereas western medicine views a cure as the removal of the causative agent, such as HIV. Hence, there is a perennial misunderstanding in this regard.

So, at the risk of being presumptuous, we believe we have the experience and knowledge to make certain statements regarding the nutrition-ART debate, based upon current facts and research:

1. There is no cure for HIV from the medical, traditional healing, or ‘alternative’ fraternities. Instead, there are proven methods for keeping HIV under control (e.g., ART), and for strengthening the immune system (e.g., sound nutrition and other practical measures).

2. ART is effective in extending life in those living with AIDS, on average extending productive health by 4 or more years. Yes, there are those who respond badly to the medications. It is also true that long-term use often leads to side effects such as liver problems. Mixed into the equation is that early ART did indeed have severe side effects due to high dose levels. These dose levels have now been reduced to less toxic levels. All these disadvantages are outweighed by the clearly demonstrated benefits of the medication. Like any chronic medication (e.g., blood pressure pills), it requires close monitoring to detect and control the side effects.

3. Nutrition likewise extends life in those living with HIV and AIDS, but through different mechanisms to ART medication. Where ART focuses upon destroying the virus or interfering with its’ ability to reproduce, nutrition focuses upon providing the body with what it needs to create new immune cells, and thus do its’ part in fighting infections. These two methods are complementary, not conflicting.

4. ART is only considered appropriate when a person living with HIV reaches a CD4 (Helper T-cell) count of 200, or when an AIDS illness emerges. Therefore, simply being infected with HIV does not qualify you to receive ART. In contrast, nutrition and other practical measures such as exercise provides tangible and effective measures for people living with HIV to get involved in their health, long before AIDS emerges, and thus before ART treatment is called for. The focus of nutrition is to improve immune function, and thus prolong the period of infection before AIDS develops. It does not prevent this from occurring – it simply delays it.

5. Without awareness of nutritional interventions (and structures such as support groups), there is little motivation to get tested early, a key to effective health management. Without the promotion of empowering options such as nutrition, promoting early testing is extremely difficult. When absent, people tend to wait until they become ill before they seek assistance.

6. Specific ART medications do indeed conflict with specific foods and herbs. Examples are garlic and Ritonavir or Saquinovir, and African Potato or Sutherlandia and most ART medications. These herbs interfere with enzymes in the stomachs that absorb the medications. This conflict is resolved by waiting for several hours after taking the medications, before consuming the herbs.

7. According to published clinical trials, African Potato does indeed improve immune function. However, it does not boost the immune system, as the immune system is not a simple unified entity. Instead, it strengthens only one part of the immune system (cellular immunity). It is this part of the immune system that deals with viruses. Heat (e.g., boiling) destroys the active ingredient of African Potato, making it useless. To obtain benefit from the plant, you need to know how it was prepared.

8. Garlic has no direct effect on viruses, including HIV. Instead, it is a sulphur-based natural antibiotic, about 1/10th the strength of penicillin. Regular garlic consumption reduces bacterial, yeast and parasitic infections. This in turn allows the immune system to put more resources into fighting viral infections. Deodorised garlic is useless if the sulphur-based ingredient is removed.

9. Beetroot is high in iron. Like garlic, beetroot does absolutely nothing to viruses. Instead, the iron improves blood oxygenation, energy levels, and supports various important body functions. Dark green vegetables and liver do the same thing. Malnourished people are often anaemic, which is a condition caused mainly by low iron levels. Pregnancy can also induce anaemia.

10. Malnourished people respond poorly to medication (including ART), and have a lower resistance to infections in general. Nutritional interventions (e.g., vitamin A supplements) have little beneficial effect when applied to groups of people (including those infected with HIV) who already have an adequate and varied diet. However, when applied to groups with a restricted diet – either in quantity or variety – specific nutritional supplements have a dramatic effect on health, including response to ART. Therefore, when evaluating nutritional studies, it is important to consider the economic background of the study group. Failure to do so leads to a perception of ‘sometimes it helps, and sometimes it doesn’t’.

11. Given the economic and other conditions that we live in, nutritional interventions should focus upon ensuring either an adequately varied diet, or supplementation of existing diets to ensure basic nutritional needs are fulfilled. It should be clearly understood that such nutritional interventions have nothing to do with ‘curing’ disease. It is simply about ensuring normal immune function. Furthermore, legislation concerning mandatory fortification of popular foods types such as maize meal needs to recognise that heat destroys vitamins (but not minerals) and that certain forms (typically the cheaper forms) of vitamins and minerals are not well absorbed.

12. The most clearly scientifically proven nutritional substance to make a statistically significant difference in how long and well a person lives with HIV is selenium. This effect occurs regardless of other dietary factors, and is seen even in those who have an otherwise good diet. This effect has been demonstrated in several controlled studies. Selenium cannot reliably be obtained from most foods, as levels of selenium in food such as vegetables depend entirely upon the soil they were grown in. Commercial agricultural methods reduce selenium levels in food because of alterations of the acid/alkaline levels of the soil. The exception is the aloe, which actively extracts selenium from the soil. Sea fish also contain reliably adequate levels of selenium. You cannot overdose on selenium from food sources. However, in pill form you should not exceed 500 micrograms per day (for adults).

13. The ‘remarkable’ effects of various nutritional products can largely be explained in terms of simply addressing underlying malnutrition. Many people have poor diets, regardless of income or volume of food consumed. This is because of processing and preserving methods that typically destroy vitamins in food. Fresh food is far better than mass-produced food for this reason. Techniques such as trench gardens make it possible for almost anyone to grow their own vegetables, even in dry and difficult situations.

14. Variety is as important as volume. There is not one (naturally-occurring) food that can give you all that you need, nutritionally. Mono-diets (e.g., maize meal with the occasional meat) can lead to malnutrition in terms of many vitamins and minerals.

15. Maintaining normal body temperature (37 degrees Celsius) through exercise and diet (e.g., energy foods, and ‘hot foods’) does indeed help the body fight viruses. The cooler the body, the more active germs become. The warmer the body, the more active the immune system becomes.

16. Treatment of chronic infections such as parasitic infections (e.g., worms), TB, malaria, and sexually transmitted diseases, does increase the body’s ability to fight HIV. This is simply because these infections place an additional burden upon the immune system.

The bottom-line is that nutritional interventions are extremely important in dealing effectively with HIV and AIDS: Before you need ART - during the longest period of living with HIV, the period from diagnosis to CD4 of 200 - take care of your body and give it what it needs to do its’ job in keeping HIV under control for as long as possible.

There are proven natural methods that do enhance your body’s ability to control and even delay the onset of many conditions. However, when your immune system becomes compromised and your CD4 count drops below 200 and your viral load increases, then ART is critical. However, even on ART, continue with good nutritional practices to maximise the benefits of ART and help your body cope with the medication.

David Patient used nutrition (that includes vitamins, minerals and good food) for most of his HIV infection. Now, 23 years into his infection, he needs ART because his immune system was starting to show some wear and tear. He takes his ART religiously each day, and he still eats well, takes his supplements, does exercise, and generally tries to take care of his body. Is this medical heresy? Is this an abandonment of nutrition?

Of course not: He didn’t abandon the methods that worked for 23 years – he simply added ART to his daily regimen because that was necessary. As a result, his immune system is great (CD4 is at 900, and undetectable viral load). In addition, he hasn’t had any negative side effects, and his liver enzyme tests are normal.

So what, we ask, is the debate really about? How much of it is about ego and sheer pig-headedness? Since when did medical science - or nutrition - demand faith – not a careful consideration of known facts – to determine care and treatment options? We have been around HIV and AIDS a long time, longer than most. We have never seen a verified case of someone ‘cured’ of HIV from any food, herb, or medication. We have, on the other hand, met many people who have lived long and healthy lives with HIV, using both medicine and sound lifestyle practices.

The objective of any treatment intervention is to promote life and health. If it does, use it. It is not a matter of faith or political conviction – it is a matter of what works, and what doesn’t. Ask anyone with diabetes and other chronic illness.

When you hear someone insisting that ‘this is it’, be cautious: Rarely will such a person tell you of the people who did not benefit from the miracle cure … you only hear about the successes. It’s your life, your body: Demand explanations and evidence. Ask questions – don’t be a helpless victim in your health.

David R. Patient (M.H.;M.H.T.)
Empowerment Concepts
Ph. +27-(0)83-226-9466
Fax to email +27-(0)86-683-4585
david@empow.co.za
www.empowermentconcepts.com

Source: AF-AIDS eForum

Rwanda: Aids Therapy Beyond Drugs

2006-06-04T01:55:00.000+07:00

Africa Renewal, June 1, 2006, By Stephanie Urdang

Kigali--Many Rwandan women and girls infected with HIV/AIDS are now getting supplemental food with their medicines.

For Grace and her daughter Juliette, the anniversary of the April 1994 Rwanda genocide means one thing: they have lived with HIV for a dozen years, and their disease has progressed to AIDS. Grace was among the estimated 250,000 women who were raped at the time and is one of the untold numbers of women who were infected with HIV as a result. Juliette, now eight years old, is also infected.

Until recently Grace was living in abject poverty, trying to cope with the stigma associated with being HIV-positive and with the daily worry that there would be no one to look after Juliette after her early death.

At first, when Grace began to get sick, she found it inconceivable that she had AIDS. Those who carried out the genocide "murdered my husband and left me to die slowly from their AIDS," she said. She found it equally inconceivable that there were drugs that could fight the disease. "In my case, only God, who knows that it wasn't my fault that I caught this sickness, could perform a miracle and heal me."

Grace and her daughter, like Josiane, Didacienne, Triphonie and other women in her situation, have now found that they do not have to wait for miracles to occur. All have been able to benefit from the Rwandan government's commitment to providing anti-retroviral (ARV) therapy to those who need it -- and for those who cannot afford it, at no cost.

These women are among the estimated 6 million Africans living with HIV/AIDS who are in immediate need of anti-retroviral medicines, out of a total of nearly 26 million HIV-positive people in the region.

Recent data from Rwanda's 2005 Demographic Health Survey indicates an estimated overall adult infection rate of 3 per cent nationally. Earlier estimates by the Joint UN Programme on HIV/AIDS (UNAIDS) for 2003 placed the prevalence rate in the towns at 6.4 per cent and in the rural areas at 2.8 per cent. The programme's Global Report for 2004, also using 2003 figures, estimated that some 250,000 Rwandan children and adults up to the age of 49 are living with HIV (figures for adults over 49 were not available). Of those, 22,000 were estimated to be children under the age of 15. Of particular concern is the high prevalence rate among young women between the ages of 15 and 24, five times the rate among young men of the same age group.

Wide treatment coverage

The Rwandan government, with financial support from a variety of sources including the Global Fund for AIDS, Tuberculosis and Malaria, the World Health Organization, the World Bank, bilateral donor agencies and private funds such as the Clinton Foundation, is able to provide ARV treatment to about 40 per cent of the people in need. Doctors and nurses are being trained, and a growing number of health clinics are able to treat AIDS patients. The estimated 19,000 people living with AIDS under treatment by December 2005 represented one of the highest coverage rates in sub-Saharan Africa.

This is particularly impressive in a country where 66 per cent of the population live below the poverty line and where the majority of households are unable to produce enough to feed themselves, even though 91 per cent rely on agriculture for their livelihoods. Rwanda's food crisis remains chronic. It is even more severe in the context of HIV/AIDS, presenting a challenge to the ultimate success of the government's treatment and care programme.

That programme involves not only medical and resource questions, but also interlocking issues of poverty, stigma and gender inequality. Because of these issues, access to ARVs is often not a reality for those who are the most marginalized and in greatest need of the medicines.

Poverty means going hungry. Hunger leads to malnutrition and a more rapid breakdown of the immune system. Social stigma against those with the disease means that many do not get tested in the first place. And gender inequality puts burdens on women that they cannot shake off on their own. Those burdens include responsibility for caring for children and other family members, ensuring that limited food supplies go first to hungry children and the risk of abandonment by men when an HIV-positive status is disclosed. Pivotal to all these issues is the need for food, a need as urgent as the drugs themselves.

Food a daily challenge

Sister Speciosa, a nurse and nun, is confronted with the reality of food every day as she provides treatment, care and counselling to AIDS patients at Butare Hospital, two hours drive from Kigali. "It is not only that they need the food to take with the medicine and that they need to eat more than they did when they were sick to get healthy," she says. "It's that their appetite increases. Some of my patients say they don't want to take the medicine because it makes them so hungry."

Although eligible for free tests and medication because of their lack of income, many find that the daily circumstances of their lives make it impossible for them to use those services. The lack of food or money for transport, difficult housing conditions, pervasive stigma, the stress of believing they will die without providing for their children's care -- all serve to accelerate a downward spiral into despair and hinder their access to ARV drugs, even when those drugs are free. Because women are primarily responsible for feeding their children and their families, they are most deeply affected by this inability.

Dr. Anita Asiimwe, coordinator for care and treatment at the Treatment and Research AIDS Centre, a government agency, also cited the food question in an interview with Africa Renewal. "It is clinically established that patients need to take their drugs with food," she said. "It's a dilemma for us, as everyone needs food. Is it right to only provide food for those on the drugs? What about everyone else who doesn't have enough to eat?"

She illustrated her point with an anecdote about a child whose mother couldn't afford to send her to school. The child, knowing that children of people living with AIDS had their school expenses covered, asked her mother why she wasn't HIV-infected so that she could go to school too.

"Would women," Dr. Asiimwe wondered aloud, "be encouraged to become infected in order to feed their children?" At times, she says, she has to try not to be despondent about the difficulty of providing for all those in need. "I have to remind myself," she said, "of how far we have come, and not despair about how far we still have to go."

'We cannot eat pictures'

The Ministry of Health's Nutrition Unit is fully aware of the need for a healthy diet for people living with AIDS, whether they are being treated with ARVs or not. In a recent interview for an assessment financed by the UN Development Fund for Women (UNIFEM) and undertaken by African Rights, a non-governmental organization, the ministry's secretary-general, Dr. Ben Karenzi, stressed that the government is not oblivious to the importance of nutrition in the fight against HIV/AIDS. However, he also underscored the huge challenge of maintaining an ongoing food support programme, particularly in the absence of adequate funding.

A woman living with AIDS cited in the same assessment highlighted this difficult reality. "They show us pictures of all the food we would love to eat, but we cannot eat pictures... We have to have the means to purchase or produce the food. Visit us in our homes and see how we live. Then you will understand."

Rape survivors

The experiences of Grace, Triphonie, Josiane and Didacienne attest to a critical need, not only for the availability of anti-retrovirals, but for more general support to enable the women to access the drugs. They were among some 200 rape victims who survived the genocide, many of whom were infected with HIV as a result, whose testimonies were included in a UNIFEM-funded report published by African Rights in 2004, Broken Bodies, Torn Spirits.

Ms. Rakiya Omaar, director of African Rights, told Africa Renewal that the most compelling issue that emerged from the the testimonies was not only women's dire need for anti-retrovirals and medication to treat opportunistic infections, but the difficulty in accessing them consistently.

"What became very clear to us was that even if the drugs were available, most of the women we interviewed were too poor to afford the food needed to take the drugs," she said. "If they did get some food they gave it to their children, as they couldn't eat when their children were hungry even if it was a matter of their own life. They also had no money for transport to the clinics. They worried incessantly about their horrendous living conditions, the desire to send their children to school. They were plagued by high levels of stress, not only for these reasons, but because they worried about their children when they were no longer around, which they knew was inevitable without ARVs."

What was especially painful to her, she added, was that a number of women cited in the report have already died. Every month she hears of more deaths, even though ARVs are now more available.

Little grounds for hope

Triphonie's story was typical. She grew thinner and sicker and her children went hungry as she tried to cope with living in a crowded, open army warehouse, rushing back and forth between her market stall and her four children to check on their safety. Her stall was rapidly failing, exacerbating the hunger.

Josiane lost four children to the interahamwe, the militia force that led the genocide. She has suffered debilitating memory loss. She was living in an unprotected shack without the means to pay for food or transport. Her 11-year-old daughter was a product of the rape and like her was living with AIDS. When her daughter got sick, Josiane would carry her to the hospital on her back. Although her CD-4 count called for them, doctors would not prescribe anti-retrovirals for Josiane because of her memory. "I was always confused," she told Africa Renewal. "I did not know the day of the week or the time of the day."

Grace, unable to support all four of her children, sent Juliette to boarding school. Juliette stopped taking her anti-retrovirals because she worried that her classmates would find out about her HIV status. Very ill, she was sent back to Butare. There she lay in hospital, unable to eat the hospital food, while Grace sobbed by her bedside, with no money to buy food Juliette could eat and frantically worrying about her three hungry children alone at home.

Didacienne would walk 10 kilometres to the nearest clinic when she was ill, a distance that, in her frail state, took her many, many hours. She could not afford the equivalent of US$0.60 for the bus that passed near her house on the outskirts of Cyangugu twice a week on market day. Not long before Africa Renewal interviewed her at her family homestead, she had spent weeks in the hospital. When she recovered and returned, she found that her small but well built house had been totally dismantled by her late husband's relatives. They explained that they thought she was going to die and therefore sold everything, including the bricks and roofing, to pay for the funeral. Didacienne and her children share a shed that housed the cooking hearth with one goat and a growing number of rabbits.

'Gift for Life'

These particular women have been fortunate. They have benefited from a small programme started by African Rights, called Gift for Life, that provides food and other basic necessities to women involved in the testimony project. The support is intended as a five-year bridge to self-sufficiency. Other organizations are also providing food to women in similar straits.

As a result, Triphonie has moved to secure living quarters minutes from the market and her stall is flourishing. Josiane's "permanent" memory loss is improving now that her stress levels are diminishing; she is taking anti-retrovirals and is planning a small business enterprise while her daughter, healthy on her anti-retrovirals, is attending a nearby school. Juliette was found a space in a local high school and Grace has found some work, and all live at home where there is enough food for all the family. Didacienne now has transport money to go on regular visits to the clinic to monitor her disease; she is getting stronger every day.

Anti-retrovirals generally make an enormous difference to physical health. But without food and other related support, they may not make a difference to mental and emotional health. Women who receive anti-retroviral therapy and food and who are able to cover the cost of transport to the clinics are finding they have the physical and emotional energy to turn their lives around. Most of the women in the African Rights programme, for instance, have opened bank accounts, a sign that they are planning for their future.

The UNIFEM assessment points out that when women living with AIDS are given food support to relieve their immediate hunger and to regain their energy, they then often request assistance for income-generating activities and skills to develop alternative livelihood strategies or to turn their failing enterprises around. "A combination of food availability and anti-retroviral therapy," says the report, can ensure that women living with AIDS "lead a productive life, become less burdensome on their families and communities and put less strain on the health system."

UNIFEM, in partnership with African Rights and with the encouragement of the Ministry of Health, has started an advocacy campaign to address the critical link between food and anti-retroviral therapy in Rwanda. The campaign regards treatment not only as a health issue, but as a critical path towards women's economic empowerment and self-confidence.

Triphonie, who was at risk of dying before African Rights came into her life, sat in the living room of her new home, her two youngest children eating with gusto out of a large bowl of nutritious rice and beans placed before them on the floor. She reflected on the changes in her life: "Only now am I able to no longer regret that I survived the genocide."

Pills, food and seeds

Many health centres in Rwanda were finding that although they were providing ARVs to women who needed them, they were not getting the results they hoped for. The women visiting the clinics complained of extreme hunger and were disheartened by their inability to obtain the food they needed. And so seven clinics, funded by the US Agency for International Development and the International Centre for Tropical Agriculture, have begun an innovative programme. One of these, in Gitarama Province, has been particularly successful.

According to African Rights, the first step was to provide fortified SOSOMA (a nutritious mixture of sorghum, soya and maize) to the women to help them regain energy. The next step was to involve them in growing their own food crops. The project is based on the introduction of indigenous vegetables and tuberous seeds, which are well adapted to Rwanda's climate and soils. With this comes training in soil fertility, crop diversification and the use of hardy seeds.

To get women living with AIDS interested in the programme, Mr. Hodali Jean Gatsimbanyi, the coordinator, cultivated a demonstration plot next to the health centre. He encouraged the women to harvest the produce for their family's consumption during their visits to the centre. Then he distributed seeds to the women for planting in their home gardens, passing on tips and monitoring their progress. In order to join the project, the women were encouraged to form associations, known as amashyirahamwe. The project in Gitarama began with 50 women and soon grew to 90 as the results started to become evident.

Once the project was underway, the centre found that the health of the majority of the participants improved considerably. They gained weight, opportunistic infections have been reduced and in some cases the participants look healthier then people who are not HIV-positive. There is also a spin-off effect in the community. Community members in general have shown greater interest in acquiring the seeds and cultivating their own plots and the women in the programme have been encouraged to impart their new knowledge and skills to non-participants in their villages.

Source: Allafrica.com

Kenya: Using ARVs to Fill Empty Stomachs

2006-06-03T22:27:00.000+07:00

by Joyce Mulama, IPS News Service, June 2, 2006

NAIROBI - "ARVs can change things, but they do not change my socio-economic status. Yes, I get the ARVs; but I cannot afford to put a simple meal on the table," says a man who insists on being identified only as wa Kimani.

"This is why I had to register at two treatment sites, so that I could get ARVs (anti-retroviral drugs) twice: utilise one set from one site, then sell the other batch from the second site, so that I can get something small to put in my stomach."

Wa Kimani spoke to IPS outside one of the centres where he obtains treatment, his face perspiring in the hot sun as he sat on a stone, awaiting the client who buys medication from him. The stigma that continues to surround AIDS in Kenya has apparently made the client wary of obtaining ARVs through official channels -- something he fears may lead to his HIV-positive status being made public.

Wa Kimani, who is unemployed, began selling the drugs last year. He charges his client just under seven dollars for a month's worth of medication.

"This is not much, but at least it helps me purchase some basic food so that I do not take the medicine on an empty stomach. It can be dangerous, you know," wa Kimani says.

"I remember once, before I thought of the trade, I would take the medicine without any food -- just porridge alone. I nearly died. I got so weak, I developed ulcers which have not healed well until now."

Until the beginning of this month, government facilities had been charging about 1.4 dollars for the same amount of ARVs; however, the fee was waived from Jun. 1. About two million people are living with HIV/AIDS in Kenya -- more than 200,000 of whom require ARVs.

Wa Kimani's case does not seem to be unique.

Patricia Asero, a member of the Kenya Treatment Access Movement, heard of six other people receiving ARVs from more than one centre last year.

"I got interested and investigated the matter further because these people belong to the same support group as me. I found out that they had registered in more than one treatment centre so that they could get extra drugs to sell and buy food to take with medication," she told IPS.

In some cases, patients who only have one source of drugs will also sell their ARVs to buy food, added Asero. However, they present a different tale to staff at their treatment centres.

"They will tell you that their medication got lost; others claim that their bags were snatched by thieves. But when you interrogate them keenly, you get to know the truth," she noted. Asero is also an HIV/AIDS counselor at a government hospital.

Other patients who live long distances from ARV sites and who are too weak to walk to there -- also too poor to afford transport -- simply skip treatment, using what money they have to buy food.

With official figures indicating that about 56 percent of the population lives below the poverty line, the temptation that certain HIV-positive Kenyans face to sell their medication is unlikely to diminish in the near future.

"The fight against HIV/AIDS must be coupled with the fight against poverty. If not, we are wasting our time," says Omu Anzala, a senior lecturer in the Department of Medical Microbiology at Nairobi University's School of Medicine. Nairobi is the Kenyan capital.

The government claims to have steadily increased the number of persons who are receiving ARV medication in recent years: 39,000 patients were treated in 2005, up from 24,000 in 2004. The aim was to have 95,000 people on the drugs by the start of 2006.

But, says Anzala, "The government should get away from giving us numbers. It should be concerned about the quality and sustainability of the service. These numbers mean nothing when the majority of the patients are skipping or selling drugs."

The alleged sale of ARVs by some patients, and the erratic way in which others are said to take the medicine, has raised fears of drug-resistant strains of HIV in Kenya.

At present, there are only about 24 ARVs on the market -- and at any one time, a patient must be on three. If present trends continue, says Anzala, "we may not have any ARVs to talk about, since people will be resistant on all of them."

"There is a need to monitor people and to see if they are taking their medication as required, as well as monitor resistant strains of the disease."

Others claim that these problems would be circumvented if more attention was given to the matter of nutrition.

"When we talk about comprehensive care in HIV/AIDS, nutrition is part of it. But the government has neglected it; it only provides nutritional counseling and that is it," notes Asero.

"Some treatment centres may only give a packet of ujimix (porridge flour) per month. This is nothing."

A report issued last month by the International Treatment Preparedness Coalition, a grouping of AIDS organisations from across the world, also cites lack of nutrition as a major obstacle in the war against HIV/AIDS in Kenya.

"Nutritional support is still minimal except for nutritional education," says the document, titled 'Missing the Target -- Off Target for 2010: How to Avoid Breaking the Promise of Universal Access'.

The report was released last week ahead of the United Nations General Assembly Special Session on HIV/AIDS, which opened May 31 in New York.

Health officials say they are trying to improve nutrition amongst AIDS patients.

"There are activities going on to provide this service. Most of the hospitals are implementing it," David Mwaniki, head of the Technical Support Department in the National AIDS Control Council, told IPS.

"But, we need to work further to strengthen it." (END/2006)

Kenya: Famine Fuels AIDS Pandemic

2006-05-21T09:36:00.000+07:00

Kenya Times, April 2006, By Ben Mitukaa

Kenya--The woman looks wasted, weary, hungry, and unhealthy. She is frail and black blisters mark her body like strange tatoo marks. A moment of silence. Then she turns her eyes slowly towards the prelate’s door. Suddenly, the door bursts open.

With a careful handshake, Bishop Daniel Osoi emerges to usher into his house yet another visitor. The Bishop’s house is a humble affair of brown mud walls and yellowing mabati .

Welcome to Taretuoki Aids Project at Emali township along the Nairobi-Mombasa highway. The project is funded by Erikshalpen of Sweden, but the patients have run short of medicines and food.

For the last one month, the patients have no food supply they are required to take with ARV medication. Uncertainty hangs in the air because of a raging tug-of-war between the government and the Global Fund, the main sponsor of the project. Panic is spreading among the patients, many of whom have retreated to their death beds.

“We gave the last supply of food and drugs about a month ago, says Bishop Osoi, “The patients will develop resistance to the Aids drugs.

TAP is a church-run project that at once crammed with Aids patients and hungry people. Each time Bishop Osoi opens his door, a hungry, weak and sick face greets him. But he is not surprised. The project office is familiar with sickness, starvation and death. Relief agencies say the Aids crisis is worsening poverty and hunger, with both evils fueling each other. According to CARE International, both the Aids and food crisis across Africa is worsening.

In Kenya, Ethiopia and Somalia, failed rains and underlying poverty have led to a catastrophic food water crisis affecting more than 12 million people. It is feared that in the process, the Aids scouge has multiplied far ahead of what is officially acknowledged.

As for the killer disease, Bishop Osoi has received hundreds of cases in the last three months alone. All of them demand his urgent attention; each day the hungry and the sick come not only to confess that they harbour the killer virus; they also want his intervention to help them get help, any help. About twenty kilometres away is a US-funded Aids facility.

“I have HIV/Aids”, the young woman bursts out, tears welling up in her eyes. The clergyman sits speechless, oblivious of the cosiness of the sofa set. One of his hands holds his chin in pensive mood.

“ I leave my children to you. I am dying,” she continues.

In her hands is the damning medical report. It says she is HIV positive. It is like being on death row. With a firing squad in facing you. With the devastating hunger, more and more people are dying of Aids.

The woman’s two year old daughter looks pleadingly, knowingly. The Bishop nods, winces in quiet understanding. He provides them with transport to the distant Mbirikani Aids village.

There, the woman will be screened and tested and her young daughter fed.

The Emali church compound is a symbolic spot in the war against Aids, which threatens to wipe out mankind.The people of Emali are lucky though, at least 35 of them are on anti –retro virals treatment, which means they may live a little longer. But only if they get good food to eat.

Scores of children of orphaned by Aids have found homes and solace from Bishop Osoi. Each day, several of the children and their dying parents and guardians throng the compound in search of medical and food aid. Medics are upbeat about ARVs, saying the drugs are working wonders by helping to prolong the lives of patients.

Some patients are said to have returned to work, digging holes to plant plantains. But a recent delay in supply of the drugs means many of them have discontinued medication. He is not a medic himself, and his resources are limited, so Bishop Osoi has a heavy task. Born as Tavariya in 1953 to a veterinary father at Enkasurai village of Olotologum location in Mashuru division in Kajiado district, he was the last born of his parents.

His wealthy parents were members of the Pentecostal Evangelistic of Africa Fellowship (PEFA), the pioneer church whose missionaries had since ventured into Maasailand.

In 1957, Osoi joined Mashuru primary school. His father wanted him to study hard and carry on the family mantle, but his education was disrupted by nomadism. He briefly migrated to Matapato in 1958 but soon returned to continue with his education.

In 1970, he joined Kumusi Bible College and trained as a pastor. He attained a Diploma in Theology three years later. Upon graduation, he began evangelistic duties at Loitokitok. Later on, he was sent back to Mashuru.

By, then he had joined the Evangelical Free Missionary church and gone back to Moshi for another stint of religious training.

In October 1974, he was posted to Emali, a dusty town which straddles the borders of Makueni, Machakos, and Kajiado districts. For over 30 years, Bishop Osoi has cut a niche for himself as
philanthropist.

Source: Kenya Times Online

Malawi calls for multifaceted approach to fight AIDS

2006-05-03T01:12:00.000+07:00

May 1, 2006, from www.chinaview.cn

LILONGWE, May 1 (Xinhua) -- Malawian President Bingu wa Mutharika on Monday observed that global efforts to fight HIV/AIDS would be fruitless if emphasis is only placed on the provision of life-prolonging drugs to infected people.

"Provision of affordable anti-retroviral drugs (ARVs) to infected persons must go hand in hand with boosting their nutritional capacities so that the drugs work well in their bodies," said Mutharika in the capital Lilongwe during activities marking Malawi's commemoration of Labor Day.

Mutharika said recent studies had shown that ARVs were only effective in bodies whose nutritional capacity was well enough compared to those people who did not have access to a good diet.

Malawi's Principal Secretary for HIV/AIDS and Nutrition, Mary Shawa, told Xinhua recently that nutritional capacity of most Malawians was low and the condition was worse among those infected with HIV.

"Progression of HIV among infected Malawians is being accelerated because of people's poor nutritional capacity, a situation that is making them require ARVs early enough," said Shawa.

Malawi, whose total number of HIV/AIDS infected people currently stands at about one million, has about 170,000 infected people who require HIV/AIDS drugs. The country has a total population of about 11.6 million people.

The government has managed to have close to 40,000 HIV positive people on free medication by December 2005 with assistance from the Global Fund.

Source: China View

ZAMBIA : Food programme help HIV/AIDS patients

2006-03-28T11:17:00.000+07:00

from Relief web, March 27, 2006

Scattered wheelbarrows litter the ground outside Kanyama Health Center's anti-retroviral clinic in Lusaka, Zambia.

Just beyond them, a long line of patients has formed, each waiting to see the sister-in-charge, as the head nurse is called.

For years, the wheelbarrows were used by young men and women to wheel sick relatives to the clinic for HIV testing and whatever treatment was available. The crude "wheelchairs" symbolized the hopelessness and poverty that HIV brought to many households in southern Africa.

Today, the wheelbarrows have new significance. More and more Zambians - who were previously too ill too walk - return to the clinic each month to refill their anti-retroviral (ARV) drug prescriptions.

Now strong, and walking under their own power, patients use the wheelbarrows that once carried them to cart away bags of maize provided through a unique partnership among several organizations - the local health district, the United Nations World Food Programme (WFP), Zambia's Catholic dioceses, and two U.S.-based non-governmental organizations, Catholic Relief Services and Project Concern International.

The free food is essential for many ARV patients, nurses said. Patients taking ARVs risk malnutrition and harmful side effects unless they can increase their overall caloric intake by as much as 40 percent. Many Aids patients in Zambia have difficulty getting enough food to tolerate the highly-toxic drugs.

Poor rains have increased food insecurity in many parts of the country, which worries organizations providing anti-retrovirals and home-based care. The World Food Programme warned last November that more than 1.6 million Zambians will need food assistance in the coming months.

"For someone to be taking medication every day, it's a challenge," Project Concern consultant Shampulula Kabamba said. She currently trains and supports home-based care volunteers in Mongu, the capital of Western Province, Zambia's poorest region, where food insecurity is a huge obstacle to successful ARV therapy. The volunteers monitor patients as they begin their treatment, as missed pills can lead to the virus becoming resistant to the drugs.

Kabamba said that when Zambia's government announced in August that it would provide free anti-retroviral drugs to all Zambians who need them, it provoked a flood of clients to HIV testing centers, many of whom were placed on the ARV therapy.

The home-based care and food distribution programs, ultimately funded by the WFP and the U.S. President's Emergency Plan for Aids Relief (Pepfar), fill the gap to ensure that even the poorest Zambians can get the food they need to tolerate treatment.

From her base in Mongu, Kabamba's 26 HIV-positive volunteers look after 440 people receiving ARV therapy. Through a home assessment, they've determined that 343 clients -- 78 percent -- need food rations to combat side effects and comply with their treatment schedule.

Nationwide, the WFP will provide food to 20,000 people on ARV therapy in the coming months, said WFP spokesperson Jo Woods by e-mail. About 40,000 people are receiving ARVs in Zambia, but the government hopes to scale up the program to offer treatment to the estimated 200,000 Zambians who need it.

But even free ARVs and free food programs do not guarantee a smooth ride for sick Zambians receiving treatment.

Kabamba said transport costs are a significant obstacle to ARV adherence for the majority of Zambians who live far from the nearest treatment clinics. Kabamba said nurses will sometimes take up collections to help rural patients who have exhausted all their resources by getting to the clinic and are stuck without money to catch a minibus home.

Transport and adherence are especially a problem for HIV-positive children, who often have an elderly grandparent traveling to the clinic each month to fill their prescriptions. Some grandparents are too sick themselves, or too poor, to make the trip - or they simply forget, Kabamba said.

U.S. and Zambian government officials, as well as representatives of non-governmental organizations, said they are looking at transport as the next hurdle to conquer in the national ARV rollout.

Still, adherence to the life-saving treatment in Mongu is over 95 percent, Kabamba said, and rates are similarly high in Lusaka, the capital of Zambia.

Members of an HIV-positive support group at Kamwala clinic in Lusaka said many of their friends and neighbors are still suspicious of ARVs' efficacy in treating Aids. But they urged an end to the rumours and skepticism.

"We don't want any people to die and leave kids behind, so we think they should take ARVs so they can see their kids growing up," said Leyford Hanangala, who has lived with the virus for almost 20 years. Hanangala said he regularly sought treatment from traditional healers, which never worked.

In fact, just one member of the Kamwala support group, Mary Chapo, said she had never sought help from traditional healers. When Chapo found out she was HIV-positive, she asked her parents to take her to a hospice to die.

Today, Chapo says she is living positively with the virus, and her children even remind her to take her ARVs at the same time every day.

"We want people to know that ARVs work and you can go back to life," she said.

Source : Relief Web

PATAM: Scaling up Access to Antiretorival Therapy

2006-03-27T08:37:00.000+07:00

By Jabulani Sithole, Zimbabwe

"We Need Food and Drugs"

Harare, Zimbabwe- "We need food and drugs," * has emerged as the message the world should get loud and clear from People living with HIV and AIDS from the ongoing Harare, Pan African Treatment Access Movement (PATAM)conference.

Speaking during a session on 'Understanding Antiretroviral (ARV) therapy'led by Francoise Louis a Technical Advisor on ARVs with Medicins Sans Frontieres (MSFE) (Doctors without borders) a united voice of AIDS activists noted that good nutrition and drugs are critical components in the fight against HIV and AIDS.

Louis' presentation explored in detail how ARV therapy has reduced a death sentence of HIV infection to a simple chronic illness. Reducing stigma and discrimination associated with the virus.

ARV therapy although expensive is available and it has changed lives of many, bringing hope for life. It helps reduce the viral levels in the body through reducing the reproduction of the virus in the body. It also helps to repair the damaged immune system of the body.

It emerged in the discussion that a successful treatment plan has to be holistic in nature and incorporates issues of nutrition. Nutrition is important to help the body rebuild and repair the cells damaged by the virus. Eating well nutritious food helps the body fight any disease.

Nutrition on its own cannot cure AIDS but it is important to reinforce treatment for opportunistic infections and ARV therapy.

Both nutrition and antiretroviral therapy are integral in the fight against the virus and they need to be provided together not one or the other.

Louis is working in the region on a number of initiatives to roll out ARVs to the public and to educate health workers in the handling of these complex drugs. She is scheduled to visit Zimbabwe in August on a mission to help MSFE in their ARV roll out plan.

Source: Pronut-hiv eForum

AIDS Requires Food Security - S.G

2006-03-27T08:33:00.000+07:00

by Jane Kagara & William Rutaremara, The New Times (Kigali), March 5, 2006

KIGALI-- The secretary general in the Ministry of Health, Dr. Ben Karenzi, has urged relevant authorities to provide good nutrition and food security to victims of gender-based violence living with HIV/Aids.

He was responding to findings of a recent research carried out by an official from African Rights, Elizabeth Rugege, during a campaign dubbed: "Sixteen days of activism".

According to her findings, "for a large number of women living with HIV/Aids in Rwanda, the burden of the disease is made worse by the lack of adequate nutrition and healthcare. Taking drugs with no balanced diet or without food weakens the Aids patients,making them eventually leave their jobs, while others stop taking the drugs."

These findings were presented during a meeting held March 3 at Hotel Novotel Umubano, Kigali. It was attended by officials from the government and donor community.

While discussing the findings, Karenzi said, "Gender-based violence makes the victim traumatised. It can prevent a woman from being a full participant in her family, community and in the process of national development."

He called on the public and policy makers to strengthen laws against gender-based violence. He proposed that any person who intentionally transmits Aids to his or her unaffected spouse should be penalised.

The research was carried out around the former provinces of Butare, Gitarama and Kigali city.

Its target group includes people on anti-retroviral drugs. A sample of 45 women was taken from patients at Butare Hospital while five men were from Kicukiro Health Centre, Kigali city.Others interviewed are Lucie Ntiyitegeka and Laetittia Umutoni in Kigoma, Gitarama.

One of the participants, Dr Mpfizi from Kicukiro Health Centre, said: "The centre used to provide food to pregnant women who tested HIV positive, but that supply was cut off as the rate of pregnancy increased beyond our capacity."

The participants agreed that humanitarian organisations and other stakeholders should address the problem of poverty and food security among people living with Aids. They were also encouraged to sensitise women especially at grass roots level to engage in income-generating activities.

Source: Pronut-HIV eForum

Uganda: Poverty Hinders HIV/ Aids Fight in Masaka

2006-03-27T07:05:00.000+07:00

Sadab Kitatta Kaaya, The Monitor (Kampala), March 22, 2006

Masaka--Adminstration of anti-retroviral drugs is facing a setback because patients lack enough food, the medical superintendent of Masaka Hospital has said.

Dr Nathan Kenya Mugisha said ARVs enhance a patient's appetite and many patients on the drug lack the capacity to get enough food.

"Many of our patients are poor. They don't have the means to get enough food. In turn, some of them end up giving up the drug," Mugisha said on March 15.

This was during a function at which 53 patients on ARVs received bicycles from the Aids Health Care Foundation (AHCF) at the Uganda Cares Clinic at Masaka Hospital.

According to WWW. health24.com, people living with HIV need a well-balanced diet because it slows down the onset of HIV to Aids and improves the patient's quality of life.

"Our development partners need to come in and help us assist these people to supplement their diet. This is the only way we shall achieve our goal because the patients are threatening to give up on getting treatment," he said.

Last year, the LC5 Chairman for Rakai district, Mr Vincent Semakula Settuba, told journalists that people living with HIV/Aids in the district were giving up the drug because of the high appetite for food the drug causes.

He said due to the long drought that hit the district, food production was low yet the demand was high.

Mugisha expressed worries about the low number of children on ARV treatment.

"Only 11 per cent of the patients on ARV treatment are children. This number is below the targeted 15 per cent," he said. The AHCF Africa Bureau Chief, Dr Bernard Okong, said the enrolment of ARV patients at the clinic had increased from 50 in 2001 to over 2,400 patients today.

The AHCF Vice President, Mr Peter Reis, said his organisation would facilitate over 500 people living with HIV/Aids with bicycles to ease their transport to the clinic for treatment.

He urged them to mobilise more patients for free ARV treatment.

Source: Pronut-HIV eForum

Zambia: Food Program Helps More Get Benefits of HIV Treatment

2006-03-27T05:53:00.000+07:00

March 24, 2006 by, Margaret McElligott

Lusaka, Zambia--Scattered wheelbarrows litter the ground outside Kanyama Health Center's anti-retroviral clinic in Lusaka, Zambia. Just beyond them, a long line of patients has formed, each waiting to see the sister-in-charge, as the head nurse is called.

For years, the wheelbarrows were used by young men and women to wheel sick relatives to the clinic for HIV testing and whatever treatment was available. The crude "wheelchairs" symbolized the hopelessness and poverty that HIV brought to many households in southern Africa.

Today, the wheelbarrows have new significance. More and more Zambians - who were previously too ill too walk - return to the clinic each month to refill their anti-retroviral (ARV) drug prescriptions.

Now strong, and walking under their own power, patients use the wheelbarrows that once carried them to cart away bags of maize provided through a unique partnership among several organizations - the local health district, the United Nations World Food Programme (WFP), Zambia's Catholic dioceses, and two U.S.-based non-governmental organizations, Catholic Relief Services and Project Concern International.

The free food is essential for many ARV patients, nurses said. Patients taking ARVs risk malnutrition and harmful side effects unless they can increase their overall caloric intake by as much as 40 percent. Many Aids patients in Zambia have difficulty getting enough food to tolerate the highly-toxic drugs.

Poor rains have increased food insecurity in many parts of the country, which worries organizations providing anti-retrovirals and home-based care. The World Food Programme warned last November that more than 1.6 million Zambians will need food assistance in the coming months.

"For someone to be taking medication every day, it's a challenge,"

Project Concern consultant Shampulula Kabamba said. She currently trains and supports home-based care volunteers in Mongu, the capital of Western Province, Zambia's poorest region, where food insecurity is a huge obstacle to successful ARV therapy. The volunteers monitor patients as they begin their treatment, as missed pills can lead to the virus becoming resistant to the drugs.

Kabamba said that when Zambia's government announced in August that it would provide free anti-retroviral drugs to all Zambians who need them, it provoked a flood of clients to HIV testing centers, many of whom were placed on the ARV therapy.

The home-based care and food distribution programs, ultimately funded by the WFP and the U.S. President's Emergency Plan for Aids Relief (Pepfar), fill the gap to ensure that even the poorest Zambians can get the food they need to tolerate treatment.

From her base in Mongu, Kabamba's 26 HIV-positive volunteers look after 440 people receiving ARV therapy. Through a home assessment, they've determined that 343 clients -- 78 percent -- need food rations to combat side effects and comply with their treatment schedule.

Nationwide, the WFP will provide food to 20,000 people on ARV therapy in the coming months, said WFP spokesperson Jo Woods by e-mail. About 40,000 people are receiving ARVs in Zambia, but the government hopes to scale up the program to offer treatment to the estimated 200,000 Zambians who need it.

But even free ARVs and free food programs do not guarantee a smooth ride for sick Zambians receiving treatment.

Kabamba said transport costs are a significant obstacle to ARV adherence for the majority of Zambians who live far from the nearest treatment clinics. Kabamba said nurses will sometimes take up collections to help rural patients who have exhausted all their resources by getting to the clinic and are stuck without money to catch a minibus home.

Transport and adherence are especially a problem for HIV-positive children, who often have an elderly grandparent traveling to the clinic each month to fill their prescriptions. Some grandparents are too sick themselves, or too poor, to make the trip - or they simply forget, Kabamba said.

U.S. and Zambian government officials, as well as representatives of non-governmental organizations, said they are looking at transport as the next hurdle to conquer in the national ARV rollout.

Still, adherence to the life-saving treatment in Mongu is over 95 percent, Kabamba said, and rates are similarly high in Lusaka, the capital of Zambia.

Members of an HIV-positive support group at Kamwala clinic in Lusaka said many of their friends and neighbors are still suspicious of ARVs' efficacy in treating Aids. But they urged an end to the rumours and skepticism.

"We don't want any people to die and leave kids behind, so we think they should take ARVs so they can see their kids growing up," said Leyford Hanangala, who has lived with the virus for almost 20 years.

Hanangala said he regularly sought treatment from traditional healers, which never worked.

In fact, just one member of the Kamwala support group, Mary Chapo, said she had never sought help from traditional healers. When Chapo found out she was HIV-positive, she asked her parents to take her to a hospice to die.

Today, Chapo says she is living positively with the virus, and her children even remind her to take her ARVs at the same time every day.

"We want people to know that ARVs work and you can go back to life," she said.

Source: Allafrica.com

Steady Progress As ARV Rollout Gathers Momentum

2006-01-07T08:15:00.000+07:00

UN Integrated Regional Information Networks, January 4, 2006

MAPUTO- When Maria (last name withheld), 35 years old and HIV-positive, reflects on the past year she gives an answer that a growing number of Mozambicans living with HIV/AIDS would probably echo.

"The year 2005 has been good for my health. It has got so much better because this year I started taking ARVs (antiretroviral drugs)," she told PlusNews.

Maria is one of 17,000 people now accessing ARVs of a national target to treat 20,000 people by the end of 2005.

"This is a major milestone, considering we started to roll [out] ARVs so late because the necessary health infrastructure was not in place," said Ivo Correia, a UNAIDS project officer.

During 2005 the government cranked up its treatment programme to reach double the number of people receiving the life-prolonging medication - a year ago, in December 2004, only between 8,000 and 9,000 Mozambicans were getting the drugs.

Even better news was that "the quality of service and support the patients receive has improved, with more health workers trained this year," Correia noted.

Maria's biggest problem in 2005 was a lack of food. "I am meant to eat a nutritious diet now that I am on ARVs, but there is not enough food for me and my family," said the single parent of two.

Her family relies on food provided by the UN World Food Programme and 'Kindlimuka', Mozambique's first association of people living with HIV. She receives no support from her husband, a driving instructor, who left her four years ago when she told him she was HIV positive.

In a country where 54 percent of the 18 million population live below the poverty line, Maria's
situation is typical of many women.

Despite working as a counsellor to patients receiving ARVs at Maputo Central Hospital as well as at her local health post, Maria has not yet publicly disclosed her status. "Stigma is still a major problem for people living with HIV," Correia pointed out.

He admitted that despite the progress achieved during the year, "a more systematic approach" was needed to address the pandemic.

As the National Action Plan for 2005-2009 gathers momentum, Correia is optimistic about the country's HIV/AIDS efforts in 2006. "We're moving now from policy into action: indicators are in place to measure progress, there will be more coordination, less duplication and we shall see the gaps more clearly," he said.

Maria hopes that in 2006 she will be rewarded for her efforts. "I am counselling people, but it is all voluntary. I don't want to live off handouts - the government should give us something."

Despite the encouraging results of the ARV rollout in 2005, an estimated 200,000 adults are in need of ARV treatment, with children lagging far behind: around 62,000 need treatment, but by mid-2005 only 1,226 were receiving it; few children receive Cotrimoxazole, a low-cost antibiotic that can nearly halve child deaths from AIDS-related diseases for only US $0.03 a day.

The UN children's agency (UNICEF) representative in Mozambique, Leila Pakkala, stressed the need for people to become aware of the importance of diagnosing and treating HIV-positive youngsters. "Communities aren't aware that such treatment can be available for children, so a demand needs to be created," she noted.

Moreover, despite the fact that as many as 326,000 children have been orphaned by AIDS, and more than 500,000 are caring for sick family members, many children do not receive support enabling them to stay in school.

Another population group to be targeted in 2006 will be the 800,000 people in the drought-affected southern half of Mozambique. The communities in the region are reeling from the double whammy of economic hardship and HIV/AIDS, which has risen along the main transport route to South Africa.

Traditional male employment in the mines in neighbouring South Africa is also drying up, while agriculture has been affected by both drought and the loss of those who fall sick and die of AIDS-related illnesses.

HIV prevalence is generally higher in these areas, for example, 18 percent of people living in Gaza province are living with HIV/AIDS, while recent health ministry figures indicate that national HIV prevalence has increased from 14.9 percent to 16.2 percent over the past two years, and women like Maria and young girls are worst-affected.

The rise in prevalence meant that Mozambique could not afford to neglect its prevention activities this year, Correia warned.

"We need to have prevention activities [implemented] regularly in a consistent and systematic manner throughout the country. People need to hear the message constantly so they talk about these issues openly," he stressed. "This is the only way to convert messages into behavioural change."

[ This report does not necessarily reflect the views of the United Nations ]

Source: AllAfrica.com

Engineers design nutrition delivery system for Kenyan AIDS victims

2006-01-07T08:09:00.000+07:00

WEST LAFAYETTE, Ind. – Purdue University engineering professors are building a nutritional supply chain to help fight AIDS in Africa.

Mark Lawley and Yuehwern Yih (YOU-wern YEE) say that without proper nutrition the drugs used to treat AIDS patients won't work. The two industrial engineering professors are putting together a system for food delivery that includes both flown-in dry food and locally grown produce. They are working with the Indiana University-Kenya Partnership and retired physician Dr. Joe Mamlin, who runs a dozen AIDS clinics treating 400 patients per month around Eldoret in western Kenya.

Lawley and Yih spent two weeks at the clinics in September and returned at the end of November. The two started the project as faculty fellows at the Regenstrief Center for Healthcare Engineering at Purdue's Discovery Park. The center's mission is to apply interdisciplinary principles to health-care delivery, and faculty fellows spend a semester working on solutions to large problems.

"We met Salina, Dr. Mamlin's first patient to whom he provided a nutrition supplement," Lawley says. "When he started treating her, she was so malnourished that the anti-retroviral drugs weren't working. So, Dr. Mamlin realized nutrition had to be part of successful treatment."

Lawley says Mamlin gave Salina money for food, the medicine began to work, and Salina is now healthy and robust. Mamlin then began acquiring farmland and growing fresh produce for his patients. There are now four operating farms and plans to expand.

The clinics are part of the Academic Model for the Prevention and Treatment of HIV, or AMPATH, which provides treatment for 14,000 HIV-infected Kenyan adults, as well as a program to prevent mother-to-child HIV transmission.

"The AMPATH program has farming expertise," Yih says. "What we're doing is solving operational issues to turn the flown-in dry food and produce from the food operation into a smooth system that delivers the correct amount and variety of food in an appropriate amount of time."

She estimates it will take two years to take the components and complexities of the delivery of nutrition to the AIDS patients and turn them into a smoothly running machine. When she and Lawley complete the project, she says there will be a brand new model that can be used to deliver food to other impoverished areas.

"We will eventually link the food distribution database with the patient medical record system so that nutritional researchers can study the effects of nutrition on AIDS treatment," Yih says. "To our knowledge, no one has done this before."

The program was receiving 19 metric tons of dry food, such as corn, beans and soybean powder, each month from the World Food Program to feed 2,200 people. The farms produce 800 eggs and 450 500-ml packets of milk product per day.

Lawley says there are many variables to evaluate, account for and ultimately coordinate: farm crops and production, yield and perishability; dry goods packing center operation and its weighing, packaging and tracking operations; the condition, reliability and mileage of delivery vehicles and how they are maintained; the generally bad road conditions; and distribution centers, supply chain and scheduling. The list goes on.

While the challenge sounds agricultural, Lawley and Yih say they look at the problems in terms of applying industrial engineering principles to the medical field in what's termed health-care engineering, which concerns itself with delivery of required treatments, medications and services to patients in as timely and efficient a manner as possible.

Yih was initially approached about becoming involved in the IU-Kenya Partnership by Dr. Thomas Inui, president and CEO of the Regenstrief (REE-gen-streef) Institute Inc., the Indianapolis informatics and health-care research organization located at the Indiana University medical campus.

The Regenstrief Foundation provided start-up funding for Purdue's Regenstrief Center for Healthcare Engineering in Discovery Park, the university's interdisciplinary research and enterprise hub. Lawley and Yih are both associated with Purdue's Regenstrief Center, which has supported their work with the IU-Kenya Partnership.

Yih says that while most people wouldn't initially think of applying industrial engineering methods to curing AIDS in an impoverished country, it is just what the doctor ordered.

"We can use the principles of industrial engineering to solve complex problems," she says. "This is important work that needs to be done. Purdue and the Regenstrief Center are making it possible for us to donate our time to this project."

Lawley says they learned from Mamlin that the project is even more complex than he and Yih had originally thought, and it is expanding rapidly.

"Dr. Mamlin realized that even feeding the patient properly wasn't enough. You have to feed the family, too, or the patient will share food with family members and not get sufficient nutrition for the medicine to be effective," he says. So the 400 patients represent 2,200 mouths to feed.

"And as the clinics have grown, there are questions of how to scale up the food operation and all the components that go into it."

On Jan. 1 the food program expanded to feed 3,000 patients and a total of 17,000 mouths per month, requiring 150 metric tons of food to be distributed. Also, there is more production from the farms due to an increased amount of farmland and the addition of a continuous-drip irrigation system.

Lawley says the final piece of the puzzle for the project's AIDS sufferers is the Family Preservation Initiative, which teaches former patients skills in agriculture and industry and offers "microloans" so they can start new businesses.

Kenya, located on the east coast of Africa, has a population of 34 million. According to U.S. government figures, 6.7 percent of the adult population is infected with AIDS. The population is desperately poor, with 50 percent living below the poverty line and 40 percent unemployed. Adult life expectancy averages less than 48 years.

"You don't see real suffering when you see scenes of Africa on television," Lawley says. "It has always been important to me to alleviate suffering, but I've appreciated that so much more deeply since we made the trip. We'll stay as long as they want us to."

Yih says that despite the country's impoverishment, "the Kenyan people are happy and welcoming."

And Yih and Lawley are already looking at the next phase.

Three of the professors' students are capturing all the numbers involved in systematizing food delivery and putting them in a database for future research work.

***
Source: Purdue News Service: (765) 494-2096; purduenews@purdue.edu
Writer: Mike Lillich, (765) 494-2077, mlillich@purdue.edu
Sources: Mark A. Lawley, (765) 494-5415, malawley@purdue.edu
Yuehwern Yih, (765) 494-0826, yih@purdue.edu

Kenya: Food On the Table Helps 'Keep the Promise'

2006-01-01T06:34:00.000+07:00

by Joyce Mulama, Inter Press Service, November 30, 2005

Nairobi - With only a quarter of Kenyans who need anti-retroviral drugs (ARVs) receiving them from government, the race is on to ensure that many more people get treatment to fend off AIDS-related diseases.

But, is a similar enthusiasm being applied -- particularly by officials-- to ensuring that ARV recipients are also provided with enough good food, without which ARVs cannot work properly?

No, says the Network of African People Living With HIV/AIDS (NAP+).

"The government has not been supportive. There is no government initiative that focuses on the issue of nutrition," Michael Angaga, national coordinator of NAP+, told IPS. "Government efforts to address HIV/AIDS have focused mainly on provision of ARVs."

Medina Yahya would probably agree with this claim. A resident of Kibera, the largest slum in the Kenyan capital of Nairobi and possibly Africa, Yahya has developed various ailments, including ulcers, through having taken ARVs on a perpetually empty stomach.

"I was put on the medication at the beginning of last year, and for a long time I was taking it without having any food to eat," she told IPS.

The 30-year-old has since been advised to go off treatment until her strength improves. But, this depends on Yahya being able to find enough food for herself and her three children. At the moment, she is dependent on hand-outs from well-wishers and the Stara Rescue Centre: an informal school that feeds the children of HIV-positive people, and also provides once-weekly rations to adults living with HIV/AIDS.

Thirty-five-year old Susan Asiko, who provides home-based care to Yahya, tells a similar tale. She has been on ARVs since she was diagnosed with HIV last year.

"At first, the drugs affected me because it was difficult for me to get enough food to eat. I was bed-ridden for a while, but when I started getting food regularly, my health improved," she told IPS. "Getting food is the main challenge here, especially if one is not working."

Kibera houses approximately 700,000 people. More than half of all Kenyans get by on less than a dollar a day, according to government statistics.

Ultimately, the price of a meal rather than the cost of ARVs may stand in the way of people with HIV/AIDS staying alive.

"What we have experienced here is parents stopping their medication because of the side effects experienced when taking the strong ARVs on empty stomachs," Josephine Mumo, the headmistress of Stara Rescue Centre and one of its founders, said in an interview with IPS.

"They remain weak and bed-ridden in their houses and unable to fend for their children. They later die, leaving their children as orphans."

Stara's attempts to get food from government have been unsuccessful, added Mumo. The school presently receives supplies from aid agencies.

Non-governmental groups have also stepped into the breach elsewhere.

NAP-Plus has embarked on a pilot project to supply Nutropath, a supplement in powder form, to those living with HIV/AIDS. The project is being run in two centres in Nairobi and the western city of Kisumu, and has targeted 150 adults and 50 children.

"The product can be mixed with water, milk or juice, and those who are currently being tested with it have shown tremendous changes in their health," says Angaga. "Those who had lost weight have regained it. Most of them say they can skip a meal and still feel strong."

For its part, government insists that the picture concerning nutrition is not as bleak as NAP+ and others claim.

"The government has a budget for supporting nutrition through the Global Fund (the Global Fund to Fight Aids, Tuberculosis and Malaria),"says Patrick Orege, director of the National Aids Control Council -- an organisation charged with co-ordinating the fight against HIV in Kenya.

The fund was created in 2002 as an international partnership to finance efforts to curb HIV/AIDS, tuberculosis and malaria.

As welcome as money from the global fund is, the question that begs asking is whether government should also be committing Kenyan revenue to nutrition programmes for those with HIV -- especially in light of its 2001 adoption of the United Nations Declaration of Commitment on HIV/AIDS.

This document says countries should "Increase and prioritise national budgetary allocations for HIV/AIDS programmes as required and ensure that adequate allocations are made by all ministries and other relevant stakeholders..."

The theme for World AIDS Day (Dec. 1) this year is "Stop AIDS. Keep the Promise." -- adopted in a bid to get governments to uphold pledges made under the U.N. declaration and elsewhere.

While food programmes may not be receive much attention in the national budget, entertainment allowances for members of parliament (MPs) do -- not to mention car grants.

Each minister and MP is entitled to a car grant of 44,600 dollars, and a monthly entertainment allowance of not less than 1,000 dollars. This means that government spends over 200,000 dollars a month on entertainment allowances for legislators.

The same amount buys about 17,000 bags of maize, which would doubtless go some way to improving the nutrition of poverty-stricken HIV/AIDS patients. At present, 2.2 million of Kenya's 32.8 million people are infected with HIV/AIDS.

Namibia: Living Positively is a Challenge

2006-01-01T06:24:00.000+07:00

by Wezi Tjaronda, New Era (Windhoek), December 2, 2005

NAMIBIA- As much as people living with HIV and AIDS are trying their best to live positively, lack of support remains a problem in their day to day lives.

While some get sick so frequently that they are retrenched from work, others, especially women, have the support they get from their spouses withdrawn once they discover they are HIV positive.

Many interventions on the epidemic focus on prevention and not on care and support, which has brought fears that without support, the infections may rise.

Several women from Windhoek's informal settlements that New Era spoke to on the issue had the same story to tell. Ebba Uzombala's husband left her in 2000, when he was informed about his wife's HIV status. They were married since 1990 and together they have two children, whose responsibility was left to Uzombala.

Kaalina Ekandjo also experienced the same when she was diagnosed HIV positive. "My husband left me but he came back when our child died,"said she, adding that it turned out that the husband was also positive.

The epidemic is still shrouded in secrecy to an extent that women are scared to share their status with their spouses. For Hernnea Rainhard, who was diagnosed positive in 1996, she only told her husband that she was HIV positive in 2004. "He was so upset he took a knife to kill me and himself," she told New Era, adding that she had to take refuge at a women's shelter to remain alive.

For those that cannot accept it, they take their lives.

Twenty-five-year- old Ndahafa Nghinyengulwa's boyfriend killed himself after he was diagnosed HIV positive.

"He called me to his place and started quarrelling with me that I am the one that gave him AIDS. Then he killed himself," said Nghinyengulwa.

She lives on her own in Ombili informal settlement, where she has to struggle to feed herself.

Being in an informal settlement, the young woman says she finds herself drinking sugar water most of the time to be able to take her medication.

"Sometimes I have food but I cannot cook it because I need paraffin to cook, and I have no money," she added.

This and many other problems such as stigma and discrimination face women who are living with the virus and are dependent on support from either their relatives or AIDS support organisations.

Penina Ita, the acting Director of the AIDS Care Trust, says food security is the main concern because over 90 percent of poor women that are positive do not have a source of income, which calls for individuals and private sector organisations to start supporting their own people.

"There are so many people including children on ARVs, but they have no food to eat. Although we give them food parcels, it is hardly enough for them to survive," Ita said.

The trust sometimes goes out of its way to care and support People Living With Aids (PLWHA) but, according to Ita, this can only happen when the donor funded trust has money.

For some women whose husbands have accepted their spouses' status, support in terms of giving them money for basic needs of the households has decreased tremendously. For instance, Rainhard said that after her husband learnt about her status, he stopped giving her money apparently because his salary was reduced.

"He never supported me properly again. He says his salary is now very low," she said. Rainhard has had to take up selling cosmetics to support the family, who along were supported by the husband.

Uzombala also sells beauty products, whose proceeds she uses for her daily needs and needs of her school-going children.

The ACT says people need a lot of awareness to change their mindset to start assisting people in need.

"Our population is so small such that we can support each other.

Instead of buying six cars each, we should adopt families whom they can help," added Ita.

Although many are laid off from their workplaces with the excuse that they are not fit for work, Ita said many PLWHA are fit and could work.

The trust has several women who at the moment are looking for work to be able to sustain themselves and their families.

The trust is also in need of clothes and food, which could be given to those that need them.

Nutritional counselling must for cancer, TB, AIDS patients

2005-11-07T07:58:00.000+07:00

Express News Service, Lucknow, India, November 5, 2005

Lucknow- Nutrition counselling - a must for speedy recovery of patients - is often neglected by the doctors. The role of the nutritionist is of utmost importance while treating cancer, tuberculosis, Malaria and even HIV/AIDS cases.

These views were expressed by experts participating in the three-day 11th Indian Society for Parenteral and Enteral Nutrition (ISPEN ) National Conference organised at Science Convention Center here on Saturday.

Underlining the role of nutritionists and dieticians, Prof K M Singh, the first Vice-Chancellor of KGMU said, “For an efficient treatment of patients we need to establish a dedicated department on nutrition and dietics in hospitals.” Singh donated Rs 51,000 for a nutrition foundation centre to complement clinical healthcare at KGMU.

Speaking on the occasion, Jacquiline Landman, registrar British Nutrition Society (UK) stressed on the need of pre and post nutritional counselling to patients. She said as per a study, it has been found that 26 per cent of the patients reported weight loss when they were discharged from the hospital. Considering this, the role of a nutritionist becomes important as he can advise patients about a proper diet that would help them regain lost weight, she said.

Prof R K Tandon, former head of gasteroenterology, AIIMS, highlighted the importance of nasogastric feeding. Experts present there said the efficacy of drugs also improves if the patient takes proper diet. They also said obesity is associated with malnourishment, adding that nutritiuonal supplement helps in wound closure, improves the immune system and assists in the recovery of the patients.

Professor Ramakant, the organising secretary said there’s an urgent need to establish a nutrition foundation to work in KGMU hospital to boost and complement the clinical care and treatment of people in various departments.

Source: Lucknow Express News Service

Kenya- Hunger threatens effective use of anti-AIDS drugs

2005-10-28T11:19:00.000+07:00

By Johnstone Wanjala, Sima Community Based Organisation, Kenya

Dressed in a beautiful brown cloths a donation from well-wishers – Grace 8, recites a poem before guests at the Nzoia county social hall in Kitale.

In her thin long hair, the light skinned orphan smiles charmingly at Standard Group’s HIV/AIDS peer educators and speaks in a strong and hopeful voice.

Her poem is touching. Her voice suddenly becomes faint. She plods on softly till the last line.

"HIV/Aids
The mother of all killers
You are shameless;
Took my parents away.
HIV/Aids
You hurt individuals
Family and households
You have brought disaster
We dare you to stop now”

Her job done, she dizzily moves to the nearest bench, where she lays her head in her aunt’s laps.

As she recited the poem, a boy aged about four kicks around a football made of plastic bread
wrappers tied with rope. After two minutes, he sits on the floor and then lies down – tired. He sucks his thumb quietly before drifting to sleep.

As a group of HIV- positive “clients” entertains journalists, the boy wakes for a minute, tries to nod his head to the rhythm of drums but is soon overcome by sleep. His mother casually picks him up and continues dancing with the group.

These are some of the lucky 76 Kenyans who have free access to anti-retrovirals (ARVs) but lack basic meals. They belong to Wakibe’s HIV/Aids support group.

Medicens Sans Frontiers (MSF) Belgium, Mbagathi Hospital and Coptic Hope Centre supports them with free ARVs, counseling and follow-up. Some are monitored to see if they actually need the ARVs.

"Mimi ni Glady’s Nyongesa na niko na HIV. Kwa kusema kweli, madawa tunayo, lakini kizunguzungu imetuzidi (I’m Glady’s Nyongesa and I’m HIV positive. We have drugs but dizziness overwhelms us),” says one member.

They all introduce themselves as MSF clients and found a sheng name for their HIV/Aids status – Uzi (thread). “Mimi nina uzi (I have thread),” they say. The connotation is that they are as thin as thread, not because of the illness but for lack of food.

Glady’s, 36, a housewife and mother of six. Tested HIV- six –month old baby died of pneumonia. “I did not believe the results. I jumped from one Voluntary counseling Test centre (VCT) to another – Avenue, Mbagathi, Casino, Kenya Medical Research Institute (Kemri) but the results were all positive. My husband and I blamed each other and did not speak for a year although we lived in the same house”

With the couple now on an ARV regime, life has been a lot better. But with her husband retired from work on medical grounds and no source of income, Glady’s weight has dropped from 83kg to 38kg. “The ARVs have made me feel better when I started. But now they make me hungry and my head goes round and round. Sometimes I have no breath so I cannot even talk or get up.”

Beatrice Naliaka, 32, a former businesswoman, says she wanted to die when she tested HIV- positive. The married mother of five boys says she had a CD-4 count of four and her mouth kept bleeding. A where she joined the group in 2003.

“Initially, Simiyu had only six members. Then we would get nutritious foods, porridge and boosters every Friday and this took care of the ARVs. But suddenly there was an influx. Over 120 widows, jobless people and their children showed up and the meals were reduced to once a month,” says Naliaka.

Naliaka, who spent most of her money on herbal medicine and witchdoctors, says she is now jobless. But being at Simiyu has made a difference. From the group, the 135 members get moral support and food twice a month.

Simiyu started as a charitable outreach health services and home-based nursing care to the Huruma community with the Nursing Council of Kenya. Says Irine Nekesa Wesonga, the director and co-ordinator: “late 2002, one of our colleagues stopped coming to work for weeks.

A vegetable vendor told us she dive and hid herself for fear of stigmatization. When we visited her, she was too sick to recognize anyone or talk. She succumbed within the week”

Feeling guilty and ashamed, says Wesonga, they asked the vegetable vendor to inform any community member willing to disclose their status to come to Simiyu flats where they had a medical clinic. That is how clients started coming in large numbers.

When members get the time and energy, they weave woolen mats; spin kikoi, bed covers, shirts and shorts. They also pack liquid soap and beads.

Dr. William Kiarie of Crystal Hill, who offers voluntary services at Simiyu and has sponsored a youth member to driving school, says lack of food affects the administration of anti-retrovirals.

“When they stop taking drugs due to starvation, the whole cycle of treatment is affected and they have to start all over again. The side- effects can be devastating,” he says.

Prepared by:
Johnstone Sikulu Wanjala, Programme Coordinator/ Journalists.

Sima Community Based Organization
PO BOX 1691, Kitale
30200 Kenya.
Phone: +254- 733 453 339.
Email: sikuluj@yahoo.com

Africa-- Food Crisis: Worsened By Aids

2005-10-16T03:17:00.000+07:00

By Thomas Kagera, The New Times (Kigali), October 14, 2005

KIGALI--The mighty and the powerful, the poor and the rich, intellectuals and peasants, all have a time when they only mind how to put food on the plates of their family members. The intermittent alternations of famine and abundance have for long been tied to weather failures, precipitated by droughts and floods.

But today a mere drought does not necessarily warrant famine, neither is it the only cause of famine in, especially, Sub-Saharan Africa. As we celebrate the World Food Day tomorrow, we need to reflect on the devastations visited upon Africa by famine and Aids

The depredations of war, the unpredictability of crop failure, the invasion of locusts in some countries and the ravages of Aids all do come into play to worsen the already deep food crisis. Aids, especially, has aggravated the food crisis in Sub-Saharan Africa.

Latest statistics show over half of those with HIV/AIDS live in rural areas, where stricken families struggle to produce enough food to survive.

Once a largely urban problem, AIDS has moved to rural areas in developing countries, devastating thousands of farming communities and leaving impoverished survivors scarcely able to feed themselves. The disease is no longer a health problem alone, but is having a measurable impact on food production, household food security and rural people's ability to make a living.

The latest statistical evidence issued by the Joint United Nations Programme on HIV/Aids (UNAIDS) on sub-Saharan Africa -- the worst-hit region -- confirms the scale of the epidemic's impact on the countryside.

UNAIDS estimates that over half of the 28 million people living with HIV/AIDS in sub-Saharan Africa live in rural areas. In order to estimate such figures, UNAIDS epidemiologists start with data taken from tests done on blood samples from pregnant women attending prenatal clinics.

They then extrapolate the figures to estimate infection rates in larger areas. Recent findings point to two of the hardest-hit countries:

Zimbabwe, where the 2000 prevalence survey showed that 31.4 percent of pregnant women living in rural areas were HIV positive. Women who listed their residence as "farm" registered a 43.7 per cent prevalence rate. Such figures mean that over 1 million people in rural areas have HIV/Aids in Zimbabwe.

Swaziland, whose 2000 survey showed that 25 per cent of the women who listed their occupation as "subsistence farming" were HIV positive, Overall prevalence among pregnant women in rural areas was 32.7 per cent. Such figures mean that over 100, 000 people in rural areas of this small southern African country, out of a total population of 938, 000, have the virus.

"This is a real wake-up call for governments," says Marcela Villarreal, FAO focal point on AIDS.

"Policy-makers are guided by evidence. Solid evidence is now coming in and will make governments understand how rural areas are actually more vulnerable to AIDS than urban areas."

Recent reports from other African countries show a similar pattern of rampant rural infection.
In FAO-supported study commissioned by Uganda's Ministry of Agriculture, Animal Industry and Fisheries, researchers surveyed 300 households in five rural districts in late 2001. The majority of the households (91 per cent) had lost a family member in the preceding 10 years, mostly in the 20-35 age-bracket. AIDS caused 56 percent of the deaths.

Study author Narathius Asingwire, of Makerere University in Kampala, says that the deaths of so many farmers in the prime of life has far-reaching implications for the country, since agriculture accounts for 43 percent of GDP, 85 per cent of export earnings and 80 per cent of employment. In addition, 85 per cent of Uganda's 22 million people live in rural areas and depend mainly on agriculture.

Asked to comment on the effects of HIV/AIDS in their households, two thirds of households replied that they now grow less food, over two thirds reported producing fewer cash crops and over half said they were eating less. The following statistic spells trouble for the many rural landless who depend on casual farm labour to survive: 85 per cent of respondents said they were using less farm labour.

Survey respondent Paulo, 80, supports five young grandchildren orphaned by AIDS. He has a banana plantation, but the biggest part is overgrown with weeds due to lack of labour. There has been a sharp reduction in food consumption among his family members -- they now only get one full meal a day, in the evening, eating just some porridge for lunch.

"Even now when I am still alive, we do not have enough to eat," says Paulo, who is ill and cannot work to augment the family income. Pointing to the youngest grandchild, he says, "You can see that young one is gloomy not because he is sick or has been punished, but because he has not eaten anything since morning."

In Kenya, the latest figures from the Ministry of Agriculture and Rural Development predict that the total number of lost wor kdays in the agricultural sector due to HIV/AIDS will reach 329,000 person years in 2020, if present trends continue. In 1990 the figure was 45,000 person years.

The district of Bondo in western Kenya has been particularly hard hit by the virus, with about 29 percent of the population infected, according to a 2000 survey, says Kenneth Ayuko, leader of an FAO community support team in Kenya. In some communities, as many as half of the adults are HIV positive.

"We have grandparents having to take care of up to 20 or even 30 orphans, and that takes a very big toll. Therefore, it is probably correct to say that food production under these circumstances of the HIV/AIDS pandemic is not possible," he says. "No wonder that the bulk of the population in Bondo is going hungry."

Poverty underlies the suffering and devastation behind these figures, says Ms Villarreal. "The HIV/AIDS epidemic cannot be addressed without doing something about rural livelihoods: how people make their living, how they get enough food, what strategies they follow in order to survive," she says.

FAO is currently formulating pilot projects that will test labour-saving techniques and low-input agriculture in African and Asian communities hard hit by the epidemic. Other priorities for the FAO HIV/Aids programme include putting up institutions that help rural communities, improving nutrition, addressing gender inequalities in access to productive resources (especially land) and helping decimated communities find a way to pass on farming knowledge to the young.

Consider the following facts;
--AIDS has killed around 7 million agricultural workers since 1985 in the 25 hardest-hit countries in Africa. It could kill 16 million more before 2020.
"
--The most-affected African countries could lose up to 26 per cent of their agricultural labour-force within two decades.

--Food consumption has been found to drop by 40 per cent in homes afflicted by HIV/Aids.

--Total spending on Aids in Africa, which goes largely to prevention, is just US$150 million a year. Barely one tenth of that sum comes from national budgets in the region.

--In 2000, close to 3 million people died of Aids and 5.3 million people became infected around the world.

--By 1999, there were 13.2 million Aids orphans, 95 percent of them in sub-Saharan Africa.

--HIV infection rates are three to five times higher in young women than in young men.

Source: pronut-hiv eForum

SAFAIDS- HIV/AIDS and Nutrition

2005-10-16T02:56:00.000+07:00

From SAFAIDS Septmber 2005 newsletter. To read this article on HIV and nutrition go to: http://www.safaids.org.zw/publications/Sahaa%20issue%2057%20September.pdf

**
Food cannot cure AIDS, nor doest treat the virus, But it can certainly improve fitness and quality of life for People Living with HIV/AIDS (PWHAs). Eating well plays a central role in your overall health and well-being.

It is very important to eat foods that will help your immune system to grow stronger. A healthy and balanced diet provides foods in the right amounts and combinations that are safe and free from disease and harmful substances. This applies to everyone-whether they are HIV positive or not.

Good nutrition is essential for achieving and preserving health. Nutrition is the process by which your body provides materials for its structural and functional needs (Romeyn 1995: Nutrition and HIV pg385)).

To prevent malnutrition, the body has to have enough nutrients. These are mainly found in food. Infection with HIV damages the immune system (the immune system is your body's natural protection), which leads to other infections such as fever and diarrhea. These infections can lower food intake because they both reduce appetite and interfere with the body's ability to absorb food. As a result the person becomes malnourished, loses weight and is weakened.

Nutrition education gives a person a chance to build up healthy eating habits and to take action to improve food security in the home, particularly with regards the cultivation, storage and the cooking of foods

Why is nutrition important for people living with HIV/AIDS?
Preventing weight loss: one of the signs of the on set of clinical AIDS is a weight loss of about 6-7kg for an average adult. A healthy balanced diet, early treatment of infection and proper nutritional recovery after infection can reduce weight loss And lessen the impact of future infection.

Reinforcing treatment: a person may be receiving treatment for opportunistic infections or combination therapy for HIV. These treatments and medicines may influence eating and nutrition. Good nutrition will reinforce the effects of any medication, herbal intake or use of supplementary pills.

Maintaining good health: when nutritional needs are not met recovery from illness will take longer. During this period the family will have the burden of caring for the person, paying for health care and absorbing the loss of earnings while the person is unable to work. Good nutrition can help to extend the period when the person with HIV/AIDS is well and working.

Source: pronut-hiv eForum

HIV Patients : Balanced Diet Needed

2005-10-03T08:49:00.000+07:00

by Brenda yofeh, Cameroon Tribune, September 30, 2005

HIV patients say their nutritional intake is vital to their health but the means at their disposal are limited.

Nutrition plays an important role for the human system to remain healthy. Good nutrition is therefore indispensable to the health of each individual.

Given that malnutrition weakens the body system, giving way for the HIV infection to propagates , it is necessary for HIV patients to receive a balanced diet. However, most HIV patients say they cannot provide the necessary diet required to maintain their depreciating health system.

Medically, it is noted that multiple nutritional abnormalities occur relatively early in the course of the HIV infection. Infected persons tend to have elevated protein and energy requirements; making it more likely for HIV patients to experience weight loss if early nutrition intervention is not available. Medical analysis indicates that such patients experience multi-system complications due to changes which result from the nutritional status and intake.

According to Catherine Djite, a dietician at the Yaounde Teaching Hospital, a healthy and balanced diet is essential for every human beings especially those living with HIV. This is so because good nutrition increases resistance to infection and disease, improves energy and makes a person feel generally stronger and more productive.

While good nutrition is important for everyone, Catherine Djite stress that it is more important for HIV patients because nutrition and HIV are strongly related to each other especially as the immune systems of HIV persons are weaker.

Noting that an HIV patient needs a special nutritional intake since he is at a risk of malnutrition, the dietician stressed the intake of all nutrients such as meals containing protein, carbohydrate, minerals, fat, energy, etc have to be doubled. Conversely, HIV patients say they can hardly provide the daily intake of the vital nutrients due to the lack of money.

In a chat with an HIV patient, she stressed that a balanced diet is important in the daily life of any HIV person. "When I do not take a balance quantity of all the necessary body nutrients needed, I feel more sick", the patient said. The patient noted that when she does not take fruits and vegetable, she feels very tired. In addition, when she consumes too much of red meat, she has digestion problem.

However, when the patient eats vegetable prepared in any manner, coupled with a glass of milk taken before bedtime, she feels very ok. Fruits, fish and chicken pose no problem to her. She concluded that an HIV patient who does not eat well has another problem besides the fact that he is HIV infected.

While other HIV patients know what to eat and are able to get what to eat, there are others who do not have money to eat what is necessary for their health. While there are those who do not even know the necessary nutrients they need. Thus, Catherine Djite says that the nutritional intake for HIV patients should be a priority.

Source: Health Gap eForum

Nutrition And HIV/ Aids At Workplaces

2005-09-09T22:02:00.000+07:00

By Kelvin Kachingwe, The Times of Zambia (Ndola) Opinionsm September 8, 2005

UNLESS all signs deceive, it seems South African President Thabo Mbeki is being proved right over his adamant stand when he links HIV/AIDS to poverty in Africa.

As has been recognised lately, good nutrition plays a key role in so far as the management of the virus is concerned. Whereas it cannot cure AIDS or prevent HIV infection, nor treat the virus, it can certainly improve fitness and quality of life for people living with the disease.

Furthermore, good nutrition can delay progression from HIV to AIDS-related diseases as well as help maintain and improve the nutritional status of a person with HIV/AIDS.

But more often than not, few people care to check the nutritional content of the food that they take, especially when they are at their workplace.

Although it is normally when people are at their workplace when they care less about the type of food that they eat, it is there that they spend most of their time. For many, it is five of the seven days in a week, and indeed a larger part of the day.

Against that backdrop, the importance of good management in so far as their food is concerned cannot be over-emphasised. And especially those living with the HIV/AIDS.

With that, Lusaka-based Mulilansolo Social Investment Fund principal co-ordinator, Stephen Chama and board chairperson, Evans Mwale have been working on ways of responding to HIV/AIDS in workplaces by encouraging good nutrition.

The first show of impetus into the programme was a workshop last week at the Longacres Lodge in Lusaka under the theme "Nutrition and HIV/AIDS at workplaces".

The two-day workshop was attended by workers from a host of companies and organisations that included Standard Chartered Bank, Lusaka City Council, ZAMPOST, Office of the President, Zambia State Insurance Corporation, Zambian Breweries and Ministry of Community Development and Social Services.

One of the things that came out strongly during the deliberations was that what many Zambians term as good food actually lacks nutrients, and should if anything, be discouraged.

To many a Zambian, a good meal is one with, say, beef, pork, chicken and chips. These are normally prepared in a lot of oil and spices. Anything less than that is not a good meal, according to many Zambians.

With that, to be seen to be eating such foods as Kapenta, vegetables, and other traditional foods, will not be considered as good food.

Little wonder, a number of people, during their lunch break at work, would only settle for chicken and chips, and one of the carbonated drinks.

Examined closely, some of these foods, especially in the way they are prepared, and how they are grown, could be said to be silent killers.

It is, therefore, important that in workplaces, good nutrition is encouraged for everyone, but more especially for those living with HIV.

This is so because nutritional care in HIV and AIDS prevention and management in workplaces improves survival rates of those infected.

According to Dorothy Nthani, a specialist in food science and nutrition, there is a vicious cycle involving malnutrition and HIV.

For a person with HIV, there is a likelihood that with poor nutrition, they will have an impaired immune system with a poor ability to fight HIV and other opportunistic infections.

But with good nutrition, not only does it help to extend survival time and improve quality of life, it also strengthens the body's ability to wade off these infections.

Furthermore, better nutrition allows HIV positive individuals to live longer, keep families together and stabilise communities in that there will be a reduced number of orphans and vulnerable children.

Simply stated, any one suffering from malnutrition and disease is at a much greater risk.

Therefore, where poor and hungry people are affected by HIV, food aid should be part of the care programmes to boost nutrition and food security.

However, in some cases, institutional meals may be the only decent food available, and as such great care and thought must be put in quality and quantity of meals provided.

For Mrs Nthani, good nutrition is when one eats a variety of safe and right foods in the right quantities to meet the body's needs.

"A balanced diet is one that has a variety of foods, all the nutrients in the right amounts (proteins, carbohydrates, vitamins, minerals, fibre, etc). It must contain daily combinations of nutrients to meet the body's functional needs.

"It must, however, be emphasised that if the body does not get enough food, it becomes weak and cannot develop or function properly," she points out.

But even then, she emphasises that nutritional care and support are important from the early stages of the infection to prevent the development of nutritional deficiencies.

Mrs Nthani further points out that a healthy and balanced nutrition is important for people living with HIV because it promotes their well-being, self esteem and positive attitudes to life for themselves first and their families as well.

As a result of that, she says healthy and balanced nutrition should be one of the goals of counselling and care for people at all stages of HIV infection.

Regarding the workplace, it may be necessary to get a nutritionist who will look after the nutritional welfare of employees.

"An effective workplace programme of nutritional care and support will improve the quality of life by maintaining people's body weight and strength, replacing lost vitamins and minerals, improving the function of the immune system and the body's ability to fight infections.

"It will further improve response to treatment, reducing time and money spent on health care, keeping HIV-infected people active, allowing them to take care of themselves and their families and keeping positive people productive, able to work, grow food and contribute to the income of their families," she says.

Like Mrs Nthani, another health education specialist, Siakwando Makono, emphasised the need for good nutrition as a complementary therapy in HIV and AIDS care.

Mr Makono says HIV/AIDS persons should plan their diets in such a way that it is balanced and does not cause adverse effects. He says because of that, it is vital to discuss diet arrangements
with a trained health provider.

This makes the buying of appropriate foods easy especially when all family members are aware of the nutritional requirements of a person living with the virus.

"Food should be kept safe for human consumption. HIV/AIDS persons require food that is kept well to avoid passing infection. It is, for instance, recommended that they avoid foods that are extensively cold or hot. Foods with a strong aroma such as those containing curry should be avoided.

"For those with mouth sores or pain, they should keep away from citrus fruits, spices and abrasive foods. The same goes for alcohol which makes them pass a lot of urine while increasing the loss of water from the body," he says.

Be that as it may, Mr Makono points out that good nutrition, or indeed any boosters, are not alternatives to ARVs. They act as complementary therapies, enhancing the body's immunity and complementing the work of ARVs.

"ARVs reduce the multiplication of viruses and the body requires good nutrition and other supplements that strengthen the body.

Some complementary therapies reduce stress, depression and anxiety that may reduce the body's immune system strength," he says.

With that, one of the participants, Tasheni Makumbi, was of the view that like the Kenneth Kaunda Children of Africa Foundation is doing, there is need to encourage the consumption of more indigenous foods which have been proved to contain a good amount of nutrients.

Hopefully therefore, there will be renewed enthusiasm to consume more of the indigenous foods, which are readily available, affordable and nutritious unlike the famous chips and chicken.

It is your health at stake after all.

Source: allAfrica.com

South Africa: HIV drugs and food not keeping up with demand

2005-07-31T16:44:00.000+07:00

by, Caroline Hooper, Health Systems Trust, South Africa

An estimated 200 000 South Africans living with HIV and AIDS are in urgent need of anti-AIDS drugs, but supply is not keeping up with demand. And, despite good nutrition being an essential pre-requisite for starting anti-retroviral (ARV) treatment, only a fraction of HIV and AIDS patients are receiving the supplements and food parcels.

This is the finding of a monitoring report compiled by the Treatment Action Campaign (TAC) and Aids Law Project, 18 months after the government approved the national HIV and AIDS treatment plan. But not all the news about the roll-out is bad. Several studies have confirmed good outcomes in the use of ARVs in the public health sector, said the report, saving the lives of thousands of people living with HIV and AIDS. About 42 000 patients are receiving ARV treatment in the public health sector.

'The unexplained and unjustified delay in formal accreditation is one of the main reasons' North West province has in the past few months increased its ARV patient numbers dramatically, a development the report attributes to exemplary leadership and commitment shown by healthcare workers.

Limpopo, on the other hand, has still not accredited essential treatment sites, and refuses to release information about its roll-out programme. And the Eastern Cape is still underspending on its health budget. A combination of a shortage of medical staff and inefficient systems has resulted in waiting lists of up to six months in some areas. The problem is compounded by the fact that several sites ready to start treatment are still awaiting formal accreditation.

The unexplained and unjustified delay in formal accreditation is one of the main reasons why several sites across the country cannot commence ARV treatment and help share the burden, the report said. In some areas waiting lists for treatment go back four months. Given the need, patient numbers in the public sector are significantly lower than what the demand actually requires, the report said.

In comparison, the number of patients on ARV treatment in the private sector is between 50 000 and 60 000. This figure includes medical scheme beneficiaries, patients on employer-funded workplace treatment programmes, out-of-pocket payments, and patients receiving treatment through the support of non-profit programmes, run mainly by faith-based and community organizations. According to the government's operational plan, the department of health's nutrition strategy must dispense a meal and micronutrient supplements to selected groups of people living with HIV/AIDS and tuberculosis.

Good nutrition is medically necessary for people with HIV and AIDS before they can start ARV treatment - yet there are serious gaps in the government's nutrition programme, the report found. About 14 million South Africans do not have a secure food supply, and 1,5 million children suffer from malnutrition.

Manto Tshabalala-Msimang, the health minister, angered AIDS activists at the South African AIDS Conference in Durban last month when she claimed that 90 percent of people who access ARV treatment through the public service are given food supplements. Strong anecdotal evidence points to the fact that few patients receive nutritional support, the report said.

At the Harriet Shezi clinic at Chris Hani Baragwanath hospital in Soweto - the largest paediatric treatment site in the country - only 6 percent of children on ARV treatment have access to nutritional support through the resident dietician. Often there are not enough social workers available to advise patients on where and how to access food parcels and supplements, the report said, and the administrative burden of processing hundreds of applications for food parcels also results in limited access. As of April, no patient at the clinic had received food parcels.

Francois Venter, the head of the Wits AIDS Research Unit, said it was noteworthy that in areas with proper leadership, results had been excellent, as in the case of North West where people on ARVs had risen from zero to 1 000. In Mpumalanga and Limpopo, however, the situation did not look good, Venter said.

(Source: Pambazuka News, July 30, 2005)

LESOTHO: Numbers of people in need increasing, WFP/FAO

2005-07-26T10:00:00.000+07:00

JOHANNESBURG, 22 Jun 2005 (IRIN) - Declining agricultural production and incomes have combined with HIV/AIDS to undermine the ability of Lesotho's poor to cope with external shocks such as drought, said a joint World Food Programme and Food and Agriculture Organisation report.

The recent WFP/FAO crop and food supply assessment mission conducted in Lesotho found that the country was facing a "triple threat of increasing chronic poverty, rising rates of HIV/AIDS and weakened government capacity".

According to the Vulnerability Assessment Committee, 548,000 people will have "a significant food deficit between June 2005 and March 2006", and will require about 20,200 mt of food aid.

"Domestic cereal production in 2004/05 is estimated at 119,000 mt, consisting of 92,129 m of maize, 16,442 mt of sorghum and 10,339 mt wheat," the assessors said.

While production showed an improvement of about 15 percent over last year's, it was about 84 percent of the five-year average.

"Lesotho's cereal production appears to be on a downward trend, especially in the main producing districts of Berea, Butha-Buthe, Leribe and Maseru. This is cause for concern and should be fully investigated. Endemic soil erosion, weather-related disasters and the impact of the HIV/AIDS pandemic are likely to be major underlying causes," the report observed.

The 'triple threat' has taken a heavy toll, particularly on the households of the rural poor in Lesotho, "who are faced with a limited number of coping strategies to respond to the intensifying hazard".

A UN Country Assessment found that 59 percent of the population are living below the poverty line, and about 40 percent of the population of Lesotho fall into the 'ultra-poor' category.

"Studies indicate that HIV/AIDS is a leading factor in the drastic reduction of household income for much of the population. Against this background, falling agricultural production, trade constraints, and collapsing employment opportunities combine to increase the vulnerability of poor households to food insecurity," the UN agencies noted.

HIV/AIDS had become not just a health issue for the government, "but rather a development issue with social, economic and cultural implications".

World Bank estimates predict that Lesotho's GDP will be halved by 2015, with HIV/AIDS having a clear effect on household food security.

Despite evidence of increasing need in Lesotho, aid agencies have struggled to run existing programmes aimed at assisting people affected by the previous year's crop failures.

"With food aid stocks and pipeline as of 1 April at 61,000 mt, there remains an uncovered deficit of 19,000 mt (6,000 mt of maize, 13,000 mt of sorghum) which need to be covered by additional donor assistance," the report pointed out.

WFP's deputy country representative, Mads Lofvall, had earlier told IRIN that the agency had to suspend its operations throughout Lesotho towards the end of May due to a shortfall in funding.

By early June the agency had managed to secure some funding and was planning to reach 80,000 people, out of the 240,000 it had initially planned to assist.

"We are having to make very difficult choices [about who gets aid]," Lofvall commented, "... as the number of orphans keeps going up and the number of HIV/AIDS patients keeps growing."

Source: Pronut-HIV eForum, to join email pronut-hiv-join@healthnet.org

Namibia: Ministry Gives ARVs, Not Food

2005-07-26T09:53:00.000+07:00

New Era (Windhoek), July 25, 2005

Though the focus has been directed towards making nutrition and the intake of antiretroviral drugs (ARVs) a top priority by most countries, the Ministry of Health and Social Services in Namibia only distributes drugs and not food to people living with HIV.

ARVs are a cocktail of drugs given to HIV infected persons to reduce the rate of replication of the virus in the body and thus prolong their lives.

These drugs are usually prescribed when the virus has reached an advanced stage in which the body's defence mechanism is compromised.

The Permanent Secretary in the Ministry of Health and Social Services, Dr Kalumbi Shangula told New Era that Namibian hospitals do not distribute food rations to people receiving these drugs.

"It's not in our mandate to do that. It falls under the drought relief programme," explained the top Health and Social Services official.

However, the chief clerk responsible for coordinating the Khomas Region Emergency Services, Sebastian Uahengo indicated that when his desk normally registers people for food rations, it does not make provisions to provide food to those receiving ARV treatment. "We only give food to pensioners, the differently abled, lactating mothers and pregnant women who are unemployed," he said.

Currently, there are 11 000 HIV/AIDS patients on ARV treatment in the whole country, confirmed the Director of Special Programmes in the Ministry of Health and Social Services, Ela Shihepo. Just like any other drug would have side effects on patients, different people are affected differently when they take the drugs; hence the recommendation that patients have something to eat before they take their medication.

In 2003, cases of HIV/AIDS people totalling 136 068 were reported to the Ministry of Health and Social Services.

Recently, a media report highlighting the plight of those affected and infected with HIV/AIDS found that many people in the country stop taking their medication due to hunger. "You must eat first, but what can you eat if there is no food? Sometimes, they are forced to stop going to the hospital for medicine, but on an empty stomach what is the use?" asked a community-based counsellor who declined to be identified.

Emphasis is being placed on the fact that although the virus can weaken the immune system, it is possible to strengthen the immune system by practicing healthy eating habits. This includes eating food that is rich in all nutrients.

In cases where an HIV and AIDS patient has no access to ARVs, nutritious foods are the best way to boost the body's immune system. Even where ARVs are available, a healthy diet is essential.

Health experts believe a combination of the right medication and good nutrition strengthens the immune system, thwarts opportunistic infections and slows the progression of HIV and eventually AIDS.

They further believe that insufficient dietary intake leads to muscle wasting which in turn increases viral replication and quickens the progression of an HIV infection to AIDS.

However, the situation calls for a concerted effort in promoting healthy eating habits.

Source: AllAfrica.com

Govt to Help 5,000 Aids Patients With Nutrition, Reveals Chituwo

2005-07-26T09:04:00.000+07:00

Doreen Kambangaji, The Post. Lusaka, July 25, 2005

The government is to assist 5,000 people on anti-retroviral (ARVs) who cannot afford good nutrition, Minister of Health Dr Brian Chituwo has said.

Speaking on ZNBC's Radio Four's Telehelp 399 programme yesterday, Dr Chituwo said plans were underway with the Ministry of Community Development to assist people on ARVs with good nutrition.

"Part of the $65 million that was received from the World Food Programme will be used for this purpose and government has targeted 5,000 people who clearly cannot afford good nutrition," he said.

However, Chituwo said the provision of food to the affected people needed cooperation from all sectors of life if the programme was to be implemented successfully.

He said good nutrition played an important role before and during treatment.

"It is very evident that the progression of HIV to AIDS takes longer if there is good nutrition," he said.

He also said the ministry had engaged in running a programme with WFP who were currently providing high-energy proteins (HEPs) to TB patients.

And Chituwo said his government would not compromise the quality of treatment just to reach the target of putting 100,000 people on ARVs by the end of this year.

"Patients have to be carefully monitored once they commence treatment to avoid future problems such as resistance to the drug by the patient," he said.

He urged other members of the community to assist the medical personnel especially in the area of counselling as reaching the 100,000 target was not the domain of medical personnel only.

And commenting on the high cost of ARVs and other laboratory costs, Chituwo said government had now started providing free laboratory services and ARVs.

He said the programme was being supported by the Global Fund on HIV/AIDS, TB and Malaria but could not predict the sustainability of the programme.

"What we need is life-long support and we cannot always depend on donors. Zambians must contribute by creating harmony in the country so that the economic sector is more productive. This will enable government to cushion the provision if the donors decide to pull out," he said.

Chituwo said what was now remaining was for the health permanent secretary to implement the Cabinet decision by issuing circulars to all the hospitals and clinics.

"The medical personnel were saying that they could not start giving out free ARVs because they only heard about this in the media and had not received circulars. However, they must have received the circulars by now from the permanent secretary," said Chituwo.

Source: AllAfrica.com

Mukula Pleads for HIV Patients

2005-07-03T18:25:00.000+07:00

By Peter Nyanzi, ,The Monitor (Kampala), July 1, 2005

Good nutrition is key to the treatment of people living with HIV/Aids, the State Minister for Health, Mr Mike Mukula, has said.

"The role of nutrition in the care and treatment of people living with Aids cannot be underestimated. There is therefore need for integration of nutrition into the national HIV/Aids responses," Mukula said.

He was opening an international workshop on the integration of nutrition into HIV/Aids care and Antiretroviral treatment (ARVs) at Kabira Country Club on Monday.

The Programme Manager of the Aids Control Programme, Dr Elizabeth Madraa, said the government had submitted proposals to the Global Fund for funds to support the integration of nutrition in the Aids control programmes in the country.

Findings
She said research had shown that good nutrition could delay the onset of full blown Aids and adherence to ART.

The participants from 13 countries of East, Central and Southern Africa were devising modalities for integrating nutrition into national ART policies. Officials from NGOs, international organisations and the private sector attended the workshop.

World Health Organisation (WHO) Country Representative, Dr Rosamund Lewis, said, "I urge you to integrate nutrition in your response to the challenges of the HIV/Aids pandemic."

Source: The Monitor

Seminar on Aids And Nutrition, Mozambique

2005-05-21T01:50:00.000+07:00

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

2005-05-12T02:45:00.000+07:00

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

2005-05-11T23:27:00.000+07:00

[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

2005-05-11T04:17:00.000+07:00

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

2005-05-09T21:22:00.000+07:00

(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.

Expert says HIV drugs give only 5-10 year window to come up with new ways to beat AIDS in Africa

2005-04-28T22:51:00.000+07:00

Aidsmap, Theo Smart, April 26, 2005

Noted researcher Dr. Tony Barnett of the London School of Economics believes the potential transmission of viral resistance could quickly limit the effectiveness of antiretroviral treatment (ART) in Africa."Five-to ten-year is the window of opportunity we have," to find other responses to mitigate the impact of an HIV/AIDS endemic in Africa - which, according to Dr. Barnett "will be with us for the foreseeable future." Dr. Barnett made these statements during his keynote address at the International Conference on HIV/AIDS and Food and Nutrition Security, held last week in Durban, South Africa.

"The problem is, we don't know what to do with that 5-10 years. There is an urgent need for innovative solutions," said Dr. Barnett. But he fears that action could lead in the wrong direction if it is based upon 'simple stories' - narratives of the epidemic and its impact that have become accepted by policy makers, donors, opinion leaders and the research community.

"We do not have long-term evidence with the kind of detailed analysis which is necessary if we are to understand the complexity and diversity of the impact of the epidemic on rural society in Africa," said Barnett.

The story of HIV/AIDS in a rural Ugandan village Dr. Barnett himself helped establish one of the best-known narratives on the effects of HIV/AIDS in Africa. Early in the epidemic, Dr. Barnett evaluated the impact of HIV/AIDS on rural households in Uganda over the course of 1980-89. He observed that Ugandan families were losing their older children to illness, followed by the head of the household and then the mother falling ill. Over this period, farm productivity would fall. In the end, orphans would be left behind to run a child-headed household.

"For quite awhile, it became a story that was accepted as 'the truth.' And that story has appeared in various forms over the last fifteen years or so," said Dr. Barnett.

These stories led to predictions that Africa would experience:

*Labour shortages as a result from the impact of the epidemic on the productive age group

*A progressive decline of agricultural production and food capability

*A reduction of cultivated land area

*A reduction of crop portfolio

*A decay of infrastructure

*Reduced production and productivity

*And possibly, some have claimed, "famine"

"But we don't have are any long-term studies tracing the effects of HIV/AIDS on rural livelihoods and food security over the last 15 to 20 years," said Dr. Barnett.

Last year, Dr. Barnett went back to the same Ugandan village where he had worked in 1989." What he found was unexpected.

"The farming system had not collapsed," he said, "because there had been a profoundly moving and very strong community response. This is not a devastated community; this is a community where the farming system has remained intact."

Hard to generalise
"But this is just what happened in one place - in a very resilient farming system," Barnett continued. "What we don't know is what has happened in other systems that are less robust. There is probably a diversity of responses."

Less resilient agricultural systems are probably less able to cope with the impact of epidemic. But little is known about the "stories" from those communities.

Barnett explained that, until recently, there were few studies of how the HIV/AIDS epidemic has been affecting the wide range of rural environment and livelihoods in Africa, including fishing communities or animal herding regions.

But recently, there has been a upsurge in such research and much of the available data on the impact of the epidemic on rural livelihoods was reviewed in a recent meta-analysis (Gillespie and Kadiyala) published by the International Food Policy Research Institute (see www.ifpri.org).
Dr. Barnett noted that, "while the analysis found an indication of increasing inequalities in some societies, my reading is that it is actually hard to generalise for all of "Africa" or even "southern Africa."

He pointed out that it is also hard to isolate the causal influence of HIV/AIDS from other underlying environmental and policy conditions: "The epidemic may be a tipping point factor, but in many circumstances, it may not be the sole reason for the effects that we are seeing. We're dealing with an extremely complex set of causal links here - which may be different or nuanced from place to place," said Barnett.

"The challenge," he added, "is to recognise the diversity and to create large-scale responses that can cope with it."

"Governments, multilateral agencies, bilateral agencies have great difficulty in dealing with diversity," said Barnett. "It's very hard to have large programmes that take into account the complexity of the situation. One size does not fit all."

Pay attention to the pathogen
Barnett believes a better understanding of HIV virology could help prepare those planning responses to the epidemic.

For example, the average time from infection to AIDS is eight or nine years. Partly, as a result of this slow rate of disease progression, "the epidemic has shown itself to be both too slow and too fast for us to respond," said Barnett. "It's so slow that it's put on the backburner for a long time, and then it moves so fast that by the time you realise what is happening it's too late to do what you should have done ten years before."

And viral resistance may limit the effectiveness of our best available
intervention: ART. Resistance should be uncommon if effective regimens are administered to motivated individuals who have continuous access to treatment. But a very high rate of adherence is necessary to keep from developing resistance to the drugs.

Dr. Barnett thinks adherence could be difficult in rural areas where access is a problem - especially because treatment centres may be effectively inaccessible to many patients. Furthermore, in remote small communities there can be very little privacy and stigma which could act as a disincentive to adherence.

"How long before we see new epidemics of resistant HIV?" said Dr.
Barnett, "and when resistance comes, the big pharmaceutical companies will not respond hurriedly to Africa's need for a new generation of antiretrovirals - not after their experience with the last generation and the lowering of prices."

An unprecedented long wave crisis
"HIV/AIDS is not like other emergencies in food and nutrition - it is a long wave event, said Dr. Barnett. "We have to recognise that the entire balance between relief, rehabilitation and development work may have changed - in some communities. Policy, operations and thinking must switch into a new paradigm."

The disease has altered regional demographics, as well as the local social and economic circumstances in which policies and programmes will be operating. "We have to recognise that institutions on the ground may have short institutional memories," said Barnett "because people who are resourcing those institutions are younger and dying young. And we need to take into account that the institutions in which we work are themselves affected by the epidemic."

In addition, when people think that they may have limited life expectancy, it affects the decisions they make. It affects their investments and the effort they put into learning new techniques and new technologies. "How we introduce innovations, responses to the epidemic at a time when people are not living long enough and not healthy enough to adopt innovations?" said Dr. Barnett.

When the Black Death struck medieval Europe, the loss of the work force made new labour saving technologies practical. "But old solutions may no longer be appropriate in the context of changes brought on by the epidemic. For example, prevention has failed miserably in Africa," said Dr. Barnett. "What happened is that we went for already installed responses, condoms and vaccine development. What we didn't go for were microbicides, which are a gender specific, woman controlled response.
And now, in the third decade of the epidemic, we are just beginning to think seriously about testing microbicides."

The challenges, according to Dr. Barnett, are to understand the situation (rather than listen to the stories) "because this situation is unprecedented and unknown. We need to engage critically with established narratives.

"We have to consider the appropriateness of known technologies and approaches and think of new and innovative responses to a novel and changing situation," he concluded.

Source: ProNut- HIV, pronut-hiv@healthnet.org

TAC/AIDS Law Project (ALP) Statement on World Health Organization (WHO) Consultation on Nutrition and HIV/AIDS in Africa

2005-04-27T12:05:00.000+07:00

"Improved social grants and scientifically accurate public information on nutrition, particularly HIV and nutrition, are essential to reduce food insecurity."
************

On 10-13 April 2005 in Durban, a number of international, regional and local organisations and scientific bodies from Eastern and Southern Africa met under the auspices of the WHO to discuss the nutritional aspects of treating persons living with HIV/AIDS in Africa.

The meeting was co-hosted by the South African National Department of Health. On Friday 15 April the Durban meeting issued a Participants' Statement. It is available at http://www.sahims.net/ and on the Treatment Action Campaign (TAC) website (http://www.tac.org.za/).

The Participants' Statement puts to rest unfounded allegations that adequate nutrition alone can cure HIV infection. It cannot. It is uncontroversial that nutrition is an essential part of managing HIV. The statement makes clear that:

**Both antiretrovirals (ARVs) and proper nutrition are essential in providing comprehensive care, treatment and support of persons living with HIV/AIDS.
**Nutrition alone cannot cure HIV infection.
**The life-saving benefits of ARVs are clearly recognised.
**Adequate nutrition is required to optimise the benefits of ARVs, which are essential to prolong the lives of people living with HIV and prevent HIV transmission from mother-to-child.

President Mbeki and Minister of Health Tshabalala-Msimang frequently cite the importance of nutrition in alleviating AIDS. However, the Minister's comments are often scientifically inaccurate, with her overemphasizing the importance of particular foods such as garlic, olive oil and the African Potato.

Both leaders also create the impression that nutrition is an alternative to antiretroviral treatment; it is not. Furthermore, there is little evidence of Department of Health action to improve nutrition in people with HIV based on science, despite the Minister's rhetoric.

TAC and ALP are conducting an investigation to see what nutritionbal interventions are being made available as part of the Operational Plan and whether they are sufficient and sustainable.The Durban meeting reached the following evidence based conclusions:

Nutrition and ARV interaction

The life-saving benefits of ARVs are clearly recognised.
** To achieve the full benefits of ARVs, adequate dietary intake is essential.
** Dietary and nutritional assessment is an essential part of comprehensive HIV care both before and during ARV treatment.

The Participants' Statement also notes that the long-term use of ARVs can be associated with metabolic complications (cardiovascular disease, diabetes and bone related problems). However, it unambiguously states that the benefits of ARVs far outweighs the risks and that metabolic complications need to be adequately managed. It made the following important recommendations:

** Interactions between nutrition and ARVs in chronically malnourished populations, severely malnourished children, and pregnant and lactating women need to be investigated.
** The effects of traditional remedies and dietary supplements on the safety and efficacy of ARV drugs need to be evaluated.

TAC and ALP also agree with the Participants' Statement that “there is a proliferation in the marketplace of untested diets and dietary therapies, which exploit fears, raise false hopes and further impoverish those infected and affected by HIV and AIDS”. In this respect, we agree that we must “strengthen the capacity of government and civil society to develop and monitor regulatory systems to prevent commercial marketing of untested diets, remedies, and therapies for HIV-infected adults and children”.

Micronutrients
** Micronutrient supplements are not an alternative to comprehensive HIV treatment including ARV therapy.
** Micronutrient intakes at daily-recommended levels need to be through consumption of diversified diets, fortified foods, and micronutrient supplementation as needed.

Macronutrients
** Adults and children living with HIV have increased energy needs compared with uninfected adults and children.
** However, there is no evidence for an increased need for protein intake of people living with HIV/AIDS over and above that required in a balanced diet to satisfy energy needs (12 to 15% of total energy intake).

Growth
** The growth and survival of children living with HIV is improved by prophylactic cotrimoxazole, ARVs and the early prevention and treatment of opportunistic infections.
** Improved dietary intake is essential to enable children to regain lost weight after opportunistic infection.

Pregnancy and Lactation
** Optimal nutrition of HIV-infected mothers during pregnancy and lactation increases weight gain, improves pregnancy and birth outcomes.

Infant and Young Child Feeding
** WHO/UNICEF recommend that HIV-infected mothers avoid breastfeeding when replacement feeding is acceptable, feasible, affordable, sustainable and safe. However these conditions are not easily met for the majority of mothers in the region. Early breastfeeding cessation is recommended for HIV-infected mothers and their infants. There is an immediate need to evaluate suitable ways of meeting nutritional needs of infants and young children who are no longer breastfed.

TAC and ALP Recommendations
We recognise that the nutritional needs of countries cannot be dealt with in isolation of prevailing food insecurity. We support the call of the conference to all governments, including our own, to implement urgent measures to “reverse the current trends in malnutrition, HIV infection and food insecurity in most countries in the region, in order to achieve the Millennium Development Goals”.

At least the following three critical interventions are needed to eliminate food insecurity in people with HIV in South Africa. The third of these is already implemented.

1. The social grant system is the most effective mechanism for ensuring people can afford to eat enough. The disability grant is insufficient, because it lapses if people commence antiretrovirals and recover, leaving them the insiduous choice between the grant or medicine. A nutrition grant for people with HIV would be problematic because it would create inequalities between people with and without HIV. A Basic Income Grant, or similar measure is therefore the only viable solution that has been offered.

2. Government must run a public information campaign providing accurate information on nutrition. The only accurate nutrition and HIV facts sheets for wide distribution that we are aware of are the two produced by Soul City and TAC. Government should use these fact sheets to produce radio, television and print media to convey useful nutritional information. Government should also resist the prevalent pseudo-scientific claims that exaggerate the usefulness of particular foods, such as garlic, or food-groups, such as vitamins, in alleviating HIV.

3. Government should continue to distribute multivitamins through public clinics to people with HIV. The balance of evidence suggests that multivitamins, in moderate doses, do have some benefit.

There are proposals and efforts to distribute food parcels and nutritional supplements, other than multivitamins, to people with HIV through clinics. This gives a greater degree of food security to people with HIV, TB and other serious illnesses. However, it should be seen as a medium-term measure because it leads to inequalities and tensions between recipients of these parcels and other poor people. The main challenge is to meet the food and income security needs of every poor household.

Source: TAC Electronic Newsletter - 26 April 2005

World Health Organization Consultation on Nutrition and HIV/AIDS in Africa: Participant's Statement

2005-04-27T11:46:00.000+07:00

Durban, South Africa, 10–13 April 2005

Participants’ Statement
HIV/AIDS is affecting more people in eastern and southern Africa than our fragile health systems can treat, demoralizing more children than our educational systems can inspire, creating more orphans than communities can care for, wasting families and threatening our food systems. The HIV/AIDS epidemic is increasingly driven by and contributes to factors that also create malnutrition -in particular, poverty, emergencies and inequalities.
In urgent response to this situation, we call for the integration of nutrition into the essential package of care, treatment and support for people living with HIV/AIDS and efforts to prevent infection.

We recognize that,
1. Far reaching steps need to be taken to reverse the current trends in malnutrition, HIV-infection and food insecurity in most countries in the region, in order to achieve the Millennium Development Goals.
2. Adequate nutrition cannot cure HIV infection but it is essential to maintain the immune system and physical activity, and to achieve optimal quality of life.
3. Adequate nutrition is required to optimize the benefits of antiretroviral drugs (ARVs), which are essential to prolong the lives of HIV-infected people and prevent HIV transmission from mother-to-child.
4. There is a proliferation in the marketplace of untested diets and dietary therapies, which exploit fears, raise false hopes and further impoverish those infected and affected by HIV and AIDS.
5. Exceptional measures are needed to ensure the health and well-being of all children affected and made vulnerable by HIV/AIDS. Young girls are especially at risk.
6. Knowledge of HIV status is important to inform reproductive health and child feeding choices.

Conclusions
This consultation reviewed the scientific evidence and discussed the programmatic experience on nutrition and HIV/AIDS and has come to the following conclusions:

Macronutrients
* HIV-infected adults and children have increased energy needs compared with uninfected adults and children. Energy needs increase by 10 percent in asymptomatic HIV-infected adults and children. Energy needs for adults suffering from more advanced disease are increased by 20 to 30%. In HIV-infected children experiencing weight loss, energy needs are increased by 50 to 100%.
* There is no evidence for an increased need for protein intake of people infected by HIV/AIDS over and above that required in a balanced diet to satisfy energy needs (12 to 15% of total energy intake).
* Loss of appetite and poor dietary intake are important causes of weight loss associated with HIV infection. Effective ways of improving dietary intakes need development and documentation.

Micronutrients
* Micronutrient deficiencies are frequently present in HIV-infected adults and children.
* Micronutrient intakes at daily recommended levels need to be assured in HIV-infected adults and children through consumption of diversified diets, fortified foods, and micronutrient supplementation as needed.
* WHO recommendations on vitamin A, zinc, iron, folate and multiple micronutrient supplements remain the same.
* Studies have shown that some micronutrient supplements may prevent HIV disease progression and adverse pregnancy outcomes. Additional research is urgently required.

Pregnancy and Lactation
* Pregnancy and lactation do not hasten the progression of HIV infection to AIDS.
* Optimal nutrition of HIV-infected mothers during pregnancy and lactation increases weight gain, and improves pregnancy and birth outcomes.
* HIV-infected pregnant women gain less weight and experience more frequent micronutrient deficiencies.

Growth
* HIV infection impairs the growth of children early in life. Growth faltering is often observed even before the onset of symptomatic HIV infection. Poor growth is associated with increased risk of mortality.
* Viral load, chronic diarrhoea and other opportunistic infections impair growth in HIV-infected children. The growth and survival of HIV-infected children is improved by prophylactic cotrimoxazole, ARV therapy and the early prevention and treatment of opportunistic infections. * Improved dietary intake is essential to enable children to regain lost weight after opportunistic infection.

Infant and Young Child Feeding
* For HIV-uninfected mothers and mothers who do not know their HIV status, exclusive breastfeeding for six months is the ideal practice because of its benefits for improved growth, development and reduced childhood infections. Safe and appropriate complementary feeding and continued breastfeeding for 24 months and beyond is recommended.
* The risk of HIV transmission through breastmilk is constant throughout the period of breastfeeding and is greatest among women newly infected or with advanced disease.
Studies further support that exclusive breastfeeding is associated with less HIV transmission than mixed breastfeeding.
* WHO/UNICEF recommend that HIV-infected mothers avoid breastfeeding when replacement feeding is acceptable, feasible, affordable, sustainable and safe. However these conditions are not easily met for the majority of mothers in the region.
* Evidence shows that safer infant feeding can be achieved with adequate support, however health systems and communities are not providing this support to make infant feeding safer.
* Early breastfeeding cessation is recommended for HIV-infected mothers and their infants. *The age for breastfeeding cessation depends on the individual circumstances of mothers and their infants. The consequences of this on transmission, mortality, growth and development need to be urgently studied. There is an immediate need to evaluate suitable ways of meeting nutritional needs of infants and young children who are no longer breastfed.

Nutrition and ARV interaction
* The life-saving benefits of ARVs are clearly recognized. To achieve the full benefits of ARVs, adequate dietary intake is essential.
* Dietary and nutritional assessment is an essential part of comprehensive HIV care both before and during ARV treatment.
* Long term use of ARVs can be associated with metabolic complications (cardiovascular disease, diabetes and bone related problems). The value of ARV therapy far outweighs the risks and the metabolic complications need to be adequately managed. The challenge is how best to apply that extensive clinical experience in managing these types of metabolic disorders in HIV infected adults and children in Africa.
* Interactions between nutrition and ARVs in chronically malnourished populations, severely malnourished children, and pregnant and lactating women need to be investigated.
* The effects of traditional remedies and dietary supplements on the safety and efficacy of ARV drugs need to be evaluated.

Recommendations for Action
Based on these conclusions all concerned parties are urged to make nutrition an integral part of their response to the challenges of the HIV/AIDS pandemic and the following recommendations are made for immediate implementation at all levels:

1. Strengthen political commitment and improve the positioning of nutrition in national policies and programmes.

* Use existing and develop new advocacy tools to sensitize decision-makers about the urgency of the problem, the impact on development targets and the opportunity to improve care.
* Advocate for increased resource allocation and support for improved nutrition, in general, and for addressing the nutritional needs of HIV-affected and infected populations.
* Prioritize the needs of children affected and made vulnerable by HIV/AIDS.
Clarify and improve multisectoral collaboration and coordination between agriculture, health, social services, education and nutrition.

2. Develop practical nutrition assessment tools and guidelines for home, community, health facility-based and emergency programmes

* Validate simple tools to assess diet and supplement use including traditional and alternative therapies, nutritional status, and food security so that nutrition support provided within HIV programmes is appropriate to individual needs.
* Develop standard and specific guidelines for nutritional care of individuals, and implementation of programmes at health-facility and community levels.
* Review and update existing guidelines to include nutrition/HIV considerations (e.g., integrated management of adolescent and adult illness, ARV treatment, nutrition in emergencies).

3. Scale-up existing interventions for improving nutrition in the context of HIV

* Accelerate the implementation of the Global Strategy for Infant and Young Child Feeding.
* Renew support for the Baby-friendly Hospital Initiative.
* Accelerate the fortification of staple foods with essential micronutrients.
* Implement WHO protocols for vitamin A, iron, folate, zinc, multiple micronutrient supplementation and management of severe malnutrition.
* Accelerate training and use of guidelines and tools for infant feeding counselling and maternal nutrition in prevention of mother-to-child transmission programmes
* Expand access to HIV counselling and testing so that individuals can make informed decisions and receive appropriate advice and support on nutrition, including in emergency settings.

4. Conduct systematic operational and clinical research to support evidence-based programming

* Develop and implement operational and clinical research to identify effective interventions and strategies for improving nutrition of HIV-infected and affected adults and children.
* Document and publish results and ensure access to lessons learned at all levels.
* Encourage scientific journals to give greater opportunity for publication of operational research and records of good practice.

5. Strengthen, develop and protect human capacity and skills.

* Include funding for nutrition capacity development in HIV scale-up plans.
* Incorporate nutrition into training, including pre-service training, of health, community and home-based care workers. Specific skills such as nutritional assessment and counselling, and programme monitoring and evaluation should be included. Such training should be not favour particular commercial interests.
* Strengthen the capacity of government and civil society to develop and monitor regulatory systems to prevent commercial marketing of untested diets, remedies, and therapies for HIV-infected adults and children.
* Improve the conditions of service and coverage of health workers, especially dieticians and nutritionists, to deliver nutritional services.
* Identify and utilize local expertise to improve response to emergency conditions.

6. Incorporate nutrition indicators into HIV/AIDS monitoring and evaluation plans

* Include appropriate nutrition process and impact indicators for clinical and community surveillance, and for national, regional, and international progress reporting.

***
Source: www.sahims.net

The Best Defense against AIDS, In the Long Run, Will Be Economic

2005-04-27T10:20:00.000+07:00

by Christina Scott , Inter Press Service, April 18, 2005

DURBAN, South Africa--If one wants to find out how AIDS is increasing hunger and malnutrition, one can expect to harvest an abundance of depressing information. But soon, this may change.

‘'In the last five years alone, there have been about 500 different papers on food and nutrition security related to AIDS,'' said Stuart Gillespie of the Washington-based International Food Policy Research Institute (IFPRI), now marking its third decade of work.

AIDS intensifies poverty in many devastating ways. Ailing farmers do not plough their fields, or pass on their knowledge of seeds and seasons to the next generation. Desperate widows are more likely to sell their bodies for sex in order to feed their children. The sick need more high-quality food than before, but find it far more difficult to eat.

Rural families reliant on money sent home by a relative working in the city suddenly find themselves with no source of income. The few people who receive life-prolonging anti-retroviral drugs (ARVs) may find that the medication is severely handicapped without expensive vitamin supplements and other food aid.

And while the richer portion of the population may make the most noise about HIV/AIDS, the poorest suffer the most.

‘'Rural people in particular adopt hedging strategies against risk, but the multiple shocks and strains lead to their collapse,'' noted Joseph Tumushabe, consultant to the Ethiopia-based United Nations Economic Commission for Africa (ECA). ‘'Rural people don't get remittances any more. They get bodies. They get orphans. They get the sick.''

Yet there are success stories. In Tanzania, human rights lawyers brought court cases on behalf of dispossessed widows and orphans that the government changed the laws of inheritance so that land and possessions did not all flow in the direction of the brothers of the deceased.

In parts of India, people researching small-scale agricultural improvements - merely plugging gullies to prevent further erosion, for example - found to their surprise that this could have a discernible knock-on impact on disease trends.

Even though there are creative ways to fill the empty stomachs triggered by the AIDS epidemic, tracking down success stories requires a lot of detective work.

One of the problems facing isolated community organisations and lobby groups is that they are simply too busy helping people to document their efforts in ways that satisfy sceptical academics and funders, who like to point out that drought, famine, politics and globalisation can also cause devastating hunger and malnutrition. In the meantime, the virus is hunting for new homes.

In addition, most small, cash-strapped organisations are not in a position to tell others facing the same issues about their attempts to solve the problem. So the epidemic spreads but solutions stay at home.

‘'Where organisations have launched actions that address these interactions between HIV/AIDS and food insecurity, they have tended to be in isolation,'' confirmed Gillespie, a nutritionist by training. ‘'They are rarely monitored and evaluated.''

For this reason, he organised an international conference on HIV/AIDS and food and nutrition security in South Africa's port city of Durban, which wrapped up Apr. 18 with a news conference in the commercial hub of Johannesburg.

The subtitle of the conference made Gillespie's intentions clear: it was called ‘'from evidence to action.'' While some academics muttered to each other at tea breaks about the need for more information, many government representatives noted that delays simply allowed the disease to continue dragging down progress on a variety of fronts.

The economic impact is already present. ‘'It is estimated that by 2010, the gross domestic product of Tanzania will be 15 to 20 percent lower than it would have been without AIDS,'' Tumushabe said. ‘'And this is despite steady economic growth.''

Gladys Mutangadura, an economics affairs officer with the United Nations in Zambia, noted that if a cure for AIDS was found today, its devastating destruction would linger for decades, like an earthquake or a tsunami.

However, some researchers took a more optimistic view, noting that HIV/AIDS provides a window of opportunity for assisting the poorest of the poor - not for charitable reasons, but to defend the rich against the spread of the disease. The best defence against AIDS, in the long run, will be economic - but there are many paths to this mountaintop.

Sub-Saharan Africa will play an important role in charting the way forward, particularly for Asian countries which are equally dependent on subsistence agriculture but lag behind the continent in terms of the epidemic's lifespan.

‘'South Asia is fertile terrain, both for the spread of the virus and for its damaging interactions with food and nutrition security,'' Gillespie predicted. ‘'It is imperative that future work extends beyond Africa in order to be better prepared in other areas where such impacts may soon be experienced.''

Turf wars were evident at the conference. Gender activists expressed surprise that anyone else could possibly be surprised when Kenyan research showed men objecting to their women moving from food crops to attractive market crops such as sugar cane in order to cope with the economic devastation wreaked by HIV/AIDS. Drugs versus food was an issue for South Africans who knew that their rollout of anti- retroviral drugs has been delayed amidst bizarre advice from the Ministry of Health suggesting that patients should eat more olive oil, local potatoes and lemons. Both are important, Gillespie said.

Meanwhile, small-scale agriculture specialists closely involved with getting HIV/AIDS patients to grow more nutritious crops bristled when economists suggested that it was more effective for farmers to grow high-value crops and buy what they needed instead.

Environmentalists suspicious of genetically modified food aid tried to bring their debates into this arena, only to be corrected by the development consultant Tumushabe. ‘'The type of food eaten by HIV-positive people in Africa is not the issue,'' he tartly told a news conference. ‘'The question is whether they are accessing food at all.''

So in part, the conference mission was to persuade various participants to work together. Michael Loevinsohn, an ecologist with the RENEWAL regional network on AIDS and rural livelihoods in east and southern Africa, summed it up when he said, ‘'weaken one link, and you weaken them all.''

For him, the problem is that while AIDS cuts across health and agriculture, trade and industry, these are all separate government departments - and frequently separate non-governmental organisations as well - accustomed to independence and a narrow window of expertise. But each is doomed to failure if it does not work AIDS into its policy.

Gillespie wants everyone trying to tackle poverty, in what ever way, to use bifocals. They needed to use what he called ‘'an HIV lens'' to view their efforts. ‘'It doesn't mean your primary goal is to eradicate HIV/AIDS. You don't have to fight the epidemic. But you won't achieve your goals, whatever they are, if you don't take AIDS into account.''

‘'We are at a watershed,'' he warned. ‘'The crucial next step - using this growing knowledge to improve and scale up effective actions has yet to be taken.'' (END/2005)

Source: allAfrica.com

More Policies Needed to Help Farmers Affected By AIDS

2005-04-27T00:46:00.000+07:00

InterPress Service, April 14, 2005

MAPUTO, Apr 14 (IPS) - Lying outside her hut on a tattered mat, 20-year-old Maria struggled with her breathing as she tried to explain why she and her five orphaned nieces and nephews in her charge had not eaten.

Maria, whose name is changed to protect the family's privacy, was dying from AIDS-related diseases, as well as from severe malnutrition. ‘'I had to sell my plot of land to survive,'' she said through her gasps for breaths. Tears rolled down her hollow cheeks. ‘'I haven't taken my tablets (for tuberculosis) for five days, because I'm too hungry. The pills make me feel sicker, if I take them without food.''

Maria explained she dropped out of school when she was 15 years old to look after her own parents, who were ill for a long time before they died. Her own husband deserted her when she fell sick, and the children living with her are offspring of her three sisters, all of whom died of AIDS. Her eldest niece at 14 years already has a baby of her own.

A month after the interview, Maria died. The children had to leave their home as someone claimed it was theirs. A neighbour, who used to visit Maria, who herself is also living with the virus, gave Maria's destitute orphaned nieces and nephews temporary shelter.

The family lives in Nicoadala, in the northern province of Zambezia, which was once known as the breadbasket of Mozambique, as it has the potential to feed the whole country. But a combination of factors, namely the effect of 16 years of civil war which ended in 1992, widespread poverty, and unpredictable weather patterns have kept most families at subsistence level, and little able to withstand the HIV/AIDS epidemic which is growing fast in the country, although its full impact is yet to be felt.

In 2003 Mozambique's HIV/AIDS prevalence rate was 13.6 percent and last year it shot up to 14.9 percent. The UN Food and Agriculture Organisation (FAO) predict that between 1985 and 2020 Mozambique will lose over 20 percent of its agricultural labour force to HIV/AIDS.

Most policy makers recognise that HIV/AIDS is not just a health issue, but developing adequate policies to mitigate the devastating impact it is having, especially on subsistence farmers - who make up 77 percent of the population in Mozambique - remains a huge challenge.

What is clear is the anecdotal stories are tragically dramatic. ‘'The story of that family (Maria and her family of orphans) and others gives us an idea of the situation,'' said Bertine Niesten, project officer for FAO and focal point for HIV/AIDS.

‘'We must remember the vice versa effect of HIV/AIDS whereby HIV/AIDS can increase the risk of food and nutrition insecurity, and in turn food insecurity can increase vulnerability to the impact of HIV/AIDS as children are forced to drop out of school and young people, especially girls, turn to risky behaviour in order to survive,'' she said.

‘'It is a challenge still to ensure local organisations integrate HIV/AIDS into projects in the agricultural sector,'' Niesten said. ‘'And it is also difficult to identify families because of the stigma attached to HIV/AIDS.''

Since 1999 government policies including in the agriculture sector, focused more on HIV/AIDS prevention. In 2002, polices started to address the mitigation of HIV/AIDS, especially in the rural areas.

And since the beginning of last year, funds became available for limited treatment with life-prolonging anti-retroviral drugs (ARVs) in the public health system and care for the sick.

Most of the research into the impact HIV/AIDS has on subsistence farming is qualitative and anecdotal. A case study carried out in Chokwe, in the southern province of Gaza on farmers' knowledge of seed, supported by FAO, published January 2004 concluded that the long-term impact of HIV/AIDS is not addressed sufficiently. The paper argues that HIV/AIDS, along with other factors, could erode into the knowledge on seed and seed management - critical to household food security.

However, a report to be presented at an international conference in South Africa on HIV/AIDS and Food and Nutrition Security this month is calling for a re-think of current views. It suggests that certain shifts in agriculture in the southern African region were not always due to HIV/AIDS but were more likely due to change in agriculture policy.

Policy makers in Mozambique agree that more focus needs to be paid to mitigating the epidemic's impact on food security. The government is now implementing different initiatives in all of the country's 11 provinces, but the numbers of subsistence farmers reached are limited compared to the scale of the epidemic. More than 1.5 million people are living with HIV/AIDS.

Albertina Alage, the head of department of rural extension and focal point for HIV/AIDS in the ministry of agriculture said, ‘'We have advanced a lot, but we have problems. Sometimes finances for our plans are not timely or do not come at all.''

Alage explained that since 1999 rural extension workers have been educating the communities both about new agricultural practices and HIV/AIDS prevention. ‘'We have a problem in that we have few women rural extension workers. So we instead appoint a woman in the community to also assist in the sessions. We also do not have enough communication material in local languages,'' she said.

In 2002 programmes focused on trying to reduce the impact. Alage gave example of demonstrating communities' agro-processing machinery, which will assist families affected by the epidemic giving them time to both farm effectively and look after the sick. ‘'They can then form associations and apply for loans but the machinery,'' she said.

FAO supports the provincial government in the central province of Sofala implement a project prolonging the lives of agricultural extension workers. The HIV prevalence rates in Sofala is over 30 percent, and extension workers have been especially at risk of HIV infection, being a highly mobile group. They are posted in areas without their families for long periods at a time.

FAO, at the request of the provincial government, supports extensions workers who are taking ARVs with transport money so that they can make the often long journey to the provincial capital to receive treatment and collect their drugs. ‘'The provincial agricultural directorate is very organised. It was their request as they were concerned at the numbers of extension workers they were losing to HIV/AIDS,'' Niesten explained.

FAO also supports some 840 orphaned pupils aged 12-17 years in the central provinces of Manica and Sofala with life skills and practical farming tips which are given on demonstration plots. The pupils learn how to prevent diseases, use fertilisers and irrigation and at the same time they learn life skills. The idea, explained Valentina Prosperi, A UN fellow for FAO, ‘'is that the pupils then teach their parents and the community.''

Another area that is crucial in the long-term to food security is the right to inheritance. The UN Children's Fund (UNICEF) and FAO are supporting the government to give more legal protection to children orphaned by AIDS.

The UN World Food Programme (WFP) also supports a number of programmes directed at improving the food security of subsistence farmers living with HIV/AIDS. For example, WFP provides corn soya blend, fortified with micronutrients to over 4,000 people, including pregnant women, who are on anti-retrovirals. People living with HIV/AIDS need 10-30 percent higher energy requirements than a person who is HIV negative.

WFP also provides 20,000 people affected by the epidemic and 50,000 orphaned children with a monthly food ration.

The deputy country director of WFP, Karin Manente, explained that, ‘'sustainability is a concern. That is why our support is for a limited time frame. For example we give food to ARVs patients for the first six months, so as to help them through the most difficult period to get back on their feet. We want to assist people to prolong their lives, this also helps children stay in school.''

Like Mozambique, most of the 13-member Southern African Development Community (SADC) countries face similar problems. Southern Africa holds two percent of the world's population; but it has 70 percent of the world's people who are living with HIV and AIDS, according to ActionAid, an international charity, based in South Africa.

Online at: http://ipsnews.net/new_nota.asp?idnews=28288

Source: AF-AIDS, join-af-aids@healthdev.eforums.com

Food insecurity fueling spread of HIVAIDS while HIV/AIDS increasing food insecurity, experts say in Durban

2005-04-24T23:04:00.000+07:00

Aidsmap, Theo Smart, April 22, 2005

"HIV/AIDS and food and nutrition insecurity are becoming increasingly entwined in a vicious cycle, with food insecurity increasing the risk of exposure to HIV, and HIV/AIDS in turn increasing vulnerability to food insecurity," said Stuart Gillespie, Ph.D., a senior research fellow with the International Food Policy Research Institute (IFPRI). Dr. Gillespie was speaking at IFPRI's International Conference on HIV/AIDS and Food and Nutrition Security, held last week in Durban, South Africa, immediately after the WHO Consultation on Nutrition and HIV/AIDS in Africa. 'Food security' means having sustained physical and economic access to food of an acceptable quality and quantity.

The IFPRI meeting bought together over two hundred development experts, policymakers, donors, and researchers from health, agriculture and other sectors to hear how HIV/AIDS is affecting food security (and visa versa). Hoping that participants would forge links across sectors, the ultimate goal of the conference was to catalyse effective, large-scale action addressing the interactions between HIV/AIDS and food and nutrition insecurity.

"This conference aims to shine a light on the interactions to figure out what they mean for programmes and policies related to agriculture, research and development and to collectively figure out ways to take this agenda forward," said Gillespie, who was also the chief organiser of the event.

Rationale for the meeting
Central to the meeting was the theme that HIV/AIDS is not merely a medical problem with a simple medical solution. It is a multisectoral and developmental issue, affecting already struggling societies on many levels.

"Within the development community, HIV/AIDS is often viewed as only a health issue, separate from agriculture and other sectors. As a result, there is limited collaboration across sectors, resulting in lost opportunities to fight this pandemic effectively," said Gladys Mutangadura, of the United Nations Economic Commission for Africa at the opening press conference.

"HIV cannot be removed from Africa's long-standing problems; it is the culmination of these problems. It cannot be divorced from all these inequalities," and Professor Joseph Tumushabe, a development consultant for the United Nations Economic Commission for Africa

HIV/AIDS spreads through developing countries in the context of hunger, malnutrition, poor health, and deepening poverty. Those who contract the disease can find it more difficult to work to feed themselves and their families. As they fall ill, their resources are depleted; and they often lose their homes and other assets. The time and resources of their families and communities also must be redirected to their care and support. When a person with AIDS dies, their families are left even deeper in poverty and at greater risk of HIV exposure and infection themselves.

As a result, whole families are being wiped out and communities devastated. With as many as one out of three adults infected, the stability of entire nations is being put at risk.

Agriculture
"This disease is having disastrous consequences for agriculture by affecting adults at the height of their productive years, reducing labour power and other resources, and making it difficult for poor people to provide food for their families," said Professor Tumushabe. But while rural agricultural communities are becoming poorer, they are often forced to care for a disproportionate number of the ill and dying.

"People go to the rural areas for care or to die, and many of the orphans are in the rural areas, but where is the funding?" said Professor Tumushabe. "It is not being equally distributed to the rural areas."

Much of the conference would focus on what is known about the interaction between agriculture (and other rural livelihood systems) with the spread of HIV and effects of HIV/AIDS.

No one magic bullet
"We have a lot of evidence to suggest that those kinds of processes are happening - but they are almost always different in different places for different reasons," said Gillespie. "We are finding that there is no one single clear-cut problem."

Many of the papers presented at the conference discussed the capacities and strategies of households and communities to respond effectively to the impacts of HIV/AIDS.

"What are the appropriate types of solutions for that place, at that time?" said Gillespie. "There is no blueprint, there is no standard magic bullet intervention."

"There is no one single solution, so we need to be capturing innovations, looking at how certain communities have effectively responded. And we have to learn from them where the gaps are and how government, civil society, the private sector and international agencies need to position themselves to provide the appropriate types of support" he concluded.

Source: Pronut-HIVeForum, pronut-hiv@healthnet.org
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Resources
Gillespie S and Kadiyala S. HIV/AIDS and Food and Nutrition Security
**From Evidence to Action. International Food Policy Research Institute,
2005. Copies of this book and other related materials may be downloaded from the IFPRI site: http://www.blogger.com/www.ifpri.org

AFRICA: New thinking needed to counter AIDS in rural communities

2005-04-24T23:03:00.000+07:00

IRIN News, April 16, 2005
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DURBAN, South Africa- The link between HIV/AIDS and hunger in rural communities has received a great deal of attention over the past few years- particularly in Southern Africa, where HIV/AIDS has added a new dimension to the recent food crisis.

But research emerging from this week's international conference on 'HIV/AIDS and Food and Nutrition Security' in Durban, South Africa, showed that very little is know about the actual impact of the pandemic on rural communities.

The three-day conference, organised by the Washington-based International Food Policy Research Institute (IFPRI), brings together policymakers, donors and researchers to develop strategies for improving and expanding the response to HIV/AIDS and food security.

In his keynote address on Thursday, Dr Tony Barnett from the London School of Economics warned against the danger of demanding action when there was only "spotty and patchy evidence" about what was happening in farming systems.

Barnett raised questions that "fly in the face of conventional wisdom" on "what we think we know" about HIV/AIDS and food and nutrition security.

According to Stuart Gillespie, conference director and senior research fellow at IFPRI, researchers attending the conference were taking "a critical look at existing evidence", and finding that "while some of the research supports conventional wisdom about the massive impact of HIV/AIDS on livelihoods, more research put on the table [this week] is forcing us to change the way we look at things."

"We're seeing that HIV/AIDS is intertwined with multiple vulnerabilities, and we have to avoid AIDS exceptionalism ... it's a complex issue that looks different in different places," he told PlusNews. As an example, Barnett mentioned three studies he conducted in a small village in the Rakai district of Uganda, examining the effects of HIV/AIDS on farming communities from 1989 to 2004.

Contrary to expectations, and despite an HIV prevalence of 8 percent in 1993, the farming system had not collapsed from the strain of AIDS-related illnesses, and all the study respondents from 1993 were still alive. The region's "fairly robust and very resilient farming systems", sustained by good soils and "high ... rainfall", had created a buffer against the impact of HIV/AIDS.

This was not a "devastated community", but the situation was not the same everywhere and there was a need for more research and a greater diversity of responses. Barnett called for large-scale donor and state-driven efforts that recognised the complex nuances in the impact of HIV/AIDS on rural households. He admitted that this would be difficult for governments, but stressed that "one size will not fit all".

Previous assumptions during the early stages of the pandemic - that HIV/AIDS impacted wealthy, more educated people - were no longer valid, as poorer households were now more affected. But policies and programmes were not changing as quickly as the virus was progressing, and rural households remained neglected.

Labour technologies used in rural communities would also need to keep pace with the epidemic, he warned, as some were no longer appropriate. "The problem is: how can we introduce innovations at a time when people are not living long enough to adopt to the innovations - is there enough time for communities to adapt to these changes; is there existing and appropriate technology which will work in these changed circumstances?" he asked.

While the benefit of antiretroviral (ARVs) medication was that it increased life spans by between 5 and 10 years, this was still not being fully exploited. "The problem is, we don't know what to do - this is a novel situation, and the response must be rapid ... [but we] don't know what works," Barnett said.

With the danger of drug resistant strains of the virus developing during this window, African countries had to ensure that ARVs were used regularly, and continued access to the treatment was available. He expressed concern that large pharmaceutical companies, already feeling the pinch from dramatic ARV price cuts, would not respond rapidly to the need for a new generation of cheaper medicines for developing countries.

"We are in perilous waters," he declared. Making matters worse, rural households still had a problem accessing treatment, while widespread stigma remained prevalent in small communities. Under these circumstances, "how long will it be before we see a new epidemic of resistant HIV in rural areas?" Barnett wondered. He cautioned that "bureaucratic inertia” and using "yesterday's solutions for today's problems" would do more harm than good.

Current prevention methods had not provided all the answers; more research into the use of microbicides as a female-controlled prevention method was needed. "The history of prevention shows us the mistakes we've made ... it cannot be business as usual," Barnett concluded.

Source: IRIN News, April 16, 2005

AFRICA: UN highlights nutrition woes of HIV-positive people

2005-04-15T10:39:00.000+07:00

[This report does not necessarily reflect the views of the United Nations]

JOHANNESBURG, 11 April (PLUSNEWS) - World Health Organisation (WHO) chief Lee Jong-wook on Monday appealed for greater attention to the nutrition of people living with HIV/AIDS in sub-Saharan Africa.

Addressing health experts from 20 African countries at a WHO meeting in South Africa's port city of Durban, Jong-wook said that despite being one of the critical aspects of care and support for HIV-positive people, nutrition had been largely ignored.

"We know that sound nutrition helps maintain the immune system, increases body weight and boosts energy levels but, in Africa, [infected people] are frequently admitted to hospital already malnourished," Lee said in statement.

The UN health agency chief warned that massive international investment in care, support and anti-AIDS treatment could be jeopardised if people receiving treatment were not sufficiently nourished.

Delegates attending the three-day meeting are to produce recommendations for immediate action to improve the nutrition and health of HIV-positive people in southern and eastern Africa.

Source: IRIN PLUS News
http://www.plusnews.org/AIDSreport.asp?ReportID=4690

Empowering rural households: New strategies for helping farmers fight HIV/AIDS with food security

2005-03-17T10:12:00.000+07:00

With more money and political interest being directed towards AIDS than ever before, it is important to bring agriculture to the centre stage of the response to the disease. Most people in AIDS-ravaged parts of Africa live in rural areas, and rely on subsistence agriculture. Agricultural productivity and food security in sub-Saharan African are precarious due to AIDS, and there is an urgent need to reduce the debilitating grip of HIV/AIDS on rural livelihoods. Empowering smallholder farmers to be food secure is vital to preventing rural households slipping into a spiral of HIV and poverty.

According to the UN Food and Agriculture Organization (FAO), the epidemic is undoing decades of economic and social development and causing rural disintegration. In areas where the disease is highly prevalent, the impact goes beyond the already incredible suffering and loss of life, undermining food security in many dimensions. HIV/AIDS primarily affects those aged 15 to 50 years – the core of the labour force. This has a direct impact on the ability of households to either produce sufficient food or to attend work in order to receive a wage and have the ability to purchase food.

Food insecurity increases vulnerability to HIV infection – poor nutrition contributes to poor health, low labour productivity, low income, and livelihood insecurity. As productive family members fall sick or die, the quantity and quality of food available to the household declines. The additional burden of caring for orphans and unproductive individuals can impact upon food security.

The agricultural sector is in a strong position to assist in both prevention and mitigation of the consequences of HIV/AIDS.

According to FAO, possible agriculture sector responses include:

**Labour-saving technologies. These include low-input agriculture; lighter ploughs and tools that can be used by older children, women and the elderly; improved seed varieties that require less labour for weeding; intercropping; minimum tillage; access to potable water; and provision of fuel-efficient stoves that can free women for more economically productive activities.

**Knowledge preservation and transmission. This includes ensuring that basic agricultural skills are transmitted through formal and informal community institutions, such as extension services and schools, as well as einforcing community-based mechanisms to preserve local knowledge, including biodiversity and gender-specific agricultural skills

**Rural institutions and capacity-building. All rural service providers – for education, health, agricultural extension, credit and finance, women’s associations, nutrition groups, irrigation committees and terrace maintenance associations – need to be strengthened, in addition to local informal community networks, which provide most assistance to AIDS-affected households.

**Gender equality. Efforts must be made to reduce gender-based differences in access to and control of resources and livelihood assets – in particular, inequalities in access to land, credit, employment, education and information.

**Improving nutrition. Strategies here include: nutritional home gardens; use of improved crop management and plant varieties with higher yields; emphasis on staple crops; use of small ruminants for consumption, sale and manure; education and labour exchange arrangements.

**Social and economic safety nets. Efforts must be made to strengthen community-based initiatives, especially safety nets that are essential for food security.

**Monitoring and evaluation. Response strategies need to be appropriately monitored and evaluated to assist in the design and implementation of more effective programmes, to alleviate the impacts of HIV/AIDS on rural livelihoods and food security. In addition, participatory monitoring systems should be developed so that the people themselves can measure progress.

**Mainstreaming HIV/AIDS. The experience of all partners, from all sectors, in addressing the HIV/AIDS epidemic must be built upon, in order to develop an effective agricultural strategy. Advocacy is necessary to increase political commitment and influence national policies.

HDN Key Correspondent
Correspondents@hdnet.org

(July 2004)

Nutrition: An integral part of any comprehensive care package for PWHA

2005-03-14T19:29:00.000+07:00

According to a recent Indian national conference on HIV/AIDS care, people living with HIV/AIDS need access to food and micronutrient supplements to improve their health status and extend their lives.

In India (and many other countries) many people living with HIV (PWHA) have limited or no access to clean water and nutritious food, which devastates their overall health status and accelerates the onset of AIDS-related conditions.

Compounding this reality for many PWHAs, access to life-saving antiretroviral drugs are also out of reach, making the need for other life-extending treatments, such as nutritious foods, all the more crucial. It has also been shown that death from nutritional complications is more likely for those who are not receiving antiretroviral therapy . Clearly, there is an urgent need for renewed focus and use of resources for nutrition as a fundamental part of any comprehensive HIV/AIDS care package to be scaled up.

While adequate nutrition is vital for health and survival for all people regardless of their HIV status, for people with HIV, access to nutritious foods is central in order to delay the onset of HIV-related symptoms, such as wasting. For a PWHA, it is estimated that energy requirements increase by 10% in order to maintain a healthy body weight and physical activity. This is the same for maintaining healthy growth among asymptomatic children living with HIV.

When a person has crossed the threshold into symptomatic AIDS-related conditions, energy requirements increase by approximately 20% to 30% just to maintain adult body weight. For children with HIV experiencing weight loss, energy intakes need to be increased by 50% to 100% over normal requirements to maintain proper body weight.

Speaking at the workshop ‘Food Security, Nutritional Care and HIV’, at the Community Care Conference in Mumbai, (7-9 December 2004), Dr Sai Subhasree Raghavan discussed the physiological aspects of nutritional complications for people living with HIV, who for various reasons are not taking antiretroviral therapy. These include wasting, loss of body mass, low albumin levels, low hemoglobin, low levels of steroid hormones, low cholesterol, high triglycerides and various micro-nutrient deficiencies.

Dr Raghavan is the founder and Executive Trustee of SAATHI (Solidarity and Action Against HIV Infection in India), a non-profit organization that aims to stablize and reduce the spread of HIV in the country.

According to Dr Raghavan, wasting is the third most common AIDS indicating symptom, and can include loss of weight through deceases is muscle tissue, fat and bone tissues. Men lose body mass disproportionatly to fat whereas women lose fat disproportionate to body mass. Gender-specific metabolic and hormonal differences account for these changes. Patients with a history of drug use have much lower body fat and mass than people who do not have a history of substance use.

Additional factors that fuel HIV-associated wasting in developing countries is the lack of access to medical care and treatment, such as antiretroviral therapy. Compounding this, many people live under the poverty line and therefore do not have access to adequate hygiene or safe water. Moreover, many refuse to even access care and treatment when it is available because of the ubiquitous and pervasive HIV-related stigma that exists in the very health care settings set up to care and treat people living with HIV/AIDS.

Recent data from Thailand and Uganda suggest that HIV malnutrition is one of the top three causes of mortality and morbidity in the developing world and is erasing previous advances made in treatment of malnutrition in developing countries.

Micronutrient deficiencies including Vitamin A, B6, B12, C, E, folic acid, selenium, and zinc levels have shown to be associated with disease progression and death (1). In India, plenty of related data exist for people who are HIV negative, however, there is very limited data specific to people living with HIV. These data are needed urgently in order to determine the type of vitamin-mineral supplements that could most effectively be provided to PWHAs.

HIV-associated malnutrition results in decreased productivity and more absence from work, decreased household income and consequently lower quality of life. Further, malnutrition is associated with slower wound healing and higher morbidity and mortality rates, which result in longer hospital stays and higher medical costs.

Nutritional health can be maintained by ensuring adequate intake of macro- and micro-nutrients; ensuring adequate access to food; ensuring water safety; maintaining body weight and body mass; increasing food supply; providing enteral or parenteral nutrition; and by providing appetite stimulants. Micronutrient supplements in the form of multivitamins with minerals can also be provided. Use of protein calorie supplements are necessary to increase the nutrient intake for prevention and treatment of weight loss. Supplements made from locally available ingredients in India need to be identified and evaluated.

Despite some gaps in scientific knowledge, there is a growing body of evidence that suggests much can be done to improve the health and lives of people living with HIV/AIDS by ensuring proper nutrition. Improving access to nutritious foods and clean water must be seen as an urgent priority related to care and support for people living with HIV. In late 2004, (December 16), the government of India took a step in the right direction when it announced that it had signed an agreement with the United Nations World Food Programme to provide food aid for people living with HIV. Hopefully the government will continue to recognize the important role nutrition plays in care and support for people living with HIV and incorporates evidence-based nutrition interventions into the national AIDS control and treatment programmes.

HDN Key Correspondent
Email: correspondents@hdnet.org

(December 2004)

Notes:

1. See http://www.aegis.com/pubs/iapac/2002/JI020401.html