Integrating Nutrition and Food Security into HIV Care Support and Treatment

Nutrition and food security are an integral part of the overall response to HIV at all levels. It is vital to address food security and nutrition in all settings to achieve the goal of universal access to HIV prevention, treatment, care and support by 2010, to which all Member States of the United Nations have committed themselves.

At a 9th ICAAP session, ‘Integrating Nutrition and Food Security into HIV Care Support and Treatment: Opportunities and Challenges’, Dr Martin W Bloem, Chief, Nutrition and HIV/AIDS Policy World Food Programme (WFP) discussed that, “Governments need to ensure the integration of food and nutritional support as part of the comprehensive care, support and treatment package for all people living with HIV ( PLHIV)”. Professor Praphan Phanuphak at the Thai-Australian Collaboration in HIV Nutrition (TACHIN) project, highlighted the impact of HIV on nutrition and food security in the Asia-Pacific region, he stated that “HIV affects metabolism and increases the need for nutrients and energy, good nutrition is of paramount importance for those with HIV, nutrition care should be a component of holistic care approach for PLHIV”. Nutrition and Food security form an integral part of Universal Access.

Food security refers to people's ability to access food, either by growing their own or buying food. HIV and AIDS have a significant impact on food security as HIV increases people's need to sell assets in return for food and medication. “Hunger can lead women to sell or exchange sex”, remarked Dr Angela Kelly, team leader Papua New Guinea Institute of Medical Research discussing the ‘Art of Living’ programme in PNG. Lack of food security constrains people’s choices about work and education, and child feeding and rearing, and can lead to increased mobility for work. Mobility and limited options for earning an income in turn can lead to high-risk behaviours such as engaging in sex for food or money.

Good nutrition plays an important role in maintaining the health of people living with HIV. Adequate nutrition is essential to maintain a person’s immune system, to sustain healthy levels of physical activity, and for quality of life. Adequate nutrition is also necessary for optimal benefits from antiretroviral therapy. Ms Kaniz Fatima, project officer WFP Bangladesh, “Large proportion of PLHIV are from the Most at Risk Populations (MARP), who also experience chronic malnutrition”. HIV impairs nutritional status by undermining the immune system, as well as nutrient intake, absorption and use. Malnutrition can exacerbate the effects of HIV and hasten AIDS-related illnesses in people living with HIV. Adults living with HIV have 10−30% higher energy requirements than a healthy adult without HIV, and children living with HIV 50−100% higher than normal requirements. Food availability and good nutrition are thus essential for keeping people living with HIV healthy for longer. A stronger, healthier body can better resist the opportunistic infections that affect people living with HIV.

Adequate dietary intake and absorption are essential for achieving the full benefits of antiretroviral therapy, and there is emerging evidence that patients who begin therapy without adequate nutrition have lower survival rates. Antiretroviral therapy itself may increase appetite and it is possible to reduce some side-effects and promote adherence if some of the medicines are taken with food.

Women are biologically, socially and economically more vulnerable than men to HIV. People without access to adequate food, income and land, especially women and girls, are more likely to be forced into situations that place them at risk of HIV infection such as mobility for work, transactional or commercial sex, or staying in abusive sexual relationships due to economic dependency. Women are usually involved in producing, purchasing and preparing food. Women are also primary caregivers. Most HIV positive children contract the virus from their mother during pregnancy, delivery or breastfeeding. Inadequate nutritional status may increase the risk of vertical HIV transmission. HIV positive mothers need access to appropriate information and replacement feeding options, in order to minimize the risk of transmission during breastfeeding.

Nutrition education and dietary counseling are currently underfunded; there is a current need for evidence to convince funding agencies like GFTAM and PEPFAR, that nutrition intervention can make a significant difference. It is important that issues of nutrition and food security are not trivialized and addressed immediately.

Nutrition should become an integral part of the countries response to HIV. It is recommended to strengthen the political commitment to nutrition and HIV within the national and global health agenda by reinforcing nutrition components in HIV policies and programmes. UNAIDS, WHO, WFP, FAO, World Bank, UNDP, GFTAM, PEPFAR, all these agencies need to collaborate and come up with an integrated Nutrition Food Security and HIV policy and programme applicable for all stages of HIV care support and treatment.

Ishdeep Kohli-CNS