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Excerpts from Key HIV/AIDS Documents

Multisectoral Responses to HIV/AIDS: A Compendium of Promising Practices from Africa

USAID-PVO Steering Committeeon Multisectoral Approaches to HIV/AIDS
April 2003
Click here to read.

The Critical Role of International Agricultural Development
in the Fight Against Undernutrition and HIV/AIDS

The Association for International Agriculture & Rural Development (AIARD) held a very informative forum on Capitol Hill on agriculture and HIV/AIDS. To view the program which includes links to speeches and their paper titled The Agriculture, Nutrition, and HIV/AIDS Connections in Developing Countries, click here.

South African Social Housing Institutions and HIV/AIDS

Rooftops Canada worked with the Social Housing Foundaiton in South Africa to produce this report on the effects of and responses to HIV/AIDS within the social housing sector in South Africa. This report analyzes current educational, and operational responses and makes recommendations for improved approaches. In the South African context, social housing includes co-op housing.
Click here to read the report.

Lessons Learned & Identified Strategies That Enhance The Participation Of HIV/AIDS Affected Households Into Productive Markets

Prepared by Mary Morgan for the SEEP Network
May 2004
Click here ot read the report.

Financing development in the shadow of HIV/AIDS, Monterrey, Mexico, March 2002 UNAIDS

HIV/AIDS has claimed over 26 million deaths in over 20 years, making it the worst epidemic in human history. In 2001 alone, an estimated 5 million people, half of whom were between the ages of 15 and 24, were infected with HIV. Over half a million children under 15 died of AIDS in 2001. Given the fact that it is common for both spouses to be infected by HIV/AIDS, many children in HIV/AIDS impacted areas lose both parents at an early age and the number of orphans is rapidly growing. In many areas of several countries, including South Africa, where the spread of the epidemic appears to be accelerating, over 30 percent of all pregnant women are HIV-positive.

More than one-third of the gross national product (GNP) of the worst affected countries comes from agriculture. Labor-intensive farming systems with a low level of mechanization are particularly vulnerable to HIV/AIDS. The loss of assets, of productive workers and of agricultural investments severely affects the production and purchase of food, affecting long-term food security.

Children and Young People in a World of AIDS, UNAIDS, 2001

An estimated 10.3 million people aged 15-24 are living with HIV/AIDS and half of all new infections - over 7000 daily - are occurring among young people. Sub-Saharan Africa has been the hardest hit. It is home to over 70% of young people living with HIV/AIDS and to 90% of the world's AIDS orphans (12.1 million children).

Biological, social and economic factors make young women especially vulnerable to HIV, sometimes leading to infection soon after women become sexually active. A study in Zambia found that 18% of young women surveyed were diagnosed HIV-positive within one year of becoming sexually active.

In 2000 alone, an estimated 600,000 infants were infected with HIV - over 90% of them through mother-to-child transmission (MTCT). About 90% of those infections occurred in sub-Saharan Africa.

HIV can be transmitted from mother to infant during pregnancy, labor and delivery or breastfeeding. The risk of MTCT varies between 15% and 30% among infants who are not breastfed. Breast-feeding increases the risk of transmission by 10-15%.

Mother-to-child transmissions in the developed world have been virtually eliminated thanks to effective voluntary counseling and testing, access to combinations of antiretroviral therapy or use of long-term regiments of MTCT prevention, sage delivery practices (including elective caesarean sections) and the widespread availability of breast-milk substitutes.

It is clear that short-term antiretroviral prophylactic treatment is an effective and feasible method of preventing MTCT. When combined with infant feeding, counseling and support, and the use of safer infant feeding methods, it can halve the risk of infant infection.

These regimens are mainly based on the use of nevirapine and zidovudine. Nevirapine is administered in one dose to the mother at delivery, and in one dose to the child within 72 hours of birth. A typical short-course zidovudine regimen is administered daily to the mother from the 36th week of pregnancy up to and during delivery. MTCT programs supported by the United Nations Inter-Agency Task Team provide these drug regimens free of charge. In 2000, nevirapine manufacturers, in partnership with the United Nations, offered developing countries the drug free of charge for a five-year period.

Most HIV-infected women live in deprived conditions and lack access to clean water and sanitation. This limits their ability to employ safe breast-milk substitutes. Research on making breastfeeding safer is a high priority. Results from one study suggest that exclusively breastfed children are less likely to acquire HIV than those receiving mixed feeding (breast milk and other foods). But these results need to be confirmed in other settings. Meanwhile, studies are underway to determine whether antiretroviral drugs provided to a mother or infant during the breastfeeding period can prevent HIV transmission.

The reluctance of many women to be tested for HIV infection must also be addressed. This reluctance is often a response to social stigma and is associated with women's concerns with being deprived of social or medical support should she be positively diagnosed.

Nutrition and HIV/AIDS: Report of the 28th Symposium in Nairobi, Kenya, April 2001

Dr. Peter Piot, Executive Director of UNAIDS, said: "Like poverty and HIV, nutrition and HIV operate in tandem, both at the level of the individual and the society. For individuals, nutrition deficits make people with HIV more susceptible to disease and infection. Indeed, malnutrition is one of the major clinical manifestations resulting from HIV infection both in children and adults. At the social level, food insecurity is a major cause of vulnerability to HIV." Dr. Piot also stated that the voice of nutrition experts must be louder and stronger in the HIV prevention and treatment fields. Piot called on the nutrition community to help apply proven strategies on a scale commensurate with the epidemic. "Care" has somehow been narrowed to the cost of anti-retroviral and this is counterproductive; nutrition must be brought into the essential care package.

At the same conference, Dr. Stuart Gillespie of the International Food Research Policy Institute (IFRPI) said: For people living with HIV/AIDS, nutritional care and support is critically important in preventing nutritional depletion. The specific objectives (of food aid programs) might include improving the quantity and quality of the diet in order to build or replenish body stores of micronutrients, prevent or stabilize weight loss, preserve muscle mass, prevent diarrhea and speed recuperation from HIV-related infections. Food aid programs might also prepare and manage AIDS-related infections that affect food consumption and dietary intake.

Dr. Gillespie also said the role of food aid in HIV/AIDS mitigation and care has only begun to be explored by field-based organizations. The biggest challenge for food-assisted interventions is providing food to meet needs but also to program interventions so that family members and communities are left with a means to improve their food and nutrition security once food assistance stops. Gillespie recommended food aid in HIV/AIDS mitigation follow four principles: (1) there needs to be a clear need for food; (2) food should be provided as part of a larger package of assistance; (3) food can be combined with training or income generating activities to improve food access and to increase self-sufficiency; and (4) close consultation with affected communities on the targeting and delivery of food assistance must be an integral part of the program.

Dr. Phetsile Dlamini, Minister for Health and Welfare of Swaziland, added that the wave of excitement surrounding anti-retrovirals has caused some of the practical and affordable solutions, including good nutrition, to be forgotten.

In a survey of homecare programs in Malawi, Dr. Elizabeth Marum of the Center for Disease Control and Prevention indicated that food was the major priority of HIV patients: 86% of the patients reported that they did not receive food on a regular basis.

Dr. Ruth Nduati indicated that the coexistence of lactation and HIV is a very significant metabolic challenge for HIV-positive women. A study in Tanzania of HIV-positive pregnant women showed that use of vitamins reduced low birth weight by 44%.

HIV/AIDS: A Guide For Nutrition, Care and Support FANTA Project, AED, September 2001

Nutrition and HIV are strongly related. Any immune impairment resulting from HIV/AIDS leads to malnutrition: malnutrition leads to further immune impairment, worsening the effect of HIV and contributing to more rapid progression to AIDS. While people with HIV and AIDS have special nutritional needs, it is important to note that all people can benefit from adequate nutrition. Good nutrition increases resistance to infection and disease and boosts energy levels, making a person stronger and more productive in general. An HIV-positive person has a greater risk of malnutrition for the following reasons:

· Reduced food intake. Adults with HIV/AIDS suffer from appetite loss and have difficulty eating.
· Poor absorption. HIV/AIDS affects how the body uses food consumed, resulting in poor absorption of nutrients (protein, carbohydrates, fats, vitamins and water).
· Changes in metabolism. If nutrients are poorly absorbed, individuals may be unable to efficiently digest foods and the body may be unable to properly gain from nutrient intake.
· Chronic infections and illnesses. Fevers and infections accompanying HIV infection demand greater nutrient requirements and may lead to reduced food intake and weight loss.

These factors are most common for adults, but are also prevalent in children infected by HIV. Children are also impacted when their HIV-positive parents cannot provide for them. For people living with HIV/AIDS, micronutrients are especially important. Many of these micronutrients (Vitamin A, Riboflavin, Vitamin B2, Niacin, Vitamin B3, Cobalamin Vitamin B12, and calcium) are derived from milk products.

American Dietetic Association

If you are a person living with HIV/AIDS, proper nutrition is extremely important. Consuming enough food can maximize your day-to-day energy level, productivity, and sense of well-being. Think of nutrition as an investment that pays off both physically and psychologically. Three or more meals and snacks each day can provide the nutrients needed to build a strong immune system. These nutrients include protein, carbohydrates, fats, vitamins, minerals and water. In addition, food keeps the digestive tract working. Because the digestive track plays an important role in building a strong immune system, the act of eating is a disease-fighting tactic. Include nutritious snacks, such as hot or cold cereal and milk with raisons, peanut butter and crackers, and frozen yogurt or ice cream, as an additional strategy for improving your nutritional health.

Examples of Prevention, Mitigation and Care-Related
Intervention Options That Use Food Aid

Prevention

  • Using food distribution sites to enable partners to raise awareness on HIV and AIDS, provide prevention information and promote and distribute condoms
  • Making certain that long-haul truck drivers are provided with risk reduction and prevention information and an ample supply of condoms
  • Training of community health workers in methods of optimal breastfeeding practices
  • Training of youth peer educators to provide information on STD and HIV/AIDS risk reduction and prevention as well as voluntary testing and counseling

Mitigation

  • Food for vocational training for street children and orphans
  • School feeding with special take home rations for families caring for orphans
  • Food for training programs which promote income-generating activities (mushroom growing, tie-dying, etc.) and are linked to small-scale credit facilities for women and older orphans
  • Food for training and food-for-work to support farmers through animal traction schemes and the provision of seeds and agricultural tools
  • Food for work to support increased agricultural production through home gardening to improve diet diversification and increase intake of micronutrients
  • Food for work and food for training to support the introduction of small scale, low labor livestock activities to (a) increase the intake of high energy, high protein food and (b) provide capital/savings that will increase over time

Care

  • Providing food for women living with HIV/AIDS and their children in order to prolong the life of the mother while ensuring the nutrition of her children
  • Supporting the training of HIV/AIDS home-based care workers in nutrition counseling to emphasize optimal nutrition and advise on optimal foods for their patients
  • Providing nutritional support to tuberculosis patients to protect their food security and as an incentive to complete their full treatment protocol (TB is one of the most common opportunistic infections found in people living with HIV/AIDS)

Source: World Food Programme (WFP) (2001c) Food Security, Food Aid and HIV/AIDS: Project Ideas to Address the HIV/AIDS Crisis. WFP: Rome.

Dynamics of HIV/AIDS Impacts and Household Responses
In an Agriculture-Based Livelihood

The following is an illustration of possible impacts and responses of an agriculture-dependent household containing an adult who contracts HIV. Many of these impacts have been shown in studies; some are speculative albeit plausible. Context is obviously crucial with regard to type and sequencing of impacts and responses at different stages of the epidemic.
  1. Adult becomes sick
  2. S/he reduces work
  3. Replacement labor is "imported", perhaps from relatives
  4. Adults work longer hours on the farm
  5. Health care expenses rise (e.g., drugs, transport)
  6. Household food consumption is reduced
  7. Households switch to labor-extensive crops and farming systems and small livestock
  8. Nutritional status deteriorates
  9. Adult stops work
  10. Increased care for the sick adult, less time for child care
  11. Divisible assets are disposed (e.g., livestock)
  12. Debts increase
  13. Children drop out of school to help with household labor
  14. Adult dies
  15. Funeral expenses arise
  16. Household may fragment as other adults migrate for work
  17. Reduced cultivation of land, more left fallow
  18. Inappropriate natural resource management may lead to increased spread of pests and disease
  19. Effects of knowledge loss intensify
  20. Increased mining of common property resources
  21. Access to household land and property may be affected (through rights of surviving widow)
  22. Solidarity networks strained, possibly to the point of exclusion
  23. Partner becomes sick
  24. Downward spiral accelerates…
Source: ACC/SCN (2001) Nutrition and HIV/AIDS. Nutrition Policy Paper No. 20. ACC/SCN: Geneva.

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