Academy for Educational Development

AED Efforts Provide Insight On Nutrition’s Role in Battling HIV/AIDS

An estimated 40 million people are living with HIV and AIDS worldwide, according to a joint UNAIDS/World Health Organization report. As this population increases, nutrition is emerging as a critical factor in care of and support for these people, particularly in Africa.

People infected with HIV have greater nutritional needs, and adequate diets are essential to promoting a strong immune response and helping people manage the symptoms and side effects of HIV-related illnesses and treatments.

In countries where malnutrition is endemic, maintaining adequate nutrition is a major challenge, and one that several AED projects are working together to address AED’s work in this area began in 2000, when the Support for Analysis and Research in Africa (SARA) project published “HIV/AIDS and Nutrition: A Review of the Literature and Recommendations for Nutritional Care and Support in Sub-Saharan Africa.”

"People infected with HIV have greater nutritional needs, and adequate diets are essential to promoting a strong immune response"

This paper was one of the first attempts to bring together the complex issues surrounding both malnutrition and HIV in Africa, and to make recommendations for programs. Its focus on care of and support for people living with HIV and AIDS built on nearly 20 years of AED work in HIV prevention, from behavior change and communication to policy analysis and advocacy. “The paper was written for policy makers and program managers in Africa and has been used to increase awareness and understanding throughout the world,” said its coauthor Ellen Piwoz, nutrition advisor for SARA and co-director of the AED Center for Nutrition.

In the years since the paper’s publication, AED has become a leader in addressing the nutritional needs of people living with HIV/AIDS in resource-poor settings. “Our work covers a wide spectrum, from advising the World Health Organization, to assisting national governments with development of guidelines, to disseminating information and training front-line health workers who provide HIV-related care and support. We do this by working together, across several USAID-supported projects,” says Piwoz. “When you look at communities affected by the HIV/AIDS pandemic, food and nutrition is one of their number one concerns,” says Piwoz.

Helping Countries Develop National Guidelines

AED has helped 11 countries in East and Southern Africa, the region most affected by HIV/AIDS, to develop and implement national guidelines on nutrition and HIV/AIDS. This has been accomplished through three major projects—Food and Nutrition Technical Assistance  (FANTA), SARA, and LINKAGES, an infant and maternal nutrition project—working in partnership with African institutions such as the Regional Centre for Quality of Health Care (RCQHC) in Uganda and the Commonwealth Regional Health Community Secretariat in Tanzania.

As a result of this work, FANTA and the RCQHC developed a handbook on how to develop and apply national guidelines that is being used widely to help countries work through this process. “From an advocacy point of view, the national guidelines process has helped to put nutrition on policy makers’ radar screens as an important component of HIV/AIDS programs,” says Tony Castleman, senior program officer for FANTA.

“At the program level, it’s providing consistent recommendations about nutritional care and how to integrate nutritional counseling into HIV/AIDS services.”FANTA is working in Uganda, Rwanda, Zambia, and Kenya to integrate nutrition into HIV/AIDS services. In Ssembabule, Uganda, people living with HIV/AIDS learned about making changes in food choices and preparation to help ease symptoms of HIV-related infections such as oral thrush.

Improving the Quality of Nutrition Training and Counseling

Improving health care workers’ capacity to counsel and provide nutrition services for people living with HIV/AIDS is another area where AED is leading the way. FANTA, SARA, and LINKAGES, in collaboration with Uganda’s RCQHC, worked together to develop “Nutrition and HIV/AIDS—A Training Manual” to help doctors and health care workers provide better care for people living with HIV and AIDS.

In addition to providing a comprehensive source of information on the subject, the manual includes technical content, exercises, and handouts that instructors can use in course work. South Africa is using the manual in its national training of health workers. While health workers play an important role in helping people living with HIV/AIDS to manage the disease, nutrition counselors can help improve their daily functioning by providing information about the impact of their food intake on their overall health.

According to Castleman, “Service providers are recognizing that to really improve the well-being of people living with HIV/AIDS, we need more than a strictly medical approach.” That’s why AED is now developing job aids for nutrition counselors. These counselors not only help people living with HIV/AIDS feel better physically,  they also provide them with a strong sense of support by listening to each patient’s needs and the individual constraints that affect  is or her diet.

“It really helps to build the dignity of people living with HIV/AIDS,” says Castleman. “By helping people eat better and manage problems, nutritional counseling transforms the interaction between service providers and their clients,” said Castleman.

HIV-positive Mothers and Their Babies

Good nutrition has a measurable impact on the health and well-being of HIV-positive others and their babies, and the risk of HIV transmission from mother to child is directly related to the health status of the mother. A study conducted by Harvard University and Muhimbili University in Tanzania found that an HIV-positive woman with good health and nutritional status is less likely to pass the virus onto her child.

According to the LINKAGES publication, Spotlight on PMTCT, ”nutritional care and support may be the only treatment to which many HIV-positive women have access, and HIV-infected pregnant and lactating women have special nutritional requirements. To support breastfeeding and maintain breast milk reserves, mothers need to eat an extra meal a day.

"In the midst of all this pessimism, nutrition is bringing hope to people living with HIV/AIDS."

Reduced appetite brought on by HIV can make this very challenging. One way LINKAGES is helping to improve the nutrition of HIV-positive mothers in Zambia, Malawi, Ethiopia, and Haiti is by informing them about ways they can increase their food intake, such as eating more frequent, smaller meals and adding a greater variety of food to their diet.

Sharing Information across Borders

In areas with very limited resources, information sharing can be invaluable for NGOs and health workers who are trying to mitigate the impact of HIV/AIDS on individuals and their communities. Through its partnership with SatelLife, AED administers an electronic forum, ProNut-HIV, which allows professionals to share up-to-date information, knowledge, and experiences in nutrition and HIV.

The forum also promotes dialogue among people living with HIV/AIDS, health workers, HIV/AIDS specialists, and policy makers. “People are really thirsty for information about nutrition and HIV/AIDS, what to do, and how to do it,” says Eleonore Seumo-Fosso, who designed ProNut-HIV and moderates the forum. A recent evaluation of ProNut-HIV reveals it has helped 92 percent of respondents in “sharing knowledge,” and nearly half of those responding are “using the information in their work and/ or life.”

Moving Forward

AED is continuing to make progress into how nutrition can help people living with HIV/AIDS  have healthier, fuller lives. AED is working on a groundbreaking study in Malawi in conjunction with the University of North Carolina and the Centers for Disease Control and Prevention that explores the link between nutrition and anti-retroviral drugs.

Castleman and Piwoz addressed that link recently during an April presentation at the World Bank, titled “Integrating Nutrition into ARV Treatment Programs: Evidence, Experience, and Suggested Actions.” In addition, through FANTA, AED is developing guidelines and applications for the use of specialized food products in the context of HIV/AIDS. The guidelines will explain the differences among the various products and which ones to use in different contexts and at different stages of the disease. “In the midst of all the pessimism, nutrition is bringing hope to people living with HIV/AIDS,” says Seuomo-Fosso.

Read more about AED's work in nutrition and HIV/AIDS.

Or, visit www.fantaproject.org, www.linkagesproject.org, and sara.aed.org.