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December 1, 2006
New Report Highlights Challenges of Integrating
Food into HIV Programs
More holistic global model of care & new development partnerships with focus on poverty needed to respond to urgent demand for food by millions with HIV and AIDS in hard-hit regions.
San Francisco-A new report entitled “Overlapping Epidemics: Challenges and Strategies for Integrating Nutrition and HIV Programs” – Grassroots Perspectives on a Global Problem” is being issued today by the Women’s Equity in Access to Care and Treatment (WE-ACTx). WE-ACTx is an international nonprofit AIDS program that began working in Rwanda in 2004 to provide HIV care and antiretroviral (ARV) treatment access to genocide and rape survivors, in partnership with the Rwandan government and local NGOs. WE-ACTx runs two clinics in Kigali serving ~ 5000 clients.
The new report examines the challenges facing grassroots AIDS groups and provider NGOs globally who are facing a rising demand for food that experts say may soon eclipse antiretroviral medicine. The report summarizes the views and ‘best practice’ ideas of representatives in international and local agencies working across the fields of HIV/AIDS, nutrition and development. Research for the report was supported by a grant from Keep a Child Alive (KCA) in New York.
“WE-ACTx is facing the urgent challenge that most groups working in the field of AIDS in poor countries are dealing with today, which is hunger and poverty that are root causes of the epidemic,” said Anne-christine d’Adesky, co- author of the report, and Executive Co-Director of WE-ACTx. She is also author of the 2004 global AIDS book, ‘Moving Mountains,’ which profiled challenges and successful efforts of early pioneers introducing HIV treatment around the world.
“Food remains the number one need of many of our clients, alongside antiretrovirals,” said d’Adesky. “Without food, people are often reluctant to start ARVs, which may be difficult to take without food, or they struggle to maintain good health if they lose access to food. We need global AIDS policies and more holistic, practical guidelines that address the link of HIV to food insecurity and poverty and gender inequity — and their impact on each other.”
WE-ACTx has been working with Rwandan NGO partners to identify and implement innovative solutions that support sustainable food access for HIV clients. “We particularly wanted to identify best practice approaches that can be shared with other grassroots groups,” said d’Adesky.
Among the findings of the report:
- Malnutrition, food insecurity and poverty remain critically overlooked factors in the global HIV pandemic. According to the UN World Food Programme, 13.8 million people will need access to HIV/AIDS care by 2008, and 6.4 million of them will need nutritional support. Out of 6.6 million also needing access to ARVs, 0.9 million will need food aid. The demand for food will increase as more people access ART based on present trends.
- The devastating impact of AIDS on the rural agricultural sector is greatly increasing food insecurity and especialy. threatens women who make up the majority of smallholder farmers in hardest-hit southern Africa. One analyst warned in 2003 that, in extremis, AIDS could produce a new ‘variant famine’ targeting rural Africans.
- Extreme poverty threatens to blunt the benefit of HIV therapy for severely malnourished individuals, who are six times more likely to die than those on ART who are not malnourished. Malnutrition decreases one’s ability to absorb HIV medicine and cope with drug side effects, and prolongs the length of recovery to natural immunity.
- Globally a more holistic model of HIV care that integrates nutrition and nutrition education, and sustainable food security and livelihood strategies is needed to address the root issue of poverty. Field providers call upon the World Health Organization to move faster to quickly develop and disseminate practical holistic field guidelines to help guide those implementing programs at the grassroots level.
- A multisector “partnership” approach can bring together groups working HIV and AIDS with those working in sustainable development fields. The private sector has an important role to play, helping to manufacture food, providing business resources to local NGOs, and opening markets for products made by their HIV clients.
- Nutrition is not specifically mentioned in the global ‘Three Ones’ principles adopted in 2001 as a framework for harmonizing national HIV programs.
- Funding for nutrition must be included in funding mechanisms to scale-up global access to HIV treatment. Experts estimate the global cost of providing nutrition to HIV-positive individuals for the next two years to be $1.1 billion — just 2% of $55 billion required to tackle the pandemic by 2008.
- A household vs. individual approach to nutrition, food access and security, and HIV is best to address the dynamic impact of overlapping illness and chronic poverty that affects families with HIV-affected members.
- Gender inequity contributes to a higher degree of poverty, malnutrition and vulnerability to HIV in women and requires specific strategies aimed at empowering women. Securing property and inheritance rights for women and children is an essential part of battling poverty.
- A range of nutrition interventions should be considered within a continuum of HIV care model, with a range of entry and exit points for interventions at different stages of malnutrition, illness and HIV status. Short-term food aid is a lifesaving intervention for severely malnourished HIV-positive individuals and needed by many starting ART, but should be linked to sustainable food security or income generation programs.
- The nutritional needs of HIV-positive refugees requires better coordination by humanitarian, refugee affairs, and public health providers with local community groups, and benefits from input by refugees into program design.
This report will be available at the WE-ACTx and KCA websites (www.we-actx.org | www.keepachildalive.org).