This document discusses the interrelationship between food security, nutrition, and HIV/AIDS based on ongoing field work. It finds that HIV infection can undermine food security through reduced productivity and access due to illness. Undernutrition exacerbates HIV disease progression through increased nutrient needs and impaired immunity. Food assistance interventions face challenges in targeting undernourished HIV+ individuals before severe immune decline. Preliminary findings show high rates of food insecurity and nutrient deficiencies among HIV+ households. A food intervention providing animal-source protein biscuits aims to delay disease progression and improve outcomes.
The Interrelationship between Food Security, Nutrition, and HIV: Findings from Ongoing Fieldwork
1. The Interrelationship
Between Food Security,
Nutrition and HIV/AIDS
Findings From Ongoing
Field Work
G. Ettyang, J. Ernst, , C. Neumann,
W. Nyandiko, A. Siika, and C. Yiannoutsos,
2. Session Outline
Food Security and HIV/AIDS
Under-nutrition and HIV/AIDS
Challenges to food assistance interventions
The HNP Approach
Preliminary findings
Concluding Remarks
4. Elements of Food Security
Food security
Access
Availability Access Utilization
5. Limitations to Food Security
in the context of HIV/AIDS
Food Availability
Production failures related to labor constraints
Gender inequality in land tenure
Loss of productive assets needed to sustain household food
production.
Food Access
Affected households and infected individuals are too ill or
overburdened to earn money to buy food
Due to stigma HH may have limited access to community net
works and markets.
6. Limitations to Food Access
in the context of HIV/AIDS
Affected households and infected individuals are
too ill or overburdened to earn money to buy
food
Due to stigma HH may have limited access to
community net works
markets
trade associations.
8. Coping Strategies
HIV infection itself undermines food security
and nutrition by reducing work capacity and
productivity and jeopardizing house hold
livelihoods leading to ;
Eating less
Substituting less nutritious foods
Selling assets
Using savings and investments to pay for basic needs
and medical care .
10. The vicious cycle of Under-nutrition
and HIV
. Poor Nutrition
resulting in weight loss,
muscle wasting, weakness,
nutrient deficiencies
Impaired immune system
Increased Nutritional
Poor ability to fight HIV
needs,
Reduced food intake HIV and other infections,
Increased oxidative
and increased loss of stress
nutrients
Increased vulnerability to
infections e.g. Enteric
infections, flu, TB hence
Increased HIV replication,
Hastened disease progression
Increased morbidity
Source: Adapted from FANTA 2003
11. Affects of HIV/AIDS on Nutrition
Decrease in the amount of food consumed
Mouth and throat sores
Side effects from Medication
Household food insecurity and poverty
Impaired nutrient absorption
HIV infection of intestinal cells
Frequent diarrhea and vomiting
Opportunistic infections
12. Affects of HIV/AIDS on Nutrition
Changes in metabolism
Increase in energy (10-15%) requirements
Infection increases demand for and utilization of
antioxidant vitamins (E, C, beta-carotene) and
minerals (zinc, selenium, iron)
Insufficient antioxidants from increased utilization
causes oxidative stress
Increases HIV replication
Leads to higher viral loads
13. Effects of Nutrition on HIV/AIDS
Weight loss associated with HIV infection,
disease progression, and mortality.
Poor absorption of fats that affects use of fat-
soluble vitamins such as A and E
Some nutrient deficiencies (vitamins A, B12, and
E, selenium and zinc) associated with HIV
transmission, disease progression and mortality.
15. Food Assistance and Disease
Progression
Given when PLHIV are already undernourished ( BMI
< 18.5) and with a compromised immune status (CD4+
count falls < 200 cells per cubic millimeter).
CD4+ count takes only about a year to decline from
350 to < 200
Risk of death increased by 69% when the initiation for
therapy is delayed until the CD4+ count drops to <350
cells per cubic millimeter.
Dearth of evidence on when food assistance may
be initiated for the asymptomatic patient.
16. Importance of early Food Assistance
Efforts
At prevention stage
Access to food may reduce adoption of livelihood
strategies that increase susceptibility to HIV
infection.
At HIV asymptomatic
Food assistance efforts to strengthen livelihoods and
meet nutrient needs can promote positive living for
PLHIV.
18. Project Background
The GL-CRSP through USAID and in partnership with
AMPATH is funding a food intervention project that is being
implemented in a rural community in Western Kenya.
The food intervention project has improvement of house hold
food security through an increased intake of animal source foods
as one of its core objective
Expected outcomes include changes in
immune and nutritional status
HIV viral load
Work productivity
quality of life
mortality
19. Project Background
Study design and target population
A randomized food intervention study
HIV+ drug naïve rural Kenyan women enrolled in
the Turbo AMPATH clinic.
The food intervention
Typical biscuit recipe modified to incorporate an
animal source protein
20. Project Background
Food intervention approximate nutrient content
per 100 grams:
Energy 460 kcals
Protein 23.2gm
Iron 2.65mg
Zinc 2.56mg
Selenium 0.02mg
Vitamin B12 1.88µg
21. Project Background
Food intervention properties
Ready to use with hardly and preparation
requirements
Palatability and digestibility taken into account
There is no need for fortification
Well accepted by both children and adults
22. Project Background
Key project incentives
safe water filters
bed nets
dairy goats
Education and training
animal husbandry ( goat)
Nutritional care and support
24. The food intervention
Intra household distribution and intervention
sharing has been avoided by ensuring observed
consumption of the biscuit.
Data collection is on going on perceived
acceptability
quality
satisfaction
25. Data collection methods
30 HIV+ drug naïve classified as WHO Stage 1 or 2
with a CD4 count > 250.
A cross-sectional survey used to collect base line
demographic and socioeconomic data.
Proxy measures of household food access and nutrient
intake.
Dietary Diversity Score (HDDS)
Months of Inadequate Household Food Provisioning
(MIHFP)
The 24 hr food recall questionnaire
Medical records source of information on CD4 count
status.
26. Household Characteristics
Land ownership
No land 39% (12)
No cultivated land 27% (9)
< 2 acres cultivated 61%(20)
Income
< 285US $/per year 71%(22)
Source of income
Casual work 42% (13)
Self employed 26% (5)
Farm labour 16% (5)
27. Extent of HH food access
Household Dietary Diversity Score (HDDS)
High prevalence of low food diversity in diets
Mean (± SD) score 6.10 ± 1.9
Months of Inadequate Household Food
Provisioning (MIHFP)
Mean (± SD) score 5.17± 1.4
28. Extent of HH food access
Months of Inadequate Household Food
Provisioning (MIHFP)
Worry due to inadequate food 37% (11)
No resource to get preferred food 43% (13)
A limited variety of foods eaten 63%(19)
Eating small meals 33%(10)
Eating fewer meals 37%(11)
29. Adequacy of Nutrient Intake
Mean (± SD) nutrient intake based on 24hr recall
Energy 1413 kcals ± (149)
Protein 67.5 g ± (11.3)
Vitamin A 318 µg ± (71.1)
Folic acid 79.5 µg ± 11.1
Vitamin B1 12.1 mg ± (10.6)
Vitamin B2 1.0 mg ± (0.13)
Zinc 4.3 mg ± (0.59)
Iron 28.2 mg ± (4.8)
30. Adequacy of Nutrient Intake
Percent consuming < the RDA
Energy 74%
Protein 43%
Vitamin A 77%
Folic acid 87%
Vitamin B1 43%
Vitamin B2 73%
Zinc 100%
Iron 40%
31. Health and Immune Status
Mean (± SD) baseline CD4+ 361 ± (22)
After 3 months before food intervention
On drugs 13% (4)
Dead 3% (1)
> CD4+ 30% ( 9)
33. Anticipated outcomes
Our aim is to delay the decline in nutritional status and
initiation of ART.
Contribute to development and implementation of
consistence evidence based strategies in nutritional
support and care.
Promote positive living for PLHIV by improve their
immune function, quality of life and productivity.
Contribute to enhancement of nutritional assessment
Foster collaboration with new partners
34. Our most dramatic outcome
At approximately 4 yrs
unable to stand or play
After 4 weeks of food intervention
35. Acknowledgement
.
This research was made possible through support provided to the
Global Livestock Collaborative Research Support Program by the
United States Agency for International Development under terms
of Grant No. PCE-G-00-98-00036-00 and by contributions of
Moi University USAID-Academic Model Providing Access to
Healthcare (AMPATH) Program.