Integration of HIV/AIDS activities with food and nutrition support in ...

In populations that are highly affected by HIV/AIDS, it is especially important that energy,
protein, fat, and micronutrient intake is sufficient to help prevent weight loss
and to help patients cope with opportunistic infections. In refugee settings, this means
that the ration should meet international standards (for a population fully dependent
on food aid the average need is often 2100 kilocalories per person per day), with 10–12%
of total energy coming from protein and 17% from fat.
A stable supply is critical to prevent interruptions in food access, which may be
particularly devastating for people who are ill. Depending on the estimated HIV
prevalence, the energy content of the general ration and the absolute protein and fat
content may be increased to reflect increased needs. RDA levels of micronutrients should
be ensured through fortification of commodities in the food basket, complemented
by consumption of fresh foods. Blended foods (e.g., corn–soya blend) should be included
to provide an energy- and nutrient-dense, easily prepared food.
Where blended foods are distributed according to World Health Organization
recommendations (40–50 g/day), an additional 20–30 g may be considered to support
PLWHA. Cereals and grains should be milled and fortified prior to distribution, until
reliable on-site fortification systems can be put in place. Families affected by HIV/AIDS
may need assistance with milling and transport of the ration.
What does this integrated programme strategy aim to achieve?
Good nutrition is necessary for health and survival. For people living with HIV/AIDS,
good nutrition (including access to adequate food and clean water) can play an important
role in slowing disease progression, fighting off illness, and maintaining quality of life.
People living with HIV/AIDS are nutritionally vulnerable and have heightened energy
requirements. It is therefore particularly important to ensure access to adequate foods in
high HIV prevalence settings. In some settings, it may be possible to help meet needs through
targeted feeding programmes (see Strategy 6). However, it may be more feasible to make
changes in the general food ration for the entire population than to try to reach HIV/AIDSaffected
individuals with targeted supplementary feeding.
No evidence-based guidance exists on how to adjust the energy content of the general ration in
light of HIV/AIDS. The SPHERE handbook and the interagency document, Food and nutrition
needs in emergencies, 19 recommend an increase of 100–200 kcals to the initial planning
figure (2100 kcals) where the health or the nutritional status of the population is extremely
poor; however HIV/AIDS is not explicitly mentioned. Clearly, for programmes that directly
reach people with HIV/AIDS who know their HIV status, the recommendations in Box 3
regarding higher energy needs are directly relevant and should be strongly considered when
designing the ration. Whether or not the energy content of the ration is adjusted, actions can
be taken to protect the nutritional value of the general ration for an AIDS-affected population,
such as ensuring the inclusion of fortified milled cereals, a fortified blended food, and assistance
with distribution for those who need it.
There are three options to consider when deciding whether to adjust the energy content of the
general ration in emergency contexts (see below). Each of these options has potential benefits
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Integrated Programme Strategy 5:
Modification of a general food distribution programme
to better meet the needs of people affected by HIV/AIDS