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

Both types of programme should ideally incorporate a nutrition education component that
provides community members (particularly the chronically ill and their caretakers) with skills
in food preparation and hygiene. HIV/AIDS sets in motion a complex struggle between the
body’s immune defences – which are affected by stress, nutritional status and other factors – and
disease agents, including HIV and environmental pathogens. People found to be HIV-positive
can stay relatively healthy by eating well, adopting healthy behaviours (e.g., hygiene, exercise,
prophylactic treatment), and seeking medical care when health problems arise. For the majority
of refugees living with HIV/AIDS in low-income countries, medical management of their
disease is confined to primary care at the local health clinic. Antiretroviral therapy remains
unavailable or unaffordable for the majority of refugee communities in low-income countries.
Local health staff may be poorly equipped to identify and manage the opportunistic infections
that frequently afflict those living with HIV, or to provide nutritional support or education.
In addition to providing nutritional care as part of routine activities, hospital and clinic
(facility-based) services can be a springboard for better home-based nutritional management of
people living with HIV/AIDS. For example, nutrition education and the involvement of family
members during inpatient feeding can be used to relay useful information to households about
care and support. Demonstration gardens at the hospital can be used to supplement the diet
with fresh foods, while at the same time encouraging households to set up homestead gardens
producing nutritious foods. Outside the facility setting, nutritional support can be incorporated
into AIDS-related care through provision of a ration (and nutrition education), either as part
of a home-based care programme for PLWHA, or to all participants in an ART programme.
Finally, nutrition can be integrated into a PMTCT programme.
As illustrated in Figure 6, VCT is an entry point to prevention, care and support services for
PLWHA, their partners and children. It is vital that the implementation of VCT services go
hand in hand with the development of care, treatment and support programmes at the facility
and household levels. The demand for VCT services is directly associated with the availability
of treatment and management options. Health care services for refugees with HIV/AIDS
should aim to provide facility-level medical and nutritional support, linked to longer-term
community-level medical and nutritional support, ideally in combination with livelihood
support interventions.
All camp-based health service providers, including agency staff and volunteers, should be given
nutritional training appropriate to their responsibilities. Health service providers (e.g., traditional
birth attendants, community health workers, community social workers, peer educators,
traditional healers, clinic staff, home-based care staff) have frequent contact with vulnerable
and chronically ill populations, and are in a position to provide valuable nutritional guidance.
With training, health service providers could advise patients on proper preparation of foods,
home gardening, and dietary diversification. Training should take into consideration locally
available foods, particularly where a population relies on a general ration, and the financial
constraints of the population. Where possible, training should be given on a continuing (rather
than a one-off) basis. In Zambia, for example, community health workers received training on
incorporating nutrition into their regular health education activities.
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