National Nutrition and HIV/AIDS Guidelines for Service Providers of ...

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CHAPTER 12 HIV/AIDS, NUTRITION AND FOOD SECURITY “When you ask people with HIV and AIDS in rural communities in the developing world what their highest priority is, very often their answer is food. Not care, not drugs for medical treatment, not relief from stigma, but food” (Piot and Pinstrup-Andersen, 2002; p11). This chapter deals with coping strategies which could be used as a guide to meet the nutritional needs of PLWHAs in food insecure situations. Food insecurity exists whenever the availability of nutritionally adequate and safe foods or the ability to acquire foods in socially acceptable ways is limited or uncertain. To be food secure, all people must be having social, physical and economic access to safe, nutritious, adequate and culturally acceptable food at all times. Household food security is characterized by four components, namely availability, accessibility, utilization and sustainability. To achieve these, households must not only have the ability to produce, purchase or store food but, must also have adequate knowledge on food groups and their nutritive value, food preparation and balancing of meals. Nutrition security implies that food security is a necessary but not sufficient precondition for ensuring satisfactory consumption and nutrition of the individual (Mugabe et al.,1998). At the aggregate level a household can be food secure while individual members are nutrition and food insecure. Intrahousehold food distribution should take into account the different nutritional needs of individual members of the household. In addition, for an individual to be nutrition secure there should be adequate nutrient intake and efficient utilization by the human body. 12.1 How HIV and AIDS affect food security HIV and AIDS are a threat to human health and to the social and economic aspects of life. HIV/AIDS has a devastating effect on nutrition and food security. HIV/AIDS increases the risk of food insecurity through its impact on productive labour, earnings and savings. Most often, individuals cut back on food intake by reducing portion size or skipping meals, diverting any earnings and savings to meet health care and funeral costs. This leads to poverty, increased vulnerability to risky behavior such as sex for food and money, child labour, crime and drug abuse, etc. Labour of healthy family members is often shifted from normal food production activities to caring for sick household members. HIV and AIDS thus affect household food security. A majority of households with PLWHA are chronically food insecure. They may be unable to follow food and nutrition recommendations due to their inability to access food required through the market or own production. 56
Key Concepts: ° Availability: Food availability addresses the issue of adequacy, variety and consistency in supply of nutritious foods to households. ° Accessibility: Food accessibility deals with the means to obtain adequate quantities and varieties of foods for every family member. ° Utilization: Utilization is about ensuring that every household member is able to properly use the food resources to meet their daily energy and nutrients requirements. ° Sustainability: Sustainability in food security is when households are food secure and family members are able to meet their food entitlements all the times. HIV and AIDS affect household food security and nutrition through multiple routes. The impact is clearly felt through diminished income, reduced well-being, increased vulnerability and high food insecurity and malnutrition, especially in the rural areas. In situations where adults are terminally ill or have passed away, children are often left to make decisions on the running of households. In most cases, they have limited decision making experience, limited access to resources, less knowledge and physical strength required to run and maintain the households' livelihoods (IFPRI, 2002). There is often a shift from labour intensive to non-labour intensive farming activities (to compensate for lost labour through HIV and AIDS) without considering the nutritive value of the substitute produce. Affected farming households tend to switch to maize crop because it requires less work particularly in terms of fighting pests like birds that feed on crops and has a better market value. Yet, this switch is more of a Devil's Trade-off. Maize is both a heavy feeder and it depletes the soil. Maize is also less drought resistant than sorghum or millet. Generally maize has fewer amino acids than millet and sorghum, and does not provide an adequate nutritional substitute which is crucial for HIV infected people (Yamano and Jayne, 2004). Culturally, women are charged with responsibility and are expected to have knowledge on food preparation, how much and what needs to be consumed in the household. However, with the advent of HIV and AIDS, these roles have shifted to caring for the sick (by women) leading to compromised household nutrition as under aged children may be required to take the responsibility of doing household chores like cleaning and food preparation. The combined effects of all the above, result in declined family welfare, reduced productive capacity of households, depleted savings and increased demand for care and support for the sick and orphans, leading to food insecurity and malnutrition. 12.2 Agriculture- related Adjustments of PLWHA and Affected Households Given the effects of HIV and AIDS as discussed in the previous section, PLWHA and affected households have been found to adjust in the following ways: ° Non-adherence to nutrition recommendations e.g. Reduction of food intake or skip meals. ° Migration of adults in search of work, this leads to the fragmentation of affected households. ° Adoption of risky behavior such commercial sex to raise cash for food. ° Witdrawal of children from school to care for sick family members and/or their 57
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NATIONAL NUTRITION AND HIV/AIDS GUI
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ACKNOWLEDGEMENTS Developing these g
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4.1.3 Symptomatic 18 4.1.4 Advanced
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TECHNICAL WORKING TEAM MEMBERS 1 Mr
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GLOSSARY LIST Asymptomatic: When a
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declining though still high, from 4
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1.8 Layout of the Guidelines Each c
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Page 26 and 27: CHAPTER 3 THE RELATIONSHIP BETWEEN
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Page 30 and 31: clients, preference should be given
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Page 34 and 35: 4.3.3 Clinical The key in clinical
Page 36 and 37: 5.1.1 Nutritional Screening It is r
Page 38 and 39: ° Ensure that all immunizations an
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Page 46 and 47: CHAPTER 8 PROTECT THE QUALITY AND S
Page 48 and 49: 8.5 Hygiene in the Kitchen ° Keep
Page 50 and 51: CHAPTER 9 PLWHA may take various ty
Page 52 and 53: As the effect of food on the effica
Page 54 and 55: Medication Purpose Recommendation/
Page 56 and 57: Appropriate dietary responses Appro
Page 58 and 59: that are presently marketed in Bots
Page 60 and 61: ° For PLWHA living in areas where
Page 62 and 63: HERB Sore mouth and throat Recommen
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Page 66 and 67: warmth, understanding, and respect
Page 70 and 71: younger siblings. ° Sale of key as
Page 72 and 73: ° Emphasize and support small scal
Page 74 and 75: ° Are there any dietary changes am
Page 76 and 77: ANNEXES ANNEX 1: Scientific Or Engl
Page 78 and 79: ANNEX 3: Nutrient Composition of a
Page 81 and 82: Annex 5: National Nutrition and HIV
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