SCN News No 34 - UNSCN

www.unsystem.org/scn SCN WORKING GROUPS 55
WORKING GROUP ON NUTRITION AND HIV/AIDS
Chair: Andrew Tomkins (Institute of Child Health), Co-Chairs: Stuart Gillespie (IFPRI), Randa Saadeh (WHO) and Bruce Cogill (UNICEF)
Highlights from discussions 25 and 27 February
Andrew Tomkins summarized achievements over the past year: greater
insight on effects of nutritional interventions on HIV disease progression and
recovery from severe malnutrition; Blantyre meeting on severe malnutrition
and HIV; increased recognition of nutrition within HIV at global and national
level including key agencies such as WHO, PEPFAR (President's Emergency
Plan for AIDS Relief ) Fund and Clinton Foundation; and, roles of industry in
financing projects and developing therapeutic foods (RUTF). Incorporation of
nutrition into HIV policies and programmes may increase collaboration
between HIV specialists (infectious disease clinicians) and nutritionists and
could foster the establishment of a Nutrition Support Unit within National and
Local HIV/AIDS committees.
Randa Saadeh gave an update from the UN highlighting capacity building,
policies and programmes, guidelines and resource mobilisation. Examples include
the Durban Consultation and Participants’ Statement, the Global Strategy
for Infant and Young Child Feeding, the new HIV/infant feeding framework
for priority actions, and the WHO/GFATM Framework for integrating food and
nutrition activities and interventions into HIV policies, programmes and funding
proposals. In addition there is the recent HIV and Infant feeding - Consensus
Statement October 2006 involving an even wider framework of collaboration.
Humanitarian reform concerns improved response through enhancing
capacity, leadership, accountability and predictability in 9 “gap” sectors. Bruce
Cogill described the Inter-Agency Steering Committee (IASC) Nutrition
Cluster which looks at coordination, capacity building, tool development,
assessments, eligibility criteria, response and supply. The Nutrition Cluster will
enable new ways of working at country level through greater collaboration
efforts. It will be rolled out in Democratic Republic of Congo (DRC), Liberia,
Uganda and Somalia.
Stuart Gillespie (IFPRI/RENEWAL) presented an analytical framework with
scientific and operational links between HIV/AIDS, Nutrition and
Livelihood/Food Security which can aid the development of evidence based
policies and programmes. Among the key questions still to be resolved are:
How should nutritional support be linked, where needed, to ARV therapy? How
can food supplements given with ARV be sustained, and should they be
sustained beyond the initial phases of treatment? How should interventions be
established when the HIV-positive individual lives within a community of other
individuals who may also be affected but not themselves living with the virus?
What role do food supplements play in AIDS-sensitive social protection
schemes by government?
Pamela Fergusson described cohort studies in Malawi of mortality,
nutritional recovery and immune status in relation to HIV status among
children with severe acute malnutrition (SAM). The place where death
occurred most often (paediatric wards) was similar for HIV infected and
uninfected children, implying the particular need to improve nutritional
management of severely malnourished children in the wards. Optimal timing
and dose regime of ARV was discussed.
Paluku Bawhere described impressive results of RUTF in the management of
SAM in general, and the good results among HIV infected individuals. A study
of SAM children gave almost 100% recovery to 85% weight/height in the HIVnegative
group, and nearly 50% recovery in the infected group. A cohort of
SAM HIV positive adults given 3 months nutritional support (500g/day of local
RUTF (Chickpea-Sesame recipe) providing 2,600 kcal/day and 70g protein/
day) showed very satisfactory rates of weight gain and high rates of recovery
from being bed-ridden to be able to walk or work. RUTF production has been
linked to income generation in the communities.
Topics discussed
Achievements in the past year
UN achievements
Humanitarian reform
IASC Nutrition Cluster
HIV, nutrition and food security
The need for ARV and for RUTF
HIV, SAM, mortality and ARV
HIV, SAM and RUTF
Some abbreviations:
Human Immunodeficiency Virus (HIV)
Sever Acute Malnutrition (SAM)
AntiRetroViral (ARV)
ARV Treatment (ART)
Ready-to-Use Therapuetic Food (RUTF)
Recommendations to SCN (extract)
1. Assess impact of nutritional
supplements among HIV infected
patients receiving ARVs, and those
not eligible
2. Integrate more effectively Nutrition
Services into HIV Services and
vice versa
3. Ensure that RUTF is made more
widely available and that
commercial promotion is not
inhibited by restrictive, potent
related, practices
Planned activities (extract)
1. Mid-year meeting to discuss the
impact of RUTF in HIV/AIDS.
2. Continue updating the Nutrition
and HIV/AIDS webpage
3. Meeting on Management of Severe
Acute Malnutrition with focus on
HIV was held 20 March at the
Centre for International Health and
Development, Institute of Child
Health London
For more details, please see
Working Group report and
presentations at the SCN Session,
as well as the Working Group’s
Nutrition and HIV/AIDS webpage
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