Nutrition and HIV/AIDS: A Training Manual - Linkages Project

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Conclusion (slide 36)The capacity to implement effective nutritional care and support depends heavily onhousehold food security. Information about optimal nutritional practices is often notsufficient to enable people living with HIV/AIDS to improve their health andnutritional status. Providers of nutritional care and support need to assess clients’food security situations and underlying factors, identify feasible dietary optionswithin the food security constraints, and where possible help address the sources offood insecurity through referrals or linkages to programs and through improvedhousehold practices and strategies.The remaining sessions of this module focus on specific dimensions of nutritionalcare and support. Successful implementation of each of these dimensions isundermined by food insecurity. Each nutritional recommendation and interventionrequires consideration of specific food security constraints and options to addressthese constraints. Considering the food security issues laid out in this session willenable stronger practical application of each topic’s information andrecommendations, thereby enabling improved nutritional care and support forpeople living with HIV/AIDS.Notes1. The United Nations Subcommittee on Nutrition (UN ACC/SCN 1991) defines foodsecurity in the following way: “A household is food secure when it has access to thefood needed for a healthy life for all its members (adequate in terms of quality,quantity and culturally acceptable), and when it is not at undue risk of losing suchaccess.” The International Fund for Agricultural Development (IFAD) organizeshousehold food security into the concepts of acquirement and utilization (“FoodSecurity – A conceptual framework”).2. This system was developed by Development Alternatives, Inc., and InternationalDevelopment Enterprises through the 5-year, USAID-funded LEAD (Linkages for theEconomic Advancement of the Disadvantaged) project (Dratt 2002). Promisingpractices on multisectoral approaches to HIV/AIDS. Washington, DC: PVO-USAIDSteering Committee for Multisectoral Approaches to HIV/AIDS; Kadiyala, S, and SGillespie. 2003. Rethinking food aid to fight AIDS. Washington, DC: IFPRI).89
ReferencesAlban, A, and L Guinness. 2000. Socio-economic Impact of HIV/AIDS in Africa. NewYork: UNAIDS.Bonnard, P. 2002. HIV/AIDS mitigation: Using what we already know. Washington,DC: FANTA Project, Academy for Educational Development.Bonnard, P, P Haggerty, A Swindale, G Bergeron, and J Dempsey. 2002. Report ofthe food aid and food security assessment: A review of the Title II Development FoodAid Program. Washington, DC: FANTA Project, Academy for EducationalDevelopment.Food and Nutrition Technical Assistance Project (FANTA). 2001. HIV/AIDS: A guidefor nutrition, care, and support. Washington, DC: FANTA Project, Academy forEducational Development.———. 2000. Potential uses of food aid to support HIV/AIDS mitigation activities insub-Saharan Africa. Washington, DC: FANTA Project, Academy for EducationalDevelopment.Gillespie, S, L Haddad, and R Jackson. 2001. HIV/AIDS, food security, and nutrition:Impacts and actions. Nutrition Policy Paper 20: Nutrition and HIV/AIDS. Geneva: UNAdministrative Committee on Coordination Sub-committee on Nutrition (ACC/SCN).Haddad, L, and S Gillespie. 2001. Effective food and nutrition policy responses toHIV/AIDS: What we know and what we need to know. FCND Discussion Paper No.112. Washington, DC: International Food Policy Research Institute.Horizons Project. 2002. Microfinance and households coping with HIV/AIDS inZimbabwe: An exploratory study. Washington, DC: Population Council, Inc.Kwaramba, P. 1997. Economic impact of AIDS in Africa. Geneva: UNAIDS. Availableat http://www2.montana.edu/scapalbo/presentation2.pptUNAIDS. 2002. Fact sheet: The impact of HIV/AIDS. Geneva.90
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Regional Centrefor Quality ofHealth
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ACKNOWLEDGMENTSThis training manual
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ABBREVIATIONS AND ACRONYMSACCAIDSAN
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INTRODUCTIONThe coexistence of high
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ContentThe content is arranged in t
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The sessions can also be taught in
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OutlineContent Methodology TimingDe
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LECTURE NOTES 1: THE BASICS OF HIV/
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gradually weakened. The infected pe
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increase in HIV prevalence of 60 pe
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infection may have a rapid onset, l
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• Dot-blot immunobinding assayUri
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• Removal of children from school
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effectively, care and support inter
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DISCUSSION POINTS 1================
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Recommended preparation1. Be famili
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LECTURE NOTES 2: LINK BETWEEN NUTRI
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AIDS, the impairment of immune func
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for healthy, non-HIV-infected peopl
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Low blood levels of several nutrien
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• Finally, a study of AIDS patien
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EXERCISE 2=========================
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SESSION 3 NUTRITION ACTIONS FOR PEO
Page 50 and 51: Required materials• LCD or overhe
Page 52 and 53: McDermott, AY, A Shevitz, T Knox, R
Page 54 and 55: Goals of nutritional care and suppo
Page 56 and 57: • Circumferences of the waist, hi
Page 58 and 59: Consider the phase of the HIV infec
Page 60 and 61: Promote adequate nutrient intake (s
Page 62 and 63: Stages of illness and symptoms. Sym
Page 64 and 65: TherapyNitrogenretention[g/day]Rate
Page 66 and 67: Nutrient supplements for people liv
Page 68 and 69: Conclusion (slide 31)Nutritional ca
Page 70 and 71: HANDOUT 3.1 Case studies in HIV and
Page 72 and 73: HANDOUT 3.2 Safe Food Handling Prac
Page 74 and 75: OutlineContent Methodology Timing1.
Page 76 and 77: Recommended preparation• Be famil
Page 78 and 79: PVO-USAID Steering Committee on Mul
Page 80 and 81: Nutritional care and support of peo
Page 82 and 83: In this session “food security co
Page 84 and 85: HIV/AIDS attacks food security not
Page 86 and 87: • Human capital: Reduced producti
Page 88 and 89: Food-insecure populations may also
Page 90 and 91: Food security constraints to nutrit
Page 92 and 93: Pregnant and lactating women (slide
Page 94 and 95: Implementation of nutritional care
Page 96 and 97: demand these foods. A good assessme
Page 98 and 99: Counselors should be aware of and i
Page 102 and 103: UNAIDS and WHO. 2002. AIDS epidemic
Page 104 and 105: 1. How does poor food availability
Page 106 and 107: 5. Will referrals and targeting of
Page 108 and 109: SESSION 5 NUTRITIONAL MANAGEMENT OF
Page 110 and 111: Required materials• LCD or overhe
Page 112 and 113: LECTURE NOTES 5: NUTRITIONAL MANAGE
Page 114 and 115: Figure 2 Cycle of malnutrition and
Page 116 and 117: IV. Late symptomatic phase (full-bl
Page 118 and 119: The following symptoms may also neg
Page 120 and 121: • Enables greater food intake by
Page 122 and 123: EXERCISE 5=========================
Page 124 and 125: HANDOUT 5.1 Caring for symptoms ass
Page 126 and 127: Illness Diet Care and nutrition pra
Page 128 and 129: SESSION 6 NUTRITIONAL CARE AND SUPP
Page 130 and 131: OutlineContent Methodology Timing1.
Page 132 and 133: Recommended preparation• Be famil
Page 134 and 135: ———. 1998. Randomised trial o
Page 136 and 137: LECTURE NOTES 6: NUTRITIONAL CARE A
Page 138 and 139: The stigma associated with HIV can
Page 140 and 141: of malnutrition, which increases th
Page 142 and 143: adolescent mother, growth and devel
Page 144 and 145: HIV infection increases the energy
Page 146 and 147: Anemia is common during HIV infecti
Page 148 and 149: The use of high levels of supplemen
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Nutritional care and support for th
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Management of secondary infections
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A. Nutrition history• Dietary int
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• Income, housing, amenities for
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multiple nutrient supplement, where
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Management of diet-related HIV prob
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Infant feeding options and risks (s
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insecurity and may increase malnutr
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Seumo-Fosso, E, and B Cogill. 2003.
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HANDOUT 6.1 Health Sector and Mater
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HANDOUT 6.2 A Guide to Nutritional
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• Educational levelLactating moth
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Did the counselor ask about: YES NO
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HANDOUT 6.4 Practical Consideration
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HANDOUT 6.5 Checklist for Nutrition
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HANDOUT 6.7 Dietary Management of C
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Dietary problemFeverNutritional int
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1. How could HIV infection affect R
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• Nutritional status, dietary int
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• Rita’s dietary intake and eat
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• Eating smaller, more frequent e
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• How was the nutritional assessm
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Estimated time: 120 minutes excludi
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Suggested reading materialsCoutsoud
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LECTURE NOTES 7: INFANT FEEDING AND
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• A viral, bacterial, or parasiti
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DNA (cell-associated virus) in colo
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Mucosal integrity (slide 18)Studies
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PMTCT interventions are most effect
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Breastfeeding techniquesIt is espec
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women with HIV/AIDS for additional
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• Providing skin-to-skin contact
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suitable for replacement feeds befo
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• Administration of ZVD and Lamiv
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Coutsoudis, A, et al. 2001. Are HIV
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Semba, RD, N Kumwenda, D Hoover, et
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Case study 1A school teacher, Regin
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• How would you respond to Hilary
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HANDOUT 7.2 PMTCT Decision-Making A
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OutlineContent Methodology Time1. E
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Suggested reading materialsAgostoni
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LECTURE NOTES 8: NUTRITION AND HIV/
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Despite these statistics, it is dif
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Etiology of growth failure among HI
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oys. Micronutrient deficiencies wil
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• Changes in eating behaviors ass
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• Address issues relevant and of
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Enhanced ARV therapy (slide 29)Chil
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• Refer children with severe maln
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DISCUSSION POINTS 8Questions for cl
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Action/activityNorman admitted to n
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OutlineContent Methodology Timing1.
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• Allocate time for each activity
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Food Medication Interactionswww.foo
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• Describes information collected
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• Antimalaria drugs such as quini
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Food effects on drug efficacy (slid
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Some antiretroviral drugs may affec
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MedicationPurposeRecommended Tobe t
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intake and poor nutrient absorption
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Anti-acid medications containing ma
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women’s nutritional status. It is
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Health provider capacityHealth prov
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• What foods should not be taken
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Gelato, M. 2003. Insulin and carboh
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eferred him to the counselor for th
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Medication Purpose Recommended Tobe
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Medication Purpose Recommended Tobe
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Side effects of each drug?Side effe
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PurposeTo provide basic information
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Factors in Transmissionand Vulnerab
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Impact on the Education Sector• D
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AcknowledgmentNutrition and HIV/AID
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Body Habitus ChangesMetabolic chang
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PurposeTo provide general nutrition
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Stages of HIV Disease andNutritionI
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IncreaseVitamin and Mineral IntakeS
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Lipodystrophy• Means fat maldistr
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PurposeTo introduce the constraints
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Effect of AIDS on Crop ProductionCr
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Pregnant and Lactating WomenFood an
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Session 5 Nutritional Management of
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Rationale, Cont.Importance of Manag
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Session 6 Nutritional Care and Supp
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Vulnerabilityof Women and Young Gir
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What Is Not KnownComparison of Nutr
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Purposeof Nutrition Care and Suppor
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Greatest Impact of NutritionImprove
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Size of the Problem in Africa• >3
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Possible Mechanisms ofTransmissionA
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Prevention-to-Care ContinuumInterve
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Session 8 Nutritional Care for Youn
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ChildrenBorn to HIV-Positive Mother
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Growth Failure Associated withIncre
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Enhanced ARV Therapy• To reduce v
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Care of the Terminally Ill ChildWhy
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PurposeTo provide knowledge and ski
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SIDE EFFECTS OF DRUGSaffectFOOD INT
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