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

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insecurity and may increase malnutrition, particularly in nutritionally vulnerablepregnant and lactating women and children.HIV/AIDS adds to the already heavy burden women face as workers, caregivers,educators, and mothers (slide 47). Women are responsible for caring for the sickwhen they themselves may be infected. At the same time, in many countries theirlegal, social, and political status makes them more vulnerable to HIV/AIDS.ReferencesAmerican Dietetic Association and Dietitians of Canada. 2000. Manual of clinicaldietetics. Sixth edition. Chicago, Illinois.Clark, TD, and RD Semba. 2001. Iron supplementation during humanimmunodeficiency virus infection: A double-edged sword? Med Hypotheses 57(4):476-79.Coutsoudis, A, et al. 2001. Are HIV-infected women who breastfeed at increased riskof mortality? AIDS 15: 653-55.———.1999. Randomized trial and testing the effect of vitamin A supplementation onpregnancy outcomes and early mother-to-child HIV-1 transmission in Durban, SouthAfrica. South African Vitamin A Study Group. AIDS 13:1517-24.Fawzi, W, et al. Randomised trial of effects of vitamin supplements on pregnancyoutcomes and T cell counts in HIV-1 infected women in Tanzania. Lancet 16; 351(9114): 1477-82.———. 2000. Randomized trial of vitamin supplements in relation to verticaltransmission of HIV-1 in Tanzania. J Acquir Immune Defic Syndr 23: 246-54.———. 2002. Randomized trial of vitamin supplements in relation to transmission ofHIV-1 through breastfeeding and early child mortality. AIDS 27; 16(14): 1935-44.Gorduek, VR, et al. 2001. Iron status and the outcome of HIV infection: an overview.J Clinical Virology 20: 111-15.153
Huffman, S, et al. 2001. Essential health sector actions to improve maternalnutrition in Africa. Washington: Academy for Educational Development/LINKAGESProject.Institute of Medicine. 1990. Nutrition during pregnancy. Part 1: Weight gain, part II:nutrient supplements. Washington, DC: National Academy Press.Joint United Nations Programme on HIV/AIDS. 2000. Report on the Global HIV/AIDSEpidemic. Geneva: UNAIDS.Levine, A, et al. 2001. Prevalence and correlates of anemia in a large cohort of HIVinfectedwomen: Women’s interagency HIV study. J Acquir Immune Defic Syndr 26:28-35.Lwanga, D. 2001. Clinical care of HIV-infected women in resource poor settings:Nutritional care and support. Baltimore, MD: Johns Hopkins Program onInternational Education for Obstetrics and Gynecology (JHPIEGO). CD-ROM tutorial.Lwanga, D, and E Piwoz. 2001. Nutritional care and support for women living withHIV/AIDS in West Africa. Washington DC: Academy for Educational Development/FANTA Project.Nduati, R, et al. 2001. Effect of breastfeeding on mortality among HIV-1 infectedwomen: A randomized trial. Lancet 357: 1651-55.———. 1995. Human Immunodeficiency virus type-1 infected cells in breastmilk:Association with immunosuppression and vitamin A deficiency. J Infect Dis 172:1461-68.Piwoz, E, and E Preble. 2000. HIV/AIDS and nutrition: A review of the literature andrecommendations for nutritional care and support in sub-Saharan Africa.Washington, DC: Academy for Educational Development/SARA Project.Semba, R, et al. 2001. Iron status and indicators of human immunodeficiency virusdisease severity among pregnant women in Malawi. Clinical infections 32: 1496-99.154
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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
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Required materials• LCD or overhe
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McDermott, AY, A Shevitz, T Knox, R
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Goals of nutritional care and suppo
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• Circumferences of the waist, hi
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Consider the phase of the HIV infec
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Promote adequate nutrient intake (s
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Stages of illness and symptoms. Sym
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TherapyNitrogenretention[g/day]Rate
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Nutrient supplements for people liv
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Conclusion (slide 31)Nutritional ca
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HANDOUT 3.1 Case studies in HIV and
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HANDOUT 3.2 Safe Food Handling Prac
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OutlineContent Methodology Timing1.
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Recommended preparation• Be famil
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PVO-USAID Steering Committee on Mul
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Nutritional care and support of peo
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In this session “food security co
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HIV/AIDS attacks food security not
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• Human capital: Reduced producti
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Food-insecure populations may also
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Food security constraints to nutrit
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Pregnant and lactating women (slide
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Implementation of nutritional care
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demand these foods. A good assessme
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Counselors should be aware of and i
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Conclusion (slide 36)The capacity t
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UNAIDS and WHO. 2002. AIDS epidemic
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1. How does poor food availability
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5. Will referrals and targeting of
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SESSION 5 NUTRITIONAL MANAGEMENT OF
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Required materials• LCD or overhe
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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
Page 150 and 151: Nutritional care and support for th
Page 152 and 153: Management of secondary infections
Page 154 and 155: A. Nutrition history• Dietary int
Page 156 and 157: • Income, housing, amenities for
Page 158 and 159: multiple nutrient supplement, where
Page 160 and 161: Management of diet-related HIV prob
Page 162 and 163: Infant feeding options and risks (s
Page 166 and 167: Seumo-Fosso, E, and B Cogill. 2003.
Page 168 and 169: HANDOUT 6.1 Health Sector and Mater
Page 170 and 171: HANDOUT 6.2 A Guide to Nutritional
Page 172 and 173: • Educational levelLactating moth
Page 174 and 175: Did the counselor ask about: YES NO
Page 176 and 177: HANDOUT 6.4 Practical Consideration
Page 178 and 179: HANDOUT 6.5 Checklist for Nutrition
Page 180 and 181: HANDOUT 6.7 Dietary Management of C
Page 182 and 183: Dietary problemFeverNutritional int
Page 184 and 185: 1. How could HIV infection affect R
Page 186 and 187: • Nutritional status, dietary int
Page 188 and 189: • Rita’s dietary intake and eat
Page 190 and 191: • Eating smaller, more frequent e
Page 192 and 193: • How was the nutritional assessm
Page 194 and 195: Estimated time: 120 minutes excludi
Page 196 and 197: Suggested reading materialsCoutsoud
Page 198 and 199: LECTURE NOTES 7: INFANT FEEDING AND
Page 200 and 201: • A viral, bacterial, or parasiti
Page 202 and 203: DNA (cell-associated virus) in colo
Page 204 and 205: Mucosal integrity (slide 18)Studies
Page 206 and 207: PMTCT interventions are most effect
Page 208 and 209: Breastfeeding techniquesIt is espec
Page 210 and 211: women with HIV/AIDS for additional
Page 212 and 213: • 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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