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

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Vulnerabilityof Women and Young Girls• Antenatal HIV-positive rates are up to 50%• Women and young girls face greater risk ofinfection than men− Biological factors− Limited access to economic opportunities− Limited access to health care increases riskfactors− Diminished social status compromising ability tochose healthier life strategies• Women are responsible for caring for the sickwhen they themselves may also be infectedWomen, Nutrition, and HIV• Good maternal nutrition is important forwomen’s health and reproduction and infantsurvival and development• Malnourished women are at higher reproductiverisk and have poorer pregnancy outcomes thanwell-nourished women• In Africa endemic malnutrition is complicatedby the AIDS epidemicMalnutrition and HIVWork in TandemMalnutritionWeakens the immune systemIncreases vulnerability and susceptibilityto infectionIncreased nutrientrequirementsNutritional Implications forthe HIV-Positive Pregnantor Lactating Woman orAdolescent GirlHIV infectionDuring PregnancyMalnutrition increases maternal morbidityand mortality• Zinc and vitamin A deficiencies increase the risk ofreproductive tract infections• Low calcium intake increases the risk of pre-eclampsiaand high blood pressure• Iron deficiency reduces resistance to disease, causesfatigue, and reduces productivity• Anemia increases risks of prolonged labor and deathfrom hemorrhageDuring Pregnancy, Cont.Malnutrition affects birth outcome• Leads to intra-uterine growth retardation and low birthweight• Decreases nutrient stores for later development• Increases neonatal mortality and morbidityMalnutrition may increase the risk of MTCT• Vitamin A deficiency associated with increased viralload in blood, genital secretions, and breastmilk• Low hemoglobin associated with increased risk of pretermdelivery and low birth weight—risk factors forMTCT
During Pregnancy, Cont.Micronutrient supplementation for HIV+ womenhas NOT reduced MTCT, but HAS producedother benefits• Vitamin A supplementation studies have shownreduced pre-term delivery (South Africa) andimproved birthweight, neonatal growth, and reducedanemia (Malawi)• Multivitamin supplements increased weight gain inpregnancy and reduced risk of fetal death, low birthweight, and pre-term delivery
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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
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Figure 2 Cycle of malnutrition and
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IV. Late symptomatic phase (full-bl
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The following symptoms may also neg
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• Enables greater food intake by
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EXERCISE 5=========================
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HANDOUT 5.1 Caring for symptoms ass
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Illness Diet Care and nutrition pra
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SESSION 6 NUTRITIONAL CARE AND SUPP
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Recommended preparation• Be famil
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———. 1998. Randomised trial o
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LECTURE NOTES 6: NUTRITIONAL CARE A
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The stigma associated with HIV can
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of malnutrition, which increases th
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adolescent mother, growth and devel
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HIV infection increases the energy
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Anemia is common during HIV infecti
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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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• 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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Page 272 and 273: women’s nutritional status. It is
Page 274 and 275: Health provider capacityHealth prov
Page 276 and 277: • What foods should not be taken
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Page 280 and 281: eferred him to the counselor for th
Page 282 and 283: Medication Purpose Recommended Tobe
Page 284 and 285: Medication Purpose Recommended Tobe
Page 286 and 287: Side effects of each drug?Side effe
Page 288 and 289: PurposeTo provide basic information
Page 290 and 291: Factors in Transmissionand Vulnerab
Page 292 and 293: Impact on the Education Sector• D
Page 294 and 295: AcknowledgmentNutrition and HIV/AID
Page 296 and 297: Body Habitus ChangesMetabolic chang
Page 298 and 299: PurposeTo provide general nutrition
Page 300 and 301: Stages of HIV Disease andNutritionI
Page 302 and 303: IncreaseVitamin and Mineral IntakeS
Page 304 and 305: Lipodystrophy• Means fat maldistr
Page 306 and 307: PurposeTo introduce the constraints
Page 308 and 309: Effect of AIDS on Crop ProductionCr
Page 310 and 311: Pregnant and Lactating WomenFood an
Page 312 and 313: Session 5 Nutritional Management of
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Page 316 and 317: Session 6 Nutritional Care and Supp
Page 320 and 321: What Is Not KnownComparison of Nutr
Page 322 and 323: Purposeof Nutrition Care and Suppor
Page 324 and 325: Greatest Impact of NutritionImprove
Page 326 and 327: Size of the Problem in Africa• >3
Page 328 and 329: Possible Mechanisms ofTransmissionA
Page 330 and 331: Prevention-to-Care ContinuumInterve
Page 332 and 333: Session 8 Nutritional Care for Youn
Page 334 and 335: ChildrenBorn to HIV-Positive Mother
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Page 338 and 339: Enhanced ARV Therapy• To reduce v
Page 340 and 341: Care of the Terminally Ill ChildWhy
Page 342 and 343: PurposeTo provide knowledge and ski
Page 344 and 345: SIDE EFFECTS OF DRUGSaffectFOOD INT
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