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

Implementation of nutritional care and support through counseling can be organizedinto three stages: assessment, option selection, and follow-up. Food security issuescan be addressed and integrated in each of these stages. Handout 4 outlines stepsto integrate food security issues into nutritional care and support counselingsessions.AssessmentThe first stage of nutritional care and support interventions is the assessment. Thisgives counselors an opportunity to assess food access gaps, sources, and options.Understanding the sources of food insecurity (slide 29)A nutritional care and support assessment consists primarily of determining theclient’s nutritional needs based on nutritional status, progression of the disease,opportunistic infections, symptoms, and medication. At this stage it is also critical toassess the client’s current food and nutrition practices and factors that may preventthe client from adopting recommended practices.Lack of knowledge may be addressed by education and counseling. Other factorsmay include lack of financial or physical capacity to purchase or produce sufficientquantities of required foods, intra-household food distribution that favors non-HIVinfectedpeople, or food taboos such as those for pregnant women. A number ofcommon constraining factors are listed above.Identifying these constraints will require discussing general household issues such asoverall food provisions from all sources, expected harvest of specific crops,employment and sources of income, and status of other household members.Understanding the approaches a household is using to maintain food security involvesasking the following questions:• What coping strategies are the household and community using and howadequate are they?• What support networks exist and how adequate are they?• What strategies used in the past are no longer possible in the context ofHIV/AIDS?83