HIV/AIDS, Nutrition, and Food Security What We Can Do List of HIV Materials Supported by FANTA

HIV

See Also: Emergency Nutrition; Food Aid; Food Security

Food and nutrition interventions are critical components of a comprehensive response to the HIV pandemic. HIV compromises the nutritional status of infected individuals, and malnutrition in turn can worsen the effects of the disease. Nutrition interventions can help break this cycle by helping people living with HIV (PLHIV) manage symptoms, reduce susceptibility to opportunistic infections, improve nutritional status, promote response to medical treatment, and improve overall quality of life. The HIV pandemic also significantly compromises the food security of affected households and communities, reducing the availability of productive labor, diverting income, depleting savings and productive assets, overwhelming social networks and safety nets, and impeding intergenerational knowledge transfers. In some contexts, food insecurity may lead to more migratory livelihood strategies and high-risk sexual behaviors that increase the risk of HIV transmission.

With support from USAID and the President's Emergency Plan for AIDS Relief (PEPFAR), FANTA provides technical assistance to strengthen nutritional care and support for PLHIV and improve food assistance and food security programming in the context of HIV. FANTA produces and disseminates program guidance on nutritional care and support interventions, the nutrient requirements of PLHIV, and food and nutrition implications of antiretroviral therapy (ART). FANTA and its partners help countries in east and southern Africa to adapt and apply HIV-nutrition guidance to their specific contexts through national guidelines, training curricula and programs, counseling materials, monitoring and evaluation support, and capacity building activities. In Kenya, Namibia, Rwanda, Uganda, and Zambia, FANTA provides in-country support to integrate and scale up nutrition interventions in HIV services.

To strengthen the evidence base about the impacts of food supplementation on malnourished PLHIV, FANTA is supporting randomized controlled evaluations in Malawi and Kenya.

FANTA works with partners to strengthen food security and food assistance responses to the pandemic. Through its technical assistance to USAID's Office of Food for Peace and implementing partners, FANTA supports improved program design and monitoring and evaluation of food-assisted programs addressing HIV and its impacts.

	A brief description of each publication is provided below. By choosing the publication title, you are able to read a detailed description and to download the publication.

1. Kenya Trainer's Manual and Trainee Toolkit for Nutrition in Comprehensive Care Centers (2007): To strengthen the capacity of HIV service providers to provide effective nutritional care and support, USAID/Kenya supported FANTA in working with the Government of Kenya's National AIDS and STI Control Program to develop a trainer's manual and trainee tools for a Kenya national training course on nutrition and HIV. Nutrition Management in Comprehensive Care Centres in Kenya: A Trainer's Manual and Nutrition and HIV/AIDS: A Toolkit for Service Providers in the Comprehensive Care Centres are intended for service providers from Comprehensive Care Centers (CCC), the health care facilities where HIV patients are treated. FANTA also conducted trainings of CCC service providers using the training course.

2. Food Assistance Programming in the Context of HIV (2007): Food Assistance Programming in the Context of HIV, a joint publication by WFP and FANTA, is a guide developed to improve the design and implementation of food security programs that respond to HIV-related challenges as well as HIV programs that utilize food and food-related activities to achieve HIV-related outcomes. The guide provides a set of tools, promising practices and key considerations that enhance the flexibility and appropriateness of program design and implementation modalities, and has been developed for program directors, program advisors and senior program managers who are directly involved in the analysis and formulation of food assistance strategies and country program activities at HQ and in regional and field offices.

3. Recommendation for the Nutrient Requirements for People Living with HIV/AIDS (2007): Based on the report of the May 2003 WHO technical consultation on nutrient requirements for people living with HIV/AIDS, this document provides information about the nutrient requirements of people living with HIV in a concise, two-page format.

4. National Guidelines and Protocol for Nutritional Support and Care for People Living with HIV/AIDS in Rwanda (2006): As a part of the Rwanda Nutrition Working Group, FANTA assisted in the development of National Guidelines on Nutritional Care and Support for People Living with HIV/AIDS in Rwanda. These guidelines were developed to define the actions that service providers need to take to provide quality nutritional care and support to people living with HIV, supplement national policies on prevention and treatment, and strengthen and standardize care and support for PLHIV across organizations, programs and services. The Rwanda Nutrition Working Group also developed an abbreviated version of the National Guidelines, referred to as the National Protocol for the Nutritional Care and Support of People Living with HIV/AIDS in Rwanda, for front-line health service providers.

5. Rwandan HIV and Nutrition Wall Chart & Counseling Cards (2006): FANTA, in collaboration with Treatment and Research AIDS Center, Rwanda (TRAC), has produced and distributed the HIV and Nutrition Wall Chart and Counseling Cards. Produced in Kinyarwanda, the charts focus on 10 messages related to healthy eating and lifestyles and proper care for PLHIV. The wall chart has also been translated into English and French, and both the wall chart and flip chart files are available for download.

6. Zambian HIV and Nutrition Wall Charts & Flip Chart (2006): To strengthen counseling of people living with HIV and antiretroviral therapy clients by home-based care and health facility providers on the importance of good nutrition, living positively, preventing and fighting illness through diet, and maternal and infant nutrition, FANTA developed a flipchart for use in HBC and two wall charts for use at the health-facility level.

7. Kenyan National Guidelines on Nutrition and HIV/AIDS (2006): With funding from USAID/Kenya, the FANTA Project provided technical assistance to the National AIDS and STI Control Programme (NASCOP) in the Kenya Ministry of Health to develop Kenyan National Guidelines on Nutrition and HIV/AIDS. The national guidelines support the 2005-2010 Kenyan National HIV/AIDS Strategic Plan, in which the Government of Kenya has identified nutrition as a key component of the national response to the HIV/AIDS epidemic. The national guidelines establish a consistent set of nutrition recommendations for people living with HIV/AIDS (PLWHA) and describe actions that service providers need to take to provide nutritional care. Topics covered include nutrient needs of PLWHA, critical nutrition actions for PLWHA, nutritional care for those taking ARVs and other drugs, nutritional management of symptoms, food security, and nutritional care for children and pregnant and lactating women living with HIV/AIDS.

8. Food and Nutrition Implications of Antiretroviral Therapy in Kenya: A Formative Assessment (2005): A formative assessment was undertaken to increase understanding of the food and nutrition needs of clients on ART and the kind of messages that maybe needed by service providers to integrate nutrition in ART care. The study was conducted by a consultant, in partnership with a team from NASCOP, at 13 facilities in 5 sites in Kenya including public, private and mission hospitals, as well as NGOs and networks of PLHIV were visited. The report discusses findings and recommendations related to food and nutrition needs of ART clients, gaps in program capacity, and client and provider perceptions about the role of food and nutrition in ART. FANTA presented the findings in the report to representatives from the Government of Kenya and its PVO partners and disseminated it among government and private stakeholders to assist the government and PVOs in creating strategies to strengthen ART services in Kenya.

9. Counseling Materials for Nutritional Care and Support of People Living with HIV/AIDS (2005): Produced by the Regional Centre for Quality of Health Care with technical and financial support from FANTA and LINKAGES and funding from USAID/REDSO, these materials are for use by counselors and service providers to support nutritional care and support for people living with HIV/AIDS (PLWHA). The materials were developed with a focus on Uganda and are being used and adapted in other countries as well.

10. Zambia Nutrition Guidelines for the Care and Support of People Living with HIV/AIDS (2005): Zambia has been hard hit by the HIV/AIDS pandemic. Based on a 2001-2002 population-based survey, the national HIV/AIDS prevalence was estimated at 16%. Knowing the importance of good nutrition, the Government of Zambia initiated development of guidelines to provide information to individuals and organizations on the nutritional care and support for people living with HIV and AIDS (PLWHA). With support from USAID/Lusaka, FANTA provided technical assistance to a team lead by the National Food and Nutrition Commission (NFNC) to complete and disseminate these guidelines.

11. Workshop on HIV/AIDS and Food Aid: Assessment for Regional Programs and Resource Integration, November 2004: FANTA and the Regional Centre for Quality of Health Care (RCQHC) convened an "HIV/AIDS and Food Aid: Assessment for Regional Programs and Resource Integration" workshop in Entebbe, Uganda November 2-5, 2004. The workshop was funded by USAID’s Regional Economic Development Services Office for East and Southern Africa’s (REDSO). The objectives of the workshop were to improve understanding of food aid programming in the context of HIV/AIDS, strengthen capacity to assess the need for food aid interventions in HIV/AIDS-affected communities, and plan assessment activities that might identify opportunities for integrating food aid interventions into REDSO’s Transport Corridor Initiative (TCI). In addition, the workshop sought to assess partner needs for regional technical or other assistance to strengthen food aid programming addressing HIV/AIDS, including identifying and sharing lessons and promising practices. There were 51 participants at the workshop including PVOs implementing food aid programs in east or central Africa; REDSO HIV/AIDS implementing partners that seek to integrate or coordinate with food-based interventions in the transport corridor; World Food Program (WFP) regional and country office representatives; USAID Washington, regional and country Mission representatives from Offices of HIV/AIDS, Food for Peace and Poverty Analysis and Social Safety Net; Famine Early Warning System Network (FEWS NET); FANTA and RCQHC.

12. HIV/AIDS: A Guide for Nutritional Care and Support 2004: This guide (revised 2004) provides information for HIV/AIDS-affected households and communities on how nutrition can help HIV-positive people live healthier lives throughout the progression of HIV disease. Malnutrition is a common complication of HIV infection and plays a significant and independent role in its morbidity and mortality. Malnutrition was one of the earliest complications of AIDS to be recognized and has been used to clinically diagnose AIDS.

13. Food and Nutrition Implications of Antiretroviral Therapy in Resource Limited Settings (2004): As access to antiretroviral (ARV) therapy increases in developing countries, a greater number of HIV-infected individuals living in resource limited settings are able to use the drugs to extend the length and improve the quality of their lives. Interactions between ARVs and food and nutrition can significantly influence the success of therapy by affecting drug efficacy, adherence to drug regimens, and nutritional status. This Technical Note examines the relationship between nutrition and ARV efficacy, especially in resource limited settings. The document, which was supported by USAID’s Regional Economic Development Services Office for East and Southern Africa (REDSO/ESA), describes the effects of specific food-drug combinations in HIV/AIDS treatment and presents nutrition guidelines for ARV program design and management.

14. Nutrition and HIV/AIDS: Evidence, Gaps, and Priority Actions (2004): This joint publication by the FANTA and SARA Projects outlines evidence, gaps and priority actions related to nutrition, and HIV and AIDS. The document outlines how HIV infection increases energy requirements, and how vitamin and mineral deficiencies may contribute to HIV progression. Other findings show where priority actions need to be taken. Nutrition counselling and support is needed for those living with HIV, as is nutritional management for HIV-related illnesses. This would include providing counselling through home-based care programmes, community efforts and clinical services so that individuals and households can use available foods to manage symptoms.

15. Nutrition and HIV/AIDS: A Training Manual (2003): Nutrition plays a critical role in comprehensive care and support for people living with HIV/AIDS. Nutritional interventions can help manage symptoms, promote response to medical treatment, slow progression of the disease, and increase the quality of life by improving daily functioning. To strengthen capacity to implement nutritional care and support in eastern and southern Africa, stakeholders in the region identified the need to improve incorporation of nutrition and HIV/AIDS into pre-service training for doctors, nutritionists, and other health care workers in the region. Nutrition and HIV/AIDS: A Training Manual is intended to complement materials used in institutions of higher learning to improve the quality of training in nutrition and HIV/AIDS. The manual provides a comprehensive source of information on nutrition and HIV/AIDS, and provides instructors with technical content, presentations, practical exercises, and handout materials that can be used for planning and facilitating courses and lectures. The intended users of the manual are instructors of masters or undergraduate level students of medical or health sciences, applied human nutrition, dietetics or home economics, and food technology and agriculture. It is expected that students exposed to these materials will acquire enhanced knowledge and skills in the nutritional management of clients infected with HIV.

16. Nutritional Care and Support for People Living with HIV/AIDS in Uganda (2003): As part of FANTA's efforts to strengthen implementation of nutritional care and support for people living with HIV/AIDS, FANTA provided technical assistance in the development and application of national guidelines on nutrition and HIV/AIDS. With support from the USAID Mission in Uganda, FANTA assisted regional and national groups to develop national guidelines in Uganda, Nutritional Care and Support for People Living with HIV/AIDS in Uganda: Guidelines for Service Providers. These nationally adopted guidelines provide recommendations on the nutritional needs of PLWHA and on steps that service providers can take to help PLWHA manage symptoms and improve functioning through nutrition actions. With support from FANTA and the Regional Centre for Quality of Health Care, the guidelines were produced by the Uganda Ministry of Health STD/AIDS Control Programme and the Uganda Action for Nutrition, a national nutrition coalition.

17. Handbook: Developing and Applying National Guidelines on Nutrition and HIV/AIDS (2003): The handbook provides guidance for country teams and national AIDS control programs to develop and apply national guidelines on nutritional care and support of people living with HIV/AIDS. The handbook provides information on building a multi-sectoral team, adapting generic and country-specific materials to write national guidelines, integrating HIV/AIDS nutritional care and support into programs and services, and monitoring and evaluating the process and outcomes. With support from USAID/REDSO, FANTA works with regional partners in east and southern Africa to strengthen regional capacity in nutrition and HIV/AIDS. The handbook is the result of collaboration between FANTA and the Regional Centre for Quality of Health Care (RCQHC), based in Uganda. Content of the handbook is based on two regional workshops on national nutrition-HIV/AIDS guidelines that USAID/REDSO, RCQHC, FANTA, and UNICEF organized for teams from 11 countries in the region.

18. HIV/AIDS Mitigation: Using What We Already Know (2002): This technical note provides a summary of the literature on the impacts of HIV/AIDS on household and community food security and livelihood strategies in rural areas. It also presents a range of promising practices derived from the broader food-security and development experience that can be applied to HIV/AIDS mitigation efforts. The information presented below orients program staff about the critical socioeconomic impacts and constraints most likely experienced in HIV/AIDS-affected environments, and suggests appropriate program designs and modifications to mitigate the socioeconomic impacts of HIV/AIDS. This technical note is also intended for the wider development community to encourage multisectoral approaches to development programs in a HIV/AIDS context.

19. Potential Uses of Food Aid to Support HIV/AIDS Mitigation Activities in Sub-Saharan Africa (2000): This paper examines how food aid programs might support the US Agency for International Development's HIV/AIDS strategy and strengthen the ability of service providers and families to cope with the multiple impacts of HIV/AIDS. Possible options for strategies and interventions for using Title II food aid for HIV/AIDS mitigation are discussed. Situations where food aid may not be an appropriate option are identified along with some recommendations for action. The analysis and recommendations are based in part on interviews with food security and HIV/AIDS stakeholders in the United States, Kenya and Uganda in 1999, supplemented by a review of the literature on the impact of HIV/AIDS and coping strategies used by households and communities.

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*Please note that links to these sites do not imply that FANTA supports either the organization listed or the views and content presented.

Family Health International (FHI)
[http://www.fhi.org/en/hivaids/index.htm]
FHI's work in HIV/AIDS includes prevention research, program management and support, and technical services.

FAO's HIV/AIDS and Food Security Website
[http://www.fao.org/hivaids/]
The Food and Agriculture Organization's HIV/AIDS and food security site features FAO information related to HIV/AIDS and is intended to be a comprehensive resource for researchers, policy-makers, nongovernmental organizations and infected people.

FAO/WHO's "Living Well with HIV/AIDS: A Manual for Nutritional Care and Support for People Living with HIV/AIDS" (2003) [http://www.fao.org/DOCREP/005/Y4168E/Y4168E00.HTM]

Food Security and Food Policy Information Portal for Africa [http://www.aec.msu.edu/agecon/fs2/test/index.cfm?Lang=en]
This portal is still in development and aims to assist African food security and food policy networks in reaching out to country-level researchers and policy makers. It is made possible through a partnership between the United Nations Economic Commission for Africa (UNECA)'s Development Information Services Division (DISD) & Sustainable Development Division (SDD), African Food Security/Policy Networks & Michigan State University, Department of Agricultural Economics.

Global Health Council [http://www.globalhealth.org]
Their Global AIDS Program works to influence policy on AIDS activities and issues worldwide through educational advocacy and information exchange. The site includes HIV/AIDS news updates and access to its newsletter, AIDSLink.

Harvard AIDS Institute [http://www.aids.harvard.edu]
The AIDS Institute at Harvard University conducts AIDS research and provides online access to the latest developments in laboratory research, publications and conferences.

The President's Emergency Plan for AIDS Relief (PEPFAR)
[http://www.pepfar.gov/]

PEPFAR: Report on Food and Nutrition for People Living with HIV/AIDS, May 2006
[http://www.state.gov/documents/organization/66769.pdf]

PEPFAR: Policy Guidance on the Use of Emergency Plan Funds to Address Food and Nutrition Needs, September 2006
[http://www.state.gov/documents/organization/75859.pdf]

PEPFAR: U.S. Five-Year Global HIV/AIDS Strategy [http://www.state.gov/s/gac/plan/c11652.htm]

Regional Centre for Quality of Health Care [http://www.rcqhc.org/]
The Regional Centre for Quality of Health Care exists to provide leadership in building regional capacity to improve quality of health care by promoting evidence based practices through networking, strategic partnerships, education, training and research. Better practices are defined as those that are effective, are institutionalized in Africa, have measured positive results, and are likely to be replicable.

UNAIDS [http://www.unaids.org]
UNAIDS, the Joint United Nations Programme on HIV/AIDS, is dedicated to strengthening and supporting an expanded response to prevent the transmission of HIV, provide care and support, reduce the vulnerability of individuals and communities to HIV/AIDS, and alleviate the impact of the epidemic. The site provides information about the epidemic, best practices. Many publications are accessible.

United Nations System Standing Committee on Nutrition (SCN) [http://www.unsystem.org/scn/]
The United Nations System Standing Committee on Nutrition is the focal point for harmonizing the policies and activities on nutrition of the UN system. Its role is to serve as a coordinating mechanism, for exchange of information and technical guidance, and to act dynamically to help the UN respond to nutritional problems. The site provides links to SCN news and reports on nutrition worldwide.

US Agency for International Development's Webpage on HIV/AIDS [http://www.usaid.gov/our_work/global_health/aids]
USAID's Global Health Bureau works with the international health community and local partners to prevent the spread of HIV/AIDS. The site has information about USAID activities, links to related resources and relevant publications.

World Food Program's HIV Web Page [http://www.wfp.org/food_aid/food_for_hiv/index.asp? section=12&sub_section=2]

World Health Organization's HIV Web Page
[http://www.who.int/hiv/en/]

World Health Organization's "Scaling Up Antiretroviral Therapy in Resource Limited Settings: Treatment Guidelines for a Public Health Approach" (2003) [http://www.who.int/hiv/pub/prev_care/en/ ARVGuidelinesRevised2003.pdf]

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