United Nations System
Standing Committee on Nutrition

 

Working Group on Nutrition and HIV/AIDS Contribution to Millennium Development Goals

held during the SCN's 33rd Session, Tuesday, 14 March 2006, 1630-1830 hours, Geneva

Chair: Andrew Tomkins (Institute for Child Health)
Co-Chairs: Stuart Gillespie (IFPRI), Randa Saadeh (WHO), Bruce Cogill (FANTA/USAID)

Documentation and presentations:

 

Andrew Tomkins introduced the co-chairs of the working group (Randa Saadeh, WHO, Stuart Gillespie, IFPRI, Bruce Cogill, FANTA/USAID). AT paid tribute to the considerable amount of work that had been done by many people since the last SCN in promoting and clarifying the issues for evidence based interventions for nutrition and food security among individuals and populations affected by HIV/AIDS. He reported on a meeting held at WHO Geneva at which representatives from the Global Fund had emphasized the importance of including nutrition components within the bids to the Global Fund for support of HIV/AIDS care, treatment and support activities at national level. He also reported that the WHO HIV groups were now emphasizing increasing awareness and action in improving dietary strategies for PMTCT, including nutritional care and support regimes for those with clinical HIV/AIDS and also care and support for those individuals, especially children, in communities affected by HIV/AIDS. He appreciated the work of the SCN core team in supporting the development of the SCN website on nutrition and HIV/AIDS and gave a demonstration of it online.

SG gave a presentation on AIDS and food security: new directions. He emphasized the close interaction between HIV and AIDS and nutrition and food security, highlighting the ways in which livelihood systems differed in terms of their risk of exposure to HIV as well as their vulnerability to the impacts of AIDS. HIV and AIDS fundamentally affects most household and community assets (including human, financial, social, natural, physical and political), and institutions at different levels (community based organizations, civil society, market, state and even global). The interplay of these effects determines the responses that can be made at different levels, and their outcomes, which include the degree of food and nutrition security.

Recent evidence suggests the importance of moving simultaneously in several areas.

  1. Strengthening household and community resistance to HIV and resilience to AIDS.
  2. Preserving and enhancing livelihood options and strategies (e.g. providing incentives for community mobilization and development, and addressing real constraints which may mean cash-saving, not necessarily labour-saving approaches).
  3. Ensuring social protection – more broad-based than economic safety nets, and with a particular emphasis on children.
  4. Strengthening capacity of governments and other stakeholders.

He noted certain challenges that need addressing:

  1. beware of proposing AIDS as an exceptional case – best to use an HIV lens, not a filter.
  2. Think about options for diversifying rural livelihoods rather than just agriculture.
  3. Beware of the prevalent “either/or” mentality – ARVs are not the single answer and nutrition is not the single answer. Both are needed.
  4. Emphasize diversity within context specific situations, while remaining aware of the need to scale up.
  5. Use and adapt tools to effectively move from understanding to responding.
  6. Focus on evidence-based actions but don’t wait for the last 5% of the evidence before getting things going.
  7. Learn by doing (action research) and by monitoring, evaluating and communicating.
  8. Be innovative and document examples of good practice and disseminate this information.
  9. Important to balance quality, speed and capacity.

SG described the evolution of RENEWAL (the Regional Network on AIDS, Rural Livelihoods and Food Security), facilitated by IFPRI. RENEWAL brings together national networks of researchers, policy makers, NGOs, public and private organizations to focus on the interactions between HIV/AIDS and food and nutrition security. RENEWAL seeks to fuse capacity development and communications with locally-prioritized action research. Seventeen studies have been commissioned in six southern and eastern African countries and results are emerging. Examples include research on the effects of HIV and AIDS on agricultural production systems in Zambia – a restudy, 13 years after the original -- ,on community resilience in Zambia, on agricultural innovation among AIDS affected rural households in KwaZulu Natal, South Africa, and the impact of a nutrition intervention for people living with HIV in Western Kenya among others.

Margaret Akinya Wagah (MW), national coordinator of RENEWAL Kenya gave a presentation on a particular case study on nutrition and food security among an HIV/AIDS affected community in Kenya. She identified the particular objectives of the project.

  1. To reduce critical gaps in understanding how livelihoods contribute to the further spread of HIV in Kenya; the impact of HIV/AIDS on livelihoods and ultimately on food and nutrition security in Kenya.
  2. To generate new policy – relevant knowledge on how households and communities may strengthen both their resistance to HIV transmission and their resilience to the impact of AIDS.

She described a joint programme of collaboration between AMPATH, Moi University and IFPRI in which 20,000 patients, 9,700 of whom are on ARVs, are included within a programme of support based around 12 satellite clinics in western Kenya. Patients who are not responding well to ARV alone were included in a HAART and Harvest initiative involving 4 farms used for food production, training, demonstration and distribution to HIV infected clients. Locally produced food, together with food purchased from outside the areas, was used to provide up to 50% RDA for 2,200 people. In practice this mostly consisted of a food basket including maize, pulses, oil and CSB to under 5s and pregnant or lactating women. Patients remained on the food programme for 6 months and were then weaned off. USAID had started to supply a supporting programme of Instamix (maize soya blend) to individual patients.

While detailed data analysis is ongoing, investigators had noticed that a range of social support networks was crucial for enabling dietary diversity. Intervention from the project was a catalyst for receiving additional support from family and community and there appeared to be improvement in the labour supply 6 months after the start of the programme, indicating that people were getting back to work faster. She noted some gaps and challenges including stigma, which remains an obstacle to accessing HIV testing and treatment, difficulty in obtaining access to animal sources of food, sustainability of formal food supplementation programmes and the need to better define eligibility criteria, and the need to find ways of working with agencies with somewhat differing agendas.

Randa Saadeh gave an account of the key political and policy activities in relation to nutrition and HIV that had been achieved in the last year. She noted the importance of nutrition and HIV in two of the specific MDGs – (1) eradicating extreme poverty and hunger, (2) combating HIV/AIDS, malaria and other diseases. She described the important meeting on nutrition and HIV/AIDS in Durban in April 2005 which produced among other outputs, the participants’ statement giving clear evidence, lessons and recommendations for action for nutrition within HIV/AIDS. Three issues were included (1) developing evidence-based strategies, (2) reviewing and disseminating latest scientific evidence and ensuring integration, and (3) producing a key research agenda.

She highlighted the scientific review on nutrition and HIV/AIDS presented at the Durban meeting showing 6 key issues:

  1. Micronutrients - HIV infection leads to micronutrient deficiency and deficiencies supplementation may affect various transmission and progression related outcomes.
  2. Macronutrients (energy and protein) – HIV infection affects energy/protein requirements and deficiencies supplementation may affect various transmission and progression related outcomes.
  3. Infant feeding and HIV transmission.
  4. Growth faltering and wasting in children.
  5. Maternal nutrition, especially among pregnant and lactating women.
  6. Nutrition and ARVs – how nutrition may affect ARV efficacy and how ARVs may lead to better nutritional status. In some cases however ARVs leading to dyslipidaemia and insulin resistance on the other hand.

RS pointed out that the documentation is available on the WHO web site (http://www.who.int/nutrition/topics/consultation_nutrition_and_hivaids/en/index.html).

She noted the importance of the inclusion of work on nutrition and HIV/AIDS on the executive board of WHO in meetings in 2005/6 together with the important resolution EB117.R2 providing a framework for policy and action.

RS identified 5 pillars of WHO strategic report:

  1. Capacity building
  2. Defining research to fill gaps in clinical and operational issues
  3. Defining appropriate monitoring and evaluation indicators
  4. Strengthening and integrating policies/strategies and programmes
  5. Establishing science based recommendations, guidelines and tools

She identified key organizations in-house in WHO (HIV/AIDS, CAH, RHR, FOS, LEG and HAC). She identified other agencies who were becoming increasingly active in nutrition HIV responses including UNICEF, FAO, UNAIDS, UNHCR, WFP, IAEA, ILO and UNDP, together with vital contributions from NGOs, institutions, universities, national groups, bilaterals and donors.

For instance, FAO, UNAIDS and WHO recognise the importance of food insecurity leading to increased risk for people living with HIV/AIDS – need to strengthen local capacities for delivering nutritional care and support services and support food security livelihoods and nutrition of infected and affected. The FAO strategies included ensuring access to food, nutritional care and support, labour and time saving technologies and practice, gender equalities in access and control of resources, capacity building, agriculture knowledge systems and policies.

WFP’s nutrition and health related HIV/AIDS programmes were increasingly active and of 4 main activity types – PMTCT 13 countries, ART 16 countries, home based care in 13 countries and nutritional support to TB patients 23 countries. In addition, activities supporting orphans and vulnerable children are increasing.

WFPs activities in building an evidence base related to nutrition and food security included the INIPSA study – 3 countries in West Africa - and collaboration with NGOs and research institutions in Mozambique, Zambia, Uganda and other countries.

UNICEF activities in nutrition and HIV included a wide range of programmes including the UN framework for priority actions on HIV and infant feeding (13 countries), national policies on HIV and infant feeding (72 countries), integrating nutrition interventions into PMTCT scale up plans – joint technical missions in 5 countries, UNICEF and WHO are collaborating in the introduction of training courses and support of governments working with orphans and vulnerable children.

WHO/Global Fund – RS noted the development of a guidance note to assist countries in incorporating nutrition into funding proposals and pointed out the importance to which the Global Fund Board, Secretariat and Technical Review Panel put on nutrition within the call for applications for disbursement of funds for HIV/AIDS. She recognized the challenges that faced individuals and organizations but said there was a need to act now rather than wait until all the knowledge gaps are filled, build capacity to make it universal and sustainable, to disseminate information and good communication and coordinate between partners and different players. There is urgent need to advocate for adequate human and financial resources to put knowledge into practice in nutrition, food security and HIV/AIDS.

Bruce Cogill gave a presentation on US Government’s support to addressing HIV/AIDS with specific focus on its food and nutrition response. Funding is provided by the President’s Emergency Plan for AIDS response (PEPFA) and is coordinated by the Office of Global AIDS Coordination (OGAC). OGAC is currently responding to a Congressional request to work with other relevant USG agencies to develop a strategy for food and nutrition support of PLWHAs in care and treatment programs. This is due to Congress in mid-May. The strategy under development will likely continue some of the existing aspects of the response and include ttherapeutic feeding targeted to severely malnourished ART patients or those who are ART-eligible, adults and children, and for severely malnourished OVCs , including infants in PMTCT programs. There is limited scope for supplementary feeding. PEPFAR will work with food assistance programs, such as USAID's Title II programs, USDA's Food for Education and Food for Progress programs, and WFP to link ("wrap around") care and treatment for PLWHAs and their families with food assistance. PEPFAR will also emphasize links to livelihood assistance programs to improve food access through agriculture and income-generating activities.

A discussion was held on the preceding presentations. Among the points made from the floor – Meera Shekar of the World Bank pointed out the key new publication by the WB – Repositioning nutrition – in which there is a strong commitment towards nutrition interventions for prevention, treatment and care of HIV/AIDS. Steve Collins of Valid International identified the early evidence that nutritional pastes could be particularly beneficial for patients who are too ill to eat normal food. Nutritional pastes may assist patients to get off their bed and receive their ARVs. Thus specific focused appropriate nutrition interventions are seen as a means of improving ARV uptake and therefore efficacy and safety.

AT introduced the work plan for the SCN working group on nutrition and HIV/AIDS between April 2006-March 2007. Several activities were identified, some were discussed and overall there was agreement on the following:

  1. A database of current research projects – using a template produced by BC will provide an important resource so that individual researchers could identify what was already being done so that they could network and work most effectively in partnerships. It was agreed that efforts would be made to incorporate these documents within the SCN nutrition and HIV website.
  2. The SCN website was reviewed and it was agreed that all interested parties and members of the working group should submit papers that they were familiar with to the working group chairs for onward transmission to the website in order to keep this up to date and relevant. In addition, an extra box on the website would be created to announce news of special events, such as meetings or new policy or training documents. In particular, organizations with strong commitment to production and dissemination of knowledge, guidelines and policies such as FANTA, RENEWAL, UN agencies, NGOs and other websites would be cross linked to the SCN website.
  3. A special edition of SCN News on nutrition, food security and HIV/AIDS could be written. It was pointed out that there was a need to raise funds for this and work would be undertaken during the next year to achieve this.

The meeting finished with an appreciation by AT of all the contributions by the presenters and the audience to make this a most informative meeting and requested ‘all hands on deck’ to implement the agreed actions in the coming year.