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SCN Working Group on Nutrition and HIV/AIDS
held during the ACC/SCN's 29th Session in Berlin, Germany, March 2002
Chair: Badara Samb (WHO)
Rapporteur: Marti van Liere (KIT)
While the role of nutrition in HIV/AIDS prevention, care and mitigation is
now better understood, there remains a large gap between commitment and action.
The main objective of this session was to add impetus to this emerging nutrition
agenda and highlight the opportunities for relevant action.
Jos Perriens' (WHO) presentation dealt with the minimum care and support
package, which includes nutritional care and counselling. For some of these
elements there is no guidance on how to scale up. Several actions such as
strategic partnerships have led to significant decreases in the price of ARVs.
In relation to drug use (especially PI, one of the nucleosides) metabolic
abnormalities draw increasing concerns: hyperlipemia, hyperglycemia,
lipodystrophy. The HIV/AIDS department in WHO does not yet discuss the relation
between HIV and nutrition. During the discussion the point was made that drugs
alone is not a sufficient response, and hunger is a growing concern.
Dan Raiten (NIH) put forward the role of diet/nutrition in HIV and issues
that would require special consideration above and beyond provision of food. He
raised many outstanding questions, which showed how many gaps persist. Instead
of becoming discouraged by this list it should be seen as a guiding framework to
prioritize and start doing some of this work. The issues mentioned varied from
the relationship between nutritional status and the natural history of HIV/AIDS,
to impact of malnutrition on drug efficacy, interaction between ARVs and
micronutrient deficiencies, nutritional requirements of HIV infected infants for
growth, effect of HIV or ARV drugs on lactation. He strongly recommended the
coordination of studies in this field with standardized protocols and
methodologies that will enable meta-analysis. We have sufficient evidence on the
relationship between infections and nutrition to warrant more resources for
research on the specific inter-relationship between nutrition and HIV.
Andrew Tomkins (Institute of Child Health) then discussed nutrition among
children and distinguished between those infected with HIV/AIDS, and those
affected because the mother was HIV positive or because both parents were sick
or dead. He showed that nutritional care in a hospital environment makes a
difference to children with HIV. Median survival was 31 months after diagnosis
and many of them even survive to go to school. For the micronutrients: vitamin A
seems to have an effect on intestinal mucosa in HIV+ children, and beneficial
effects on diarrhoea and pneumonia were found in three African populations.
However there is no evidence for zinc, selenium or vitamin E and nothing on
multi-micronutrient supplementation. Most HIV+ mothers produce small, premature
infants of which 75% are HIV-. Low birthweight does not seem to differ between
HIV+ and HIV- mothers, but when it does this is related to the nutritional
status of the mother. A recommendation here would be to put a strong emphasis on
improving maternal nutritional status both in terms of weight and micronutrient
status. For infants whose parents are both sick or dead, the conceptual
framework is quite broad and includes growth, cognition, physical activity,
sensory capacity, immunity, resilience, personal peace. The strategies adopted
in this case are traditional such as orphanages, food distribution, financial
support for foster families, income generating activities. Often good
initiatives are community-based and the question is how to scale up without
losing quality?
Maren Lieberum (independent consultant) presented a short overview of the
several initiatives dealing with nutritional care and support for people living
with HIV/AIDS of several UN agencies including nutritional guidelines, training
course, and a guide on providing food aid.
Stuart Gillespie (IFPRI) focused on the livelihoods perspective in the
relationship between nutrition security and HIV/AIDS. He posed two questions: a)
how should policies and programs be altered to reduce risk to HIV exposure and
infection and increase resilience to HIV/AIDS, and b) is it "more and
faster" or should it be different? An "HIV lens" was proposed to
facilitate the assessment of HIV/AIDS impacts and interactions with nutrition
insecurity, to mainstream HIV responses in different relevant sectors, and to
anticipate both short- and long-term consequences. He recommended priority
attention be given to communication and information sharing, understanding the
location-specific dynamics of household and community response to HIV/AIDS
including the main determinants of risk and resilience, highlighting options for
effectively using food aid to strengthen local capacity and increase livelihood
opportunities, the need to learn how best to preserve social capital, how to
mainstream the use of the HIV-lens, and how to scale up community responses.
Recommendations and action plan
- A consultative meeting should be organized to review and compare all
initiatives dealing with nutritional care and support. The meeting should
include all stakeholders especially community-based organizations. This
meeting should be convened by the SCN.
- The new chair of the working group should approach Nutritionnet (www.nutritionnet.net)
to open up an information sharing forum on nutrition and HIV/AIDS and permit
day-to-day dialogue between those active and concerned with these issues.
- The SCN chair should write to Peter Piot and heads of HIV/AIDS departments
in UN agencies of the commitments to nutrition and HIV/AIDS shown last year
and summarized in the SCN Statement. These letters should identify several
interventions that have proven to work.
- The working group should elaborate a conceptual framework for research
priorities; this framework should be used in consultative meetings.
- The Secretariat should consider bringing together the various
presentations made on March 14 in Berlin and publishing these along with
short summaries from other presenters, possibly in SCN News.
- The new chair of this working group should discuss with other working
group chairs, well in advance of the 30th session in Chennai, how to
incorporate HIV/AIDS into working group agendas with a view to harmonizing
coverage.
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