[pronut-hiv] Nutrition and care for HIV positive infants and children born to HIV positive mothers

[jmatji@unicef.org]

Greetings from Pretoria, South Africa

Here are some responses to the questions raised:

1. Currently South Africa has developed nutrition guidelines for PLWHA, TB
and chronic illnesses - in order to achieve a more integrated approach to
food based interventions which will not only focus on PLWHA. Some pamphlets and leaflets have also been developed ( though not yet evaluated) on the same guidelines as a sort of user friendly version of the guidelines. In Oct 2002 WHO/Geneva pretested the 1.5 day training course on nutrition and HIV in Durban and on the basis of this they are revising the materials and are planning to have another try at using them in SA. Clearly development of guidelines and supportive materials is great but still not sufficient.
Many people who are responsible for counselling PLWHA actually seldom have much orientation on nutrition and thus it makes it difficult for them to
impart this new knowledge ( some of which may be complex scientific
stuff!!!). So a challenge is how to develop capacity of "lay counsellors"
or home based caregivers to understand the key messages around nutrition and
HIV.

I thin we also need to acknowledge that especially with the advent of
HIV/AIDS where we all want a quick fix solution, this has given rise to an
amazing number of fad diets, quacks, homeopathic and traditional remedies
whose scientific basis is often undetermined. Further in a country such as
SA which has a very vibrant food manufacturing element some of these diets/ "immuno-boosters come at an amazing price and beautiful packaging and horrendous health and medical claims which are difficult to control and
ensure that the medicines control council can adequately police and prevent adhoc marketing thereof!

I think in the nutrition field we need to start documenting what works,
what we know and what we really do not know about the interaction between certain antioxidant nutrients, micronutrient, and macronutrients and
HIV/AIDS. We further need to document what the possible effects  various
companies displayed their immuno-boosting products ( many having African
potato root/ garlic or micronutrients like selenium, zinc and other
antioxidants- a real hodge podge of recipes) there were constantly
questions about the efficacy of the remedies when taken concurrently with
triple therapy or HAART - what are the immediate outcomes and what are the long term impacts and outcomes.

Personally in my work I am constantly asked the following key questions
around monitoring nutrition of PLWHA and I would appreciate some help in
trying to address them:
- what can we do and recommend  for monitoring the nutritional status of
pregnant women who are enrolled in PMTCT programmes. Whilst ANC services may assess weight changes and may or may not document these and sometimes women are given Fe/folate tablets, what more nutrition advise can be given
- what other nutritional interventions can be made at this time - . I would
really appreciate your help in this area as we are supporting a project
that will follow up mothers from pregnancy to post delivery and beyond and
they would really like to focus on nutrition interventions. What nutrition
questions would need to be included in interviews with the mother - would a
24 hour recall be sufficient to address current dietary trends or would you
recommend going beyond that?


Regards


Joan Nteboheleng Matji
Nutrition Project Officer
UNICEF - Pretoria
South Africa
jmatji@unicef.org 
tel: -27-12-338-5255
fax: -27-12-320-4085/6



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