[pronut-hiv] HIV, antiretroviral therapy (ART) and Nutrition

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HIV, antiretroviral therapy (ART) and Nutrition
Eleonore Seumo, FANTA/AED
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kamogediso mokongwa wrote:
I need your advise.  I am a human rights activist in Gaborone.  I believe
nutrition plays an important role in the lives of people living with
Aid/hiv.  But where the Government has taken a decision to give ART to 
help patients, wouldn't it be better for the patients to get rx as soon as it
becomes clear from the tests that they need treatment immediately, say, 
when the CD4 count is low.  I am asking this because at the referral 
hospital, patients are always told to go back and wait for months, 
apparently, because the list is too long?  Some patients die, weeks 
later.  Dont you think this is murder?

Eleonore Seumo's views
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Thanks to all HIV/AIDS programme planners and human rights activists fighting for increased access to ART to those who need them in all countries. However, in resource poor settings, I often wonder if we are fighting the "right battle."
>From George M. Carter's contribution and various scientific sources, ART should be initiated when CD4 < 200 - and Viral load > 100,000. 
For people living with HIV/AIDS (PLWHA) with CD4 >200, does it mean that they should wait until their CD4 drop to 200 to enlist for ART?

1. What I don't hear about ART
Like any other medications, antiretroviral (ARVs) medications have side effects and their interactions with foods can lead to reduced food intake, which may have negative impact on the PLWHA nutritional status. I believe that all PLWHA should have equal access to treatment, however I also believe that PLWHA should be properly informed about the limitations and constraints of ART.
PLWHA should be informed that ARVs have side effects and food and drugs interactions that need to be properly managed. I don't know how the health system in resource poor setting is getting prepared to properly addressed the food and ARVs interactions in the advent of scaling up of ART.
Why present ART as THE solution to HIV/AIDS when we know that ART should be initiated only a certain stage of the disease? We know that failure to properly manage the side effects and food and ARVs interactions may lead to poor adherence and create resistance to ARVs medications. Therefore, the nutritional implications of ARVs medications need to be addressed. Insufficient access to food may also constitute a serious constraint and need to be addressed.

2. Why not advocate for proper nutrition and good care practices for PLWHA?
The scaling up of ARVs has created a lot of hope from PLWHA in resource poor settings, however there are not aware of some the limitations and challenges involved. Most of all, I don't understand why governments, NGOs, and donors are not promoting proper nutrition for those infected and affected by HIV/AIDS.
 I think that access to proper nutrition and care are human rights.
Proper nutrition and good care practices for PLWHA is a strategy that should be promoted to mitigate the impact of HIV/AIDS on individuals, households and communities. Promoting proper nutrition and care practices for PLWHA is beneficial for the affected households and communities.
If well informed, communities can mobilize to support PLWHA to improve their diets so that they can maintain and improve their nutritional status and live a longer and productive life and continue to take care of their household.    
It is still not clear why so little is being done in this direction. In the context of the HIV/AIDS pandemic, proper nutrition for PLWHA is something that infected and affected individuals, households and communities can do. I know many PLWHA who are living a healthily life because of proper and good care practices such as prompt treatment of any health problems and good hygiene practices.

In the fight against HIV/AIDS, we should stop being so fatalistic. We should help people to LIVE with HIV/AIDS. We should be more positive, challenge, and empower people and communities to do something for themselves and proper nutrition is something they can do with or without ART.

Eleonore Seumo
FANTA/AED
Washington DC

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