[pronut-hiv] Widening essential nutrition actions

[Judy Canahuati <jcanahuati@care.org>]

Widening essential nutrition actions
Important issues raised about holistic programming
Judy Canahuati
-------------------

I think that George and Robert raise really important issues about holistic 
programming.  This is something I'm trying to address in thinking about 
issues of rights and infant feeding from the programmatic point of 
view.  For example, you and I probably take B-vitamins (or at least a good 
multi-vitamin capsule) every day (hopefully, as we all have gaps in what we eat) because we are "conscious" and have the means to be able to pay the cost.

Recommendations are important, and should certainly be based on "good 
science", but If we think in terms of duty bearers, where does the 
responsibility of the state (??) to provide HIV affected communities with 
essential vitamins begin and end, is it only with recommendations?

There was a time that at least some Ministries of Health provided at least 
a multi-vitamin capsule during pregnancy, but now, with the understanding that neural tube defects are linked closely to folic acid deficiency and 
the understood effects of anemia on women, MOHs have cut back on even that basic support.  Does this need to be part of what we request when we are proposing care and support for HIV communities?  What role to CBOs and FBOs play in all of this?

What should be our position on fortification?  In the US, if it weren't for 
fortification we would be seeing lots more micronutrient deficiency than we already see... what about developing countries?  How should that square with our attempts to help at least rural populations become more 
independent of the market in terms of micronutrients at least, through the 
use of permaculture, "sustainable agriculture" and other more low-tech, 
non-market solutions to food production?

How is "good science" linked to rights here?  Do we have any case studies 
where this has taken place?  Last week I was at a Hearth training of 
trainers workshop and one of the things that people discussed was the lack of impact Hearth, without ARVs, had on improving the nutritional status of malnourished <3s in HIV affected communities...same true for malaria, TB,deworming, etc.  As Robert asks, what other interventions need to go into our Care and Support programs.

Incidentally, thanks for all the leads on the HIV and Nutrition CD.  It is 
shaping up nicely and I'll let you all know when its finished.

Judy

Judy Canahuati, MPhil, IBCLC
Senior Technical Advisor for Nutrition
CARE
151 Ellis St., NE
Atlanta, GA 30030
Tel:404-979-9328; Fax:404-589-2624
mailto:jcanahuati@care.org 

---------------------------------------------------------------------------------------
Dr. Robert Mwadime wrote:
>Friends,
>
>I love what George is suggesting. But the list George has is only part of
>the story. In the context of HIV/AIDS, the Essential Nutrition Actions
>(ENAs) for Women and Young Children can't remain as we have had them,
>whether they are 6 actions promoted by BASICS or the longer list of 10
>actions promoted by the RCQHC/LINKAGES. We need to (re)look at these ENAs 
>in the context of HIV/AIDS.
>
>For instance, sanitation and safe food handling is a key action in the
>context of HIV/AIDS, and has serious implications on nutrition. But should
>this be included (including deworming) in the ENAs?
>
>Robert Mwadime
>
>- 
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