[pronut-hiv] Nutrition and HIV/AIDS

["Janet Feldman" <kaippg@earthlink.net>]

 Nutrition and HIV/AIDS in the field
-----------------------------------------


Dear Friends,
Hello and here is another great organization doing excellent work in the
field of nutrition and HIV/AIDS. I have run across several good articles
posted a year ago in the AF-AIDS and INTAIDS forums
(af-aids@healthdev.net ), so will post those if I can. I have also heard
from several people requesting info after my posting about KAIPPG's
nutritional program in Kenya, and will answer everyone this week. I am
planning to write up a short list of sources and resources I have gathered
on this subject, so will post that and send it to the individuals who have
written as well. Below find this exciting program by Vida Pos in Mozambique,and hope someone from that org. is in this discussion group (will cc them in case they have more to add and tell them about ProNut if they don't know about it). With many thanks and all best wishes, Janet Feldman, Director,KAIPPG/International, kaippg@earthlink.net 


Nutrition and HIV/AIDS-Vida Pos,MZ

This email is in response to the article posted by KAIPPG (Kenya AIDS
Intervention/Prevention Project Group), and their excellent efforts in the
area of HIV/AIDS and Nutrition. We would like to describe a similar program currently underway in Mozambique, run by the National AIDS Council (Conselho Nacional de Combate ao HIV/SIDA).

 ************************
Vida Positiva (Positive Living) is a program run under the auspices of
the National AIDS Council of Mozambique, specifically to provide knowledge and skills resources to NGO's, Faith-Based Organisations, HIV-focal points in State departments, and Community-based Organisations working directly with people living with HIV, nationally. This program is partially based upon the book 'Vida Positiva', which is an at-home hysical, emotional and spiritual 'survival kit' for those living with HIV (pre-AIDS), based upon research of long-term non-progressors, written by Neil Orr, and cofacilitated with David Patient, PWA. This program commenced in February 2002, and consists of a 14-month training program, along with other interventions. It is funded via a Common Fund of donors. Our motto or battle-cry (credo) is: "Vida Positiva: Sim, eu posso! Tu tambem". ("Positive Living: Yes, I can! So can you").

A central component of the program is nutrition, although there are fourteen other components to the program, including behaviour change and understanding people's health motivations, empowerment methods, support structures for PWA's, and so forth.In the nutritional component, we focus upon a balance between three things:

(1) Vitamin and Mineral substances which have a demonstrated activity in
strengthening the immune system in HIV and other viral infections.  Local
food types are researched in terms of these substances, and receive
prominence in choosing what to grow at home; (2) The so-called 'balanced
diet' essential for health in general; (3) Easy-to-access indigenous food
sources and also family 'kitchen gardens', including medicinal plants for
treating minor opportunistic infections. The rationale for including the
immune-enhancing food types is simply that, with limited resources (time,
finances, and effort), it makes sense to give prominence to food types that
will help to alleviate poverty, and simultaneously increase resistance to
illnesses such as HIV-related infections. We refer to this as an
'immune-focused balance diet'.

At present, Mozambique is suffering from three major 'epidemics': HIV/AIDS, Poverty, and Gender Inequity. The HIV/AIDS infection rates are climbing,especially along the economic corridors, and in some areas, the ratio of women:men infections are 2:1. Furthermore, famine is occurring in some provinces, especially those adjoining countries such as Zimbabwe and Malawi.

The HIV/AIDS and Nutrition issue are intimately linked: those who are hungry and poor typically also progress to AIDS faster than average, respond poorly to some medical treatments due to malnutrition, thus increasing the burden upon limited medical resources. Furthermore, families who have a member ill with AIDS, or who have lost a member due to AIDS, have typically also lost a person who has provided food for the family. Women are particularly vulnerable, as they need to obtain food for themselves and their children,which sometimes results in compromising sexual choices, and trading sex forfood and shelter. This impacts directly upon the severity of the AIDS orphan situation.

An important long-term impact of HIV/AIDS on food security in
Mozambique -and we suspect elsewhere - is the loss of knowledge in producing local food types, and farming skills, leading to a gradual deterioration of food production and diversity. The introduction of mono-cropping (e.g.,Maize) also leads to great vulnerability in times of drought, and a general deterioration of health due to restricted dietary intake of nutrients. In the Vida Positiva Program, we have integrated and involved diverse sectors, including private sector, NGO's, churches, various government ministries, to ensure that skills such as trench-gardening (family-focused kitchen vegetable gardens), producing and harvesting vegetables (especially indigenous types which are drought resistant) is filtered into the broad community.  We have also included medicinal plants in this 'Family Garden' approach, such as aloe ferox, bulbinella, and garlic, to assist in the prevention and treatment of minor infections.

The approach is based upon the 'pay-it-forward' principle: Delegates
from all sectors attend a week-long training per month on specific
components of HIV/AIDS, such as nutrition, and then return to their
communities or organisations. Part of the training participation agreement
is that they will teach three colleagues, in case the organisation loses
this skilled person. The person is also committed to teaching the skills to
three people outside of their organisation, such as teachers, concerned
citizens, nurses, community workers, and so on. A geographic network is
built over the 14-month training program, and during the training itself
these small 'cells' collaborate to implement defined community-based
workshops within their communities, such as the nutrition component, or
HIV/AIDS behaviour-change/awareness, or gender-focused empowerment. Once these 'cells' are established, the National AIDS Council sends trainers and facilitators to the provinces, to evaluate and assist in the community workshops, in conjunction with the provincial co-ordinators, radio stations,and other structures.

It is common in such programs to find that the activities are slow to start,
and dissipate over time, until sufficient momentum is obtained.
Due to the scale of the pandemic, activation for delivery is crucial.
accelerate this process, we have implemented several 'activation'
methods: Upon the completion of a specific HIV/AIDS training module, all
radio stations and newspapers are sent a briefing of what the delegates have learned to do. Agreements in this regard are negotiated and established in advance. Upon return to their region, the delegates are then interviewed on local radio and newspapers, describing what they have learned. Their names and their organisation's contact details are provided. This ensures that people know about what they are skilled to teach, and can be requested to provide such training. Furthermore, each training module is followed by a specific project, which is evaluated. Organisations who cannot attend the training due to lack of resources for transport or too few personnel to release a person for a week per month, are also notified by the National AIDS Council, regarding which delegates are skilled in a specific area.Delivery is thus the focus. NAC Provincial co-ordinators are also briefed of the training progress, and facilitate and co-ordinate activities in theirregions.

It should be noted that many of these community interventions do not
necessarily mention the words 'HIV-positive'. The reason is simple: The
great majority of those infected with HIV do not know that they are
infected, and most are likely never to be tested, due to the scarcity of
testing centres and similar facilities. Although testing is encouraged,  the
reality is that this will remain problematic for many years to come.
Therefore, focusing upon the general high-risk groups and their families
remains the central focus. Until people become aware that there are
indeed benefits that can be achieved in maintaining health after a
HIV-positive diagnosis, there is often a general perception that there is no
point in getting tested.  Therefore, facilities such as VCT sites are being
encouraged to provide referrals to nutritional and other activities, as this
will lead to a shift in perception regarding testing itself:  "Once
you know, you can do specific things to stay healthy for as long as
possible - if you do not know, you will not benefit".

An important aspect of nutrition - beyond the obvious physical
benefits -is that it provides PWAs and their families with something
tangible to do, in terms of taking the initiative in their health. It is
empowering to those who have little access to medications, and are not
likely to have access. When these nutritional guidelines are focused upon
immune-enhancing food types, the PWA also experiences extended health,  thus
decreasing the burden on the medical facilities available. The healthier a
person with HIV is, the longer she or he is capable of being productive,
thus slowing down the disruptions within economic and community structures.
It also supports medical treatment, where this occurs. For example,
antiretroviral therapy requires the patient to take the various medications
at specific times, before, during or after meals. Without the necessary
meals, these medications may have adverse effects, or may not be as
effective as they could be.

There are many issues which are not necessarily apparent in addressing
the nutritional needs of those living with HIV. For example, it is often
assumed that communities have traditional knowledge and skills
pertaining to agricultural methods. Often, this is no longer the case, due
to the loss of these skills due to civil wars and other social catastrophes.
Furthermore, the introduction of mono-cropping as an emergency effort to
alleviate famine, has led to a gradual loss of diversity in food types, and
loss of seed stocks of indigenous and non-hybrid food types. This
also leads to greater reliance upon structures outside of the community, in
terms of food production. Dense urbanisation near economic hubs also results in lack of access to land for the production of food, except for small areas in the back of the home. In these situation, community
gardens are not practical, as there is a great distance to travel from home
to land that is large enough for such large food production activities.
Therefore, although community gardens are feasible in the rural areas, this is not always the case in urbanised settings, where HIV-infection rates are high, hence the focus upon small kitchen gardens. The latter is easily extended in rural areas.


For more information, please contact Neil Orr or David Patient at
vida.pos@tvcabo.co.mz.
--
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