[pronut-hiv] Rwanda: Assuaging HIV Afflictions

["ProNut-HIV" <pronut-hiv@healthnet.org>]

Rwanda: Assuaging HIV Afflictions
The New Times (Kigali)

OPINION
June 26, 2006

Isaac Mugabe
Kigali

Adequate consumption of the right kinds and quantities of foods
certainly improves fitness and quality of life of PLWHAs (people living
with AIDS) and those already infected with the HIV virus. I understand
that the Treatment and Research Aids Centre (TRAC) is very cautious when
it comes to commending a patient for the ARV's, lest they get
devastating results.

So availability of sufficient and proper foods and a balance of
different foods would help to maintain body weight and muscles, maintain
and improve the performance of the immune system, and reduce the impact
of many of the symptoms of HIV/AIDS and its opportunistic infections.

To fully utilize and benefit from the nutritional management angle to
HIV/AIDS care, we must improve our understanding and knowledge of the
interrelationship between nutrition and the disease, including the
possibilities and limitations of nutritional care and support for
PLWHAs, the skills and techniques to apply innovative and programmatic
approaches in our efforts to implement and communicate information on
nutritional care and support to PLWHAs, their caregivers, health workers
and others. The government, TRAC and the AIDS Commission must provide
the motivation to strengthen existing services and initiate new
approaches to improve nutritional care and support for people with HIV,
with their full involvement and those of all target groups.

In broad terms, therefore, it could be said that nutritional care for
HIV/AIDS must include considerations for such factors like HIV disease
progression and implications for immunity and nutritional status,
HIV-related complications like diarrhoea, weight loss and loss of
appetite, the role of anti-oxidants and other micronutrients in HIV,
support for children with HIV, food security, food safety and hygiene.
It should also include nutrition education in Rwanda's curriculum,
communication and counselling for PLWHAs, implementation and integration
of well-thought-out nutritional care and support in programmes/
policies, which must take into consideration all necessary practical
work on translation and dissemination of guidelines into culturally
specific recommendations, preparation of recipes and nutrition
education.

A good opportunity to send this message across to the public would be
at the end of the communal labour (Umuganda) instead of thanking locals
for turning up in big numbers and addressing issues of security and
Gacaca alone. I for one have never heard anything to do with HIV/AIDS
discussed at the end of the few umuganda sessions I have participated
in. Not because I dodge them but simply for the reason that I am out on
an assignment.

Therefore the most important message should be caring for or
controlling HIV/AIDS which goes far beyond just access to ARVs. Probably
more than ARVs, PLWHAs in resource-poor settings -and indeed everywhere-
need proper medical, psychological and social care, nutrition,
qualitative home and community care including administration of other
essential drugs, opportunities to play certain roles in their
communities and beyond. Capacity development, improvement of HIV/AIDS
and other related community-based organizations, and improved positive
perception of home and community-based palliative care by health workers
and all caregivers should as well be prioritised. The 'code of conduct
for HIV/AIDS care' proposed in this context is only intended to be an
adaptable model of care with details and operating procedures set out
and approved; including the need to care for the caregivers, since most
of them are older persons who have lost to HIV/AIDS the human generation
between them and t heir grandchildren especially in Africa.

In recognizing that medications for treatment of HIV/AIDS and
opportunistic infections are increasingly being provided, and indeed
targets have been set for many national strategies to ensure that
therapeutic, psychosocial and palliative care is available in some
countries in Africa, the dearth of infrastructure for implementing such
strategies is another problem. Efforts are needed to ensure adherence to
the drugs prescriptions, support people through emotionally trying
times, promote disclosure, and provide informed home and community-based
care especially in poor-resource settings. It is important in such
settings to try and have health personnel who have experience with
treating HIV-positive patients, could prescribe antiretroviral in
clinically justified ways, provide voluntary counselling and testing
(VCT), and perform HIV-testing or tests for CD4-counts and/or viral
load. The idea is to ensure effective care, service delivery,
commitment, preparedness, and availability of support for maintenance
and expansion of services.

Now, I call unto you all Rwandans to think about this deeply. Otherwise
access to ARV's which has been made easy by the government and other
concerned institutions is not enough, but much support in terms of
nutritional support to PLWHAs now is what they cherish so much.