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Nutrition key factor to treat AIDS patients

In a joint article, Dr. Lee Jong Wook, director general of the World Health Organization, and James Morris, WFP executive director and special envoy of the UN secretary general for southern Africa, warn that treatment of HIV/AIDS demands an integrated approach to people's physical, nutrition and health needs.

In a joint article, Dr. Lee Jong Wook, director general of the World Health Organization, and James Morris, WFP executive director and special envoy of the UN secretary general for southern Africa, warn that treatment of HIV/AIDS demands an integrated approach to people's physical, nutrition and health needs.

Sometimes, doctors are accused of treating the disease, not the patient. But to tackle HIV/AIDS, we cannot focus all of our energies on treatment alone. HIV and AIDS attack on many fronts, and our defense must be multifaceted as well. So far, much of the discussion on AIDS has ignored one of the critical aspect of the care and support for people living with HIV/AIDS, and that is nutrition.

That was already a problem when the pandemic was centered mostly on the developed world, where most people living with HIV/AIDS had adequate diets to start with. But today, 95 percent of the people who are HIV positive live in poor countries, and many of them struggle to get enough to eat.

Take 46-year-old Benedicte from Busia in western Kenya, for example. Benedicte is HIV positive; his wife died five years ago, leaving him to care for his 6- and 8-year-old sons. One in three households in Busia is so poor that even if they spend all of their money on food, they are still unable to get enough to eat. One in five residents is living with HIV/AIDS. When the World Food Program first started a project to provide food to families in Busia, and antiretroviral treatment started being given to people living with HIV/AIDS, Benedicte had to be carried on a stretcher to collect his rations.

The world has thankfully awakened to the need to get antiretroviral therapy to millions more people living with HIV/AIDS in poor countries. But this massive investment in care, support and treatment can be jeopardized if the people who will finally receive treatment are not sufficiently well nourished to get the full benefit of the drugs.

In Africa, AIDS patients are frequently admitted to hospital already malnourished. Sadly, in most places there is no systematic approach to meeting their nutritional needs. There is no scientific consensus on whether HIV infected people have any special nutritional needs over and above a good, balanced diet. But we do know that sound nutrition helps maintain the immune system, increases body weight and boosts energy levels.

Back now to Benedicte in Busia. Once he started receiving antiretroviral treatment and regular food, he was able to ride to the distribution point and wheel the sacks of maize, beans, oil and sugar back home on his bicycle.

People who are suffering from malnutrition are more likely to fall ill with opportunistic infections and less likely to recover from them. At the same time, HIV and related opportunistic infections can exacerbate the effects of malnutrition because they reduce appetite and interfere with the body's ability to digest food and absorb essential nutrients. We also believe that antiretroviral treatment has a better chance of succeeding when people are better nourished.

This weekend, in Durban, South Africa, the World Health Organization hosts the first-ever regional conference on the special nutritional needs of people living with HIV/AIDS. The consultation aims to provoke immediate action to improve the nutrition and health of HIV-infected people in southern and eastern Africa.

In addition, an agenda for future research will be developed from the key gaps identified by African scientists and the community of people living with HIV/AIDS.

It's about time. Finally, experts in HIV, medicine, nutrition and public health will focus on the evidence and try to determine the specific nutritional needs of communities grappling with this epidemic and how best to respond to them. We hope that this will trigger governments and donors to integrate nutrition in their HIV/AIDS policies and programs.

The conference must keep in mind one basic fact. Whatever the scientific conclusions on the nutritional needs of people living with HIV/AIDS, most of the 30 million HIV infected people in Africa don't even have secure access to the basic nutrients any human being needs to live a healthy life, let alone fight off tuberculosis and the other infections to which they are prone.

Ensuring that people living with HIV/AIDS have at least the basic recommended levels of micronutrients and adequate energy is the bare minimum. Adequate nutrition, which is best achieved through consumption of a balanced healthy diet, is vital for the health and survival of all individuals--regardless of their HIV status.

On its own, feeding people in hospitals is not the answer. When they return home after recovering from AIDS-related illnesses and starting antiretroviral therapy, there is no guarantee that they will have access to the food they need to keep them well.

A healthy, balanced diet helps keep people well and active. Improved attention to diet and nutrition may also boost the adherence to and effectiveness of antiretroviral therapy. That could provide huge savings for both governments and donors, who are already straining to respond to this public health crisis. Access to nutritious food can stop poor people from turning to activities like sex work that put them at even greater risk of infection. And there's even evidence emerging that keeping children in school longer can keep them HIV-free; we've known for years now that providing nutritious school meals attracts children to school and encourages them to stay there.

It is vitally important to link nutrition and food security with the support and treatment that people living with HIV/AIDS need to stay healthy. This is not a disease that can be tackled by medicine alone, but one which demands an integrated approach to people's physical, nutrition and health needs. AIDS patients in the Western world have never been allowed to starve while receiving antiretroviral treatment. We shouldn't allow it to happen elsewhere, either.