The global AIDS response is working. Today, people with HIV are living longer thanks to better access to antiretroviral treatment.
Even so, two out of three people who need treatment for HIV have no access to antiretroviral therapy. And even for the lucky ones like Miriam, a 28-year-old single mother of two who was accepted into a program for free antiretroviral drugs in Dar es Salaam, Tanzania, the circumstances can be challenging.
Despite receiving medicine, her situation was worsening. She was losing weight and getting sicker.
“Sometimes I had to skip the medicines up to five days because of lack of food,” she says, explaining that the drugs, taken on an empty stomach, made her violently ill.
Fortunately, a local health worker recognised Miriam’s plight and arranged for food assistance. After nine months she regained her strength and had secured a $50 grant to re-start her small donut-selling business in the local market. “Food support kept me alive. Had I been sent back to my home village, I would have died by now.”
Miriam’s story says it all: antiretroviral drugs alone will not ensure successful HIV treatment. Today, effective drugs to treat HIV are reaching record numbers. Some five million people in low and middle income countries are receiving antiretroviral therapy – a tenfold gain over the previous five years.
HIV alters a person’s metabolism, affecting appetite and also impeding the body’s ability to digest and absorb the nutrients in food. While the body struggles to fight the disease, it also requires more calories; an adult can need up to 30 per cent more calories, while a child with AIDS can require 50 to 100 per cent more calories to fight the disease.
Unfortunately many of the people affected are also very poor and, therefore, cannot afford a healthy diet. HIV makes poverty worse. HIV related illnesses affects people’s ability to work while also often raising household expenses, for example in order to pay for the transport to the clinic. While many people have too little to eat before they get sick, others have to skip a meal to make ends meet only once HIV strikes their lives. In both cases it is a tragedy. While their body needs more and better food, it gets less.
It is not surprising, therefore, that recent studies have shown the link between good nutrition and successful uptake of and adherence to treatment. Only a person who takes up treatment and adheres to it can return to a relatively healthy life. This also means that including nutritional support to people living with HIV and giving them food when they are poor can be crucial in keeping them alive.
That’s why UNAIDS and the UN World Food Programme are calling for better integration of food and nutrition assistance in all aspects of HIV programmes. To mitigate the impact of the disease on people living with HIV’s health and their families’ livelihoods, we must reshape nutrition assistance as part of comprehensive treatment for people living with HIV.
Without access to adequate and nutritious foods at the right time, lives are put at risk, medications are not as efficient as they should be and patients leave treatment programmes that could have sustained their lives and the lives of their families. The sick and hungry cannot wait.
Josette Sheeran is Executive Director of the UN World Food Programme
Michel Sidibé is Executive Director of UNAIDS