At the dawn of the post-2015 development agenda, the global health community is rallying around the “ending of AIDS by 2030”, a goal that now appears within reach. With the power of antiretroviral therapy (ART) to both extend the lives of people living with HIV and prevent new infections, treatment has rightly been placed at the core of the strategy for moving forward.
But, with just 38 percent of adults in need of treatment actually on treatment, and increasing recognition of the difficulty in keeping people on treatment long-term, it is clear that critical barriers remain.
Simelane Sabelo (not his real name) tells the story of how WFP links with the national ART programme to deliver food to patients (also known as ‘Food by Prescription’), along with nutrition assessment, counseling and other support.
Every month, the Swaziland farmer takes home a bag of nutrient fortified corn soya blend which helps keep him healthy and acts as an incentive to stick to his treatment. The nutrition counseling Simelane received while in the programme opened his eyes to a new way of eating. “Before, I just ate. I didn’t care what it was,” he says.
The programming guide for policy makers and practitioners, entitled “Nutrition assessment, counseling and support for adolescents and adults living with HIV,” demonstrates how many barriers can be addressed with effective food and nutrition interventions.
The guide uses nutrition assessment, counseling and support (NACS) as an organizing framework and elaborates on how each of those components can be integrated into HIV programmes. Importantly, it recommends that assessment and counseling should be part of HIV care for everyone, worldwide, irrespective of nutritional status, treatment and food insecurity.
Biologically, nutritional recovery is essential for patients starting on ART with a low body weight (body mass index <18.5), as they are 2-6 times more likely to die during the first six months of treatment than those with a normal body weight.
As a behavioral intervention, particularly in food-insecure settings, food support—whether in-kind or as cash or vouchers—may provide the critical safety net needed to prevent patients from having to choose between a bus ride to the clinic to receive treatment or a meal to fill empty stomachs.
The guide considers a range of context-specific programme components, such as community involvement, whether household food support is needed to complement individual support, and referrals to broader social protection or safety net measures to strengthen livelihoods.
WFP hopes this guide will advance the comprehensive integration of food and nutrition in HIV and TB strategies and programmes.