Food Security and Nutrition Interventions in Response to the Aids Epidemic: Assessing Global Action and Evidence

Abstract

The number of people receiving antiretroviral therapy in developing countries has increased dramatically. The last decade has brought an increased understanding of the interconnectedness between HIV/AIDS, food insecurity, and undernutrition and a surge of evidence on how to address the food security and nutrition dimensions of the epidemic. We review this evidence as well as the corresponding evolution of policy support for incorporating food security and nutrition concerns into HIV programming. The available evidence, although varied in scope and methodologies, shows that nutrition supplementation and safety nets in the form of food assistance and livelihood interventions have potential in certain contexts to improve food security and nutrition outcomes in an HIV/AIDS context. In the face of funding uncertainties and competing priorities, we must maintain momentum towards effective and sustainable solutions to the epidemic through continued systematic research to inform policy and through the strengthening of monitoring systems to dynamically inform intervention development.

Levels and Predictors of Food Insecurity among HIV Positive Adult Patients Taking Highly Active Anti-Retroviral Therapy at Arba Minch General Hospital, Southern Ethiopia, 2016

“…Millions of HIV infected people live in countries with high levels of poverty and food insecurity. Food insecurity and HIV/AIDS are interlinked and causing significant morbidity and mortality in sub-Saharan Africa [15][16][17].…”

ART Adherence as a Key Component of Prevention With Persons Living With HIV in Mozambique

“…Our data highlight the need for a more systematic effort to understand the role of food insecurity (Aberman, Rawat, Drimie, Claros, & Kadiyala, 2014; Young et al, 2014) as a barrier to adherence in this population and the need to examine approaches to address this issue. Various other countries that have documented food insecurity in PLWH have implemented small interventions that focus on integrating food or agricultural programs with HIV activities.…”

“…A pilot project in Kenya showed that a microfinance-based agricultural support program integrated with HIV care led to increased food for consumption in the home, improvements in agricultural output and income, and particular benefits for women living in poverty (Pandit et al, 2010). There is agreement that food insecurity is related to both risk of HIV acquisition and HIV outcomes, and that improving food security could improve HIV outcomes, including adherence (Aberman et al, 2014; Young et al, 2014). However, future research, including longitudinal studies that can clearly link these small interventions (e.g., microfinance programs) to improved HIV-related outcomes, is needed.…”

Adherence to HIV and TB Care and Treatment, the Role of Food Security and Nutrition

“…Grede et al [28] focus on social and economic costs of TB by analysing the role of food assistance in mitigating the social and financial consequences of TB at individual and household levels. Aberman et al [29] assess the global action in response to the AIDS epidemic in the context of food and nutrition security interventions as well as the evolution of policy supporting their integration into HIV programming. Martinez et al conclude with a study from Honduras where the provision of household assistance in the form of a food basket and nutrition education improved adherence to HIV treatment by 20 % (p = 0.01) within 6 months among 400 clients with previous sub-optimal adherence [30].…”

“…eligibility for therapeutic or supplementary food, integration of nutrition assessment counseling and support, linkages to HIV sensitive and HIV specific safety nets, referral systems to PMTCT and reproductive health, social protection, etc.) and communities (behavioral interventions at community level using task shifting and health care workers to track malnourished clients, creating nutrition support centers and referral systems) [27] • Socio-economic consequences of TB include stigma, social isolation, increased out-of-pocket expenditures for medical and non-medical costs and reduced income [28] • Social transfers in the form of food, cash or vouchers can mitigate the negative effects of TB by enabling diagnosis seeking behaviours, protecting minimum food expenditures, reducing the need to accumulate debt and reduce productive assets [28] • Social transfers also reduce the negative impacts on other household members, particularly young children and school-age children [28] • A current practice is the integration of nutrition assessment, counseling, and support (NACS) in the HIV response by strengthening links between nutrition and specific services by the health, agriculture, food security, social protection, education, and rural development sectors for more comprehensive care [29] • Nutrition supplementation and safety nets in the form of food assistance and livelihood interventions have potential in certain contexts to improve food security and nutrition outcomes in an HIV/AIDS context [29] • Providing household assistance in the form of a food basket along with nutrition education improved adherence to HIV treatment by 20 % (p = 0.01) among a group of non-adherent patients [30] Demand side barriers related to socioeconomic status, social norms and knowledge, and physiology may be objective or also only subjective (i.e. fear of unbearable side effects, when these may actually be tolerable) [25] S462 AIDS Behav (2014) 18:S459-S464…”