Nutrition and Food Security: Twin Resources in the Management of HIV/AIDS KEEPING IT REAL

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1 Nutrition and Food Security: Twin Resources in the Management of HIV/AIDS KEEPING IT REAL GOULDA A. DOWNER, PhD, RD, CNS Principal Investigator/Assistant Professor Howard University, College of Medicine Washington DC

2 KEEPING IT REAL Goals/Learning Objectives: Describe how to optimize food and nutrition in the management and overall well being for individuals diagnosed with HIV/AIDS. Articulate the importance of food security as a component of quality HIV/AIDS management. Develop strategies to insure food security and resource linkages to manage medication side effects in HIV/AIDS.

3 Vicious Cycle of Malnutrition and HIV Poor Nutrition (food insecurity) results in wt. loss, muscle wasting, weakness, nutrient deficiencies Increased Nutritional needs, Reduced food intake and increased loss of nutrients, dehydration HIV Increased vulnerability to infections e.g. Intestinal infections, flu, TB, etc. hence Increased HIV replication, Hastened disease progression Increased morbidity Impaired immune system; Poor ability to fight HIV and other infections; Increased oxidative stress Source - Adapted from RCQHC and FANTA 2003

4 Deficits in certain micronutrients such as: Iron Selenium Copper Zinc Vitamin A Vitamin C Vitamin D

5 Unhealthy diet pattern: High fat diet - saturated fat Low quality protein Low - fresh fruits and vegetables Inadequate water

6 Effects of Malnutrition on HIV Malnutrition HIV impairment of immune reconstitution prolonged period of opportunistic infection risk adverse effects on drug absorption lower threshold for drug toxicity decreased physical function

7 Affects of HIV/AIDS on Nutrition 1. Changes in metabolism 2. Decrease in the amount of food consumed 3. Impaired nutrient absorption

8 FOOD INSECURITY Food insecurity is the lack of regular access to ample quantity and quality of safe, nutritious, culturally appropriate food at anytime, such that the dietary needs of individuals and communities are not met. Goulda A. Downer, 2005

9 FOOD SECURITY (USDA) Food security for a household means access by all members at all times to enough food for an active, healthy life. Food security includes at a minimum: 1. the ready availability of nutritionally adequate and safe foods, and 2. an assured ability to acquire acceptable foods in socially acceptable ways (that is, without resorting to emergency food supplies, scavenging, stealing, or other coping strategies)

10 Elements of Food Security Food security Availability Access Access Utilization

11 Causes of Decreased Food Consumption Mouth and throat sores Loss of appetite leading to fatigue, depression, and changes in mental state Side effects from medication Household food insecurity and poverty

12 Effects of Food Security on HIV/AIDS complementary food responses: alleviate side effects improve medication efficacy maintain nutritional status ensure continued adherence to the medication

13 Effects of HIV/AIDS of Food Availability and Access HIV/AIDS creates additional nutritional needs Reduces labor availability Decreases income Depletes savings Leads to sale or loss of assets Depletes food reserves Weakens safety nets and support systems

14 Effects of Food Insecurity on HIV/AIDS May increase risky behaviors May lead to livelihood strategies that increase risk of infection Reduces access to preventive education and commodities Increases severity of HIV/AIDS impact

15 Effects of Food Insecurity on HIV/AIDS Food insecurity in itself is a risk factor for HIV/AIDS transmission

16 TREATMENT THERAPIES ANTIRETROVIRAL DRUGS: Keep the virus from reproducing and infecting new immune cells PROTEASE INHIBITORS: Interfere with the enzyme Protease Keep immature virus from maturing

17 Food and Drug Interactions Poor access to foods needed to alleviate side effects, improve drug efficacy, and maintain nutritional status Side effects leading to poor adherence to medications Counselors: Identify medication-food requirements and limitations and food options and help plan drug-meal schedules

18 During Assessment: Understand Sources of Food Insecurity Assess nutritional status and practices Assess factors that prevent adoption of improved practices, including food access and availability and knowledge Assess the status of food supply, income, and employment Identify coping strategies used Assess the negative effects of these strategies Identify components that need external support

19 During Assessment: Identify Food and Nutrient Access Gaps Identify the core foods and nutrients the client needs. Identify the causes of food/nutrient gaps Identify capacities in the household (Supplemental Nutrition Assistance Program [SNAP]; WIC etc, support from other members) Identify options to strengthen nutritional practices

20 Understanding the approaches a household is using to maintain food security involves asking the following questions: What coping strategies are the household and community using and how adequate are they? What support networks exist and how adequate are they? What strategies used in the past are no longer possible in the context of HIV/AIDS? Which coping strategies are having negative e.g., sale of assets, risky lifestyle activities)? What components need to be supported and built up and how?

21 KEY POINTS TO REMEMBER:

22 Conclusions HIV affects nutrition in key overlapping ways: 1. Nutritional status affects HIV disease progression and mortality 2. Improving nutritional status may improve some HIVrelated outcomes 3. Counseling and other interventions to prevent weight loss probably have their greatest impact early in the course of HIV infection 4. Nutritional supplements, particularly antioxidant vitamins and minerals, may improve HIV-related outcomes, particularly in nutritionally vulnerable populations

23 Conclusions Information and knowledge are not enough for effective nutritional care and support without household food security. Nutritional care and support providers need to assess client food security, identify feasible options, and help address food insecurity

24 KEY POINTS TO REMEMBER: TAKING MEDICATION WITHOUT EATING PROPERLY IS LIKE WASHING YOUR HANDS,THEN DRYING THEM IN MUD. Goulda A. Downer