HIV, Livelihoods, Nutrition

1
HIV, Livelihoods, Nutrition Health Research

• Global Ministerial Forum on Research for Health
• Nov 2008, Bamako Mali
• By Robert Ochai
• Executive Director
• TASO Uganda
• www.tasouganda.org

2
Uganda Overview HIV Prevalence by Region
2.3
8.2
3.5
5.3
6.5
6.9
8.5
Overall prevalence among those 15 to 49 years is
6.4
Kampala 8.5
5.9
3
TASO The AIDS Support Organisation

• TASO exists to contribute to the process of
  preventing HIV, restoring hope and improving the
  quality of life of persons, families and
  communities affected by HIV infection and
  disease.
• TASO complements the public health systems and is
  a key actor in the national response.
• It provides a holistic range of services that
  radiate from the index client, into their
  families, and to the general public.
• TASO actively involves people living with
  HIV/AIDS and local communities in its activities.

4
TASO 2008-2012 Goals
5
Core TASO Services

• This slide has some pictures so the attachment
  could not come Ill bring the slide on flash
  drive!!!

6
The Dynamic Interactions of HIV, Nutrition,
Livelihoods and Health
7
Three coexisting/interacting crises
Source RENEWAL
8
Malnutrition and HIV disease progression

• Malnutrition is associated with immune function
  decline
• Degree of malnutrition is clearly linked to
  mortality risk
• Compromises efficacy increases toxicity of ARVs
• Undesirable ARV side effects
• Threats of decline in ARV adherence
• Higher mortality in the first three months of ART
  initiation
• Studies show that high levels of vitamin B, C, E,
  and folate, slow the progression from HIV to AIDS
  and contribute to increased CD 4 counts and
  reduced viral loads.

9
HIV/AIDS and Food Insecurity

• Vulnerability to HIV infection results from
  multiple, entwined processes a key one is food
  insecurity.
• Food security deteriorates when an adult family
  member becomes chronically ill. The illness
  results in loss of labor, reduces productivity,
  reduces income, increases expenditures on
  medication and on a futile search for a cure.
  Even the care-givers lose their productivity.
• The overall impacts of ill-health on
  agriculture/food production depend on several
  variables including
• household demographics
• quantity, quality and mix of assets (household
  and community)
• labour demand (type, degree, seasonality)
• institutional context, social support (stigma)
• concurrent multiple shocks (e.g. drought)

10
Integrating nutrition security interventions

• Due to its impact on health, it is important to
  integrate food assistance into programs for
  people affected by HIV AIDS.
• TASO, like many other organizations integrates
  livelihood/food security into its programming.
• Admittedly, the evidence base on effectiveness of
  the various possible interventions is still weak
  however, due to the great need, we have build the
  boat while sailing we can not afford to wait for
  all the answers.

11
TASOs commitment to evidence based nutrition
security programming

• Utilizing the data we have (2002-2007)
• Key questions How does the provision of food
  assistance affect BMI and change in WHO staging?
• Preliminary Results
• Food assistance had a positive impact on weight
  gain
• Food assistance helped slow transitions in WHO
  Stage
• Impacts varied by initial WHO stage at which food
  assistance is provided (earlier is better)
• (RENEWAL/IFPRI Concern Worldwide, WFP, Univ.
  of Illinois and others)

12
TASOs evidence based nutrition security
programming (contd..)

• Impact evaluation and cost-effectiveness of
  nutrition supplementation to Pre-ART individuals
  and their households
• This study is ongoing
• Key Outcomes
• Disclosure, stigma, high risk behaviors, access
  to care
• Clinical progression nutrition outcomes
• Quality of life
• Household welfare (food security, assets,
  expenditures patterns)
• Intra-household outcomes (labor allocation,
  nutritional status and schooling)
• Cost-effectiveness
• (RENEWAL/IFPRI , WFP, Concern Worldwide, Univ. of
  Illinois and others)

13
Research Gaps

• Health the forms and models of implementing HIV
  initiatives influences the following components
  of health systems strengthening
• service delivery
• health workforce
• information
• medical products, vaccines and technologies
• financing
• leadership and governance
• Understanding the nature and magnitude of this
  effect is a key research area.

14
Research Gaps - II

• Livelihoods the impact of HIV on individuals,
  households and communities influences the
  following components of livelihoods programming
• premature illness and deaths of adults who
  provide the bulk of family labor power
• rupture of customary intergenerational knowledge
  transfers
• Proper understanding the macro-economic impacts
  of HIV/AIDS remains an important policy issue.

15
Research Gaps - III

• Nutrition As HIV impacts on households and
  families and communities, food production gets
  distorted
• Difficulties in food production lead to poor
  nutrition (protein-energy malnutrition and
  deficiencies in micronutrients e.g. zinc, iron
  and vitamins)
• Poor nutrition leads to compromised immune
  systems (individuals become more prone to
  infection)
• Understanding the mechanisms here would improve
  programming. TASO is currently partnering with
  IAEA and WFP in a study aimed at throwing more
  light on these questions.

16
Conclusions

• Food security is critical to health especially
  in HIV/AIDS care. The linkages are scientifically
  documented.
• While some efforts have been taken to improve
  nutrition, the need is still enormous more work
  needs to be done urgently.
• Good research has been done, but there is need
  for more in order to improve understanding of the
  interactions between HIV, nutrition, and health
  this will improve programming and advocacy.
• Research findings must be transformed into
  practical benefits i.e. better policies and
  programs for health!

17
Acknowledgements

• TASO staff and clients
• RENEWAL/IFPRI
• Concern Worldwide