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AIDS and malnutrition inextricably linked

London Peter Moszynski

The importance of the links between AIDS, nutrition, and food security is only just being realised, a conference in London was told last week. The disease is having a devastating impact on the availability of food. And a shortage of food is increasing deaths from the disease, the conference heard.

In April last year, the World Health Organization held a consultation meeting in Durban, South Africa, on nutrition and HIV/AIDS in Africa, at which participants concluded that “the HIV epidemic is increasingly driven by, and contributes to, factors that also create malnutrition—in particular, poverty, emergencies, and inequalities.”

This nexus was examined last week at a conference at BMA House in London, convened by Concern UK, an aid agency that has developed an integrated approach to food crises, known as community based therapeutic care.

This method has been adapted to help with the supplementary nutritional requirements of people with HIV/AIDS in Africa, where it is increasingly recognised that adequate nutrition is a crucial factor in non-symptomatic and advanced stages of infection.

Organiser Karl Deering told the BMJ that the meeting was intended to “start a discussion of a holistic approach to the combined elements of food security, nutrition, and HIV/AIDS and how they can be tackled together rather than as three separate issues.”

Kate Sadler, nutrition adviser for Valid International, a research organisation that specialises in improving the quality and accountability of humanitarian assistance, said, “High levels of poverty, food insecurity, childhood illness, and HIV/AIDS combine to increase the risk of malnutrition, which is associated with more than 50% of childhood deaths in the developing world.”

She believes that community based therapeutic feeding initiatives have several advantages over centrally administered and inpatient programmes, including earlier intervention, improved accessibility, and reduced stigma attached to seeking treatment.

Dr Stuart Gillespie, of the International Food Policy Research Institute, described nutrition as the “pivotal interface between food security and health security.” He explained that the issue was more complex than the mere availability of food, citing how parasites cause malnutrition through malabsorbtion and intestinal bleeding, and weaken the immune response by forcing it to respond to the invaders. “Infectious and parasitic diseases and malnutrition thus create an environment of enhanced risk,” he said.

Recent research suggested that children fetching water or washing clothes in slow moving streams could subsequently be at significantly increased risk of HIV transmission and infection due to genitourinary tract damage caused by schistosomiasis.

Although it was agreed that adequate nutrition was essential to improve the outcomes of people living with HIV and AIDS, the meeting was reminded that supplements should only be used in conjunction with, rather than as an alternative to, proper medical treatment and antiretroviral agents.

See www.concern.org.uk for more information.

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