**Good Nutrition: An Essential "Treatment" for People with HIV/AIDS**

Press Club WDC, Town Hall Meeting, December 18^th^, 2003

Land O'Lakes International Development

Rolf W. J. Campbell, Director of Technology

[Land O'Lakes' Background in Africa, HIV/AIDS, Nutrition]{.underline}

-   Implementing USAID Development projects in 8 African countries since
    1993

-   Conducted a Nutrition & Mother to Child Transmission of HIV and
    nutrition assessment for USAID, South Africa, 2002/3

-   Active in researching the HIV malnutrition connection, and
    commercial development of nutritional beverages in Kenya for four
    years through subsidiary ABCI

[Linking Nutrition with the President's initiative]{.underline}

There is a proven role for nutrition in effective drug therapy and
palliative care for people with HIV/AIDS. In the successful care and the
growth of orphans, nutrition holds a central position.

[Building the Case for the Role of Nutrition for People with
HIV/AIDS]{.underline}

AIDS is a progressive disease and does not manifest itself as one set of
symptoms at one time. From acute HIV infection to advanced HIV disease
can be an indefinite period of often many years (or as little as a few).
After initial infection, a person may live asymptomatically (and
productively) for a long time -- *if* they have the proper care (drug
therapy being ideal), living arrangements, and adequate nutrition.
During each phase of HIV/AIDS there are stresses on the body that have
crucial implications for the quality of nutrition needed and the body's
capacity to ingest, absorb, and utilize nutrients effectively.

As HIV infection progresses into AIDS disease, hyper metabolic
responses, mal-absorption of nutrients in the gut, diarrhea, and
anorexia all contribute to severe challenges to intake and maintenance
of adequate nutrition: protein, energy, and micro nutrients.

Active AIDS disease weakens the immune system and body's defenses
opening the way to many often sub-clinical secondary physical conditions
as well as serious co-diseases that further weaken the body, deplete
nutritional stores, and reduce nutrition uptake, collectively leading to
death. Some of these include:

Oral Thrush, Diarrhea, Nausea, Skin lesions, Compromised immune
response, TB, Malaria, Hepatitis, Pneumonia, cancers, Respiratory
infections, Anorexia & Weight loss, Constipation, Chronic fatigue,
Depression, Medications secondary effects. It is often these co-diseases
opportunistically invading the body because of compromised immune
function that cause deaths in people with AIDS.

Quoting Mr. Paul Harvey from his 2003 HIV/AIDS literature review: "In
the early stages of HIV infection adequate nutrition can help to slow
the progression to HIV/AIDS and diets rich in protein, energy and
micronutrients are likely to help build immune resistance to
opportunistic infections. This has led for calls for food relief rations
to be revised to reflect the needs of people living with AIDS. **of V**

Good Nutrition can change their life: reduces the cost of medical care,
reduces complications and hospitalizations, shortens the duration of
hospital stays, improves effectiveness and tolerance to medications and
treatments, Increases productivity and independence, and Increases the
ability to remain at home." [^1]

> "The potential for micronutrient deficiencies to act as co-factors in
> HIV transmission and progression is most obvious in poor populations
> with inadequate dietary intake and a high infectious disease burden.
> But since micronutrient deficiencies may be precipitated by HIV
> infection per se, a role for micronutrients is likely even in affluent
> populations.....Micronutrient deficiencies could be co-factors in the
> progression of HIV infection to AIDS and death, in the sexual
> transmission of HIV, and in mother-to-child transmission of HIV."[^2]

**Nutrition & Mother to child transmission of HIV/AIDS**: *Combining
nutritionally dense food with care for women who are pregnant or nursing
and for their infants, helps to turn the tide of HIV disease and death
in four specific ways:*

1.  Fully nourished mothers cope successfully with the physical demands
    of pregnancy, and if HIV positive, remain healthy care providing
    mothers, longer.

2.  Higher birth weight, stronger infants from well nourished mothers
    can fend off disease and maintain health.

3.  Mother's and child's bodies are in better condition for responding
    to HIV drug therapy when it is available.

4.  Nursing Mothers have adequate energy and micronutrients themselves
    during breast milk production

**Five elements showing how good nutrition must be considered an
essential treatment for people in Africa with HIV/AIDS.**

1.  Good Nutrition is essential to meet physiological requirements of
    people with AIDS disease including the hunger and metabolic
    requirements associated with drug therapies.

2.  The nutritional status of a large percentage of (HIV positive)
    Africans and (orphans) African children is depleted (micro and macro
    nutrient deficiencies) they are not starting off well even if they
    are fortunate enough to receive diagnosis and formal medial care.
    Their nutrition intake is inadequate.

3.  HIV status is frequently not known or if known kept private reducing
    the potential for access to disease specific therapy. Typically with
    advanced AIDS disease more obvious disease symptoms do become
    evident, only then motivating the search for care and drugs.

4.  Delivering nutritionally dense, affordable supplemental foods is A)
    crucial to *maintaining* health, and B) an essential input to drug
    treatments for effective recovery from debilitating HIV/AIDS
    conditions.

5.  Private African and US Industry, in alliances with NGO's and
    institutions are in a position to deliver nutritionally dense foods
    to people with HIV/AIDS disease and orphans.

A comprehensive, effective, and realistic response to the HIV/AIDS
crisis in Africa, must include nutrition as a contributor to sustaining
peoples' health or promoting recovery. The following are some best
practices success stories of organizations engaged in delivering
nutrition.

**Templates for Success #1**

*A South Africa alliance to deliver nutrition*; Community AIDS Response
(CARE) and Econocom Foods,

These two organizations have aligned their complimentary assets. Their
story carries important lessons. Econocom Foods has taken the lead in
formulating a fully-fortified precooked maize meal and soya - "e"-pap -
that is instantized so it can be prepared with pre-boiled or sanitary
warm water. It is a leadership product in the field of micronutrient
fortification and its efficacy in the diet of people living with
HIV/AIDS has been substantiated through many trials

CARE is a young progressive South African NGO that has successfully
engaged in extensive home care outreach for HIV/AIDS patients. The
fortified "e"-pap is being used both as a job creation and income
opportunity for community workers who distribute it, and as an
affordable food in the diets for those most in need. CARE has the
responsibility for controlling distribution and works through its own
volunteer force, as well as including CBO's, clinics, relief agencies,
traditional healers. CARE Agents who distribute E-pap receive training
in running a small business, nutrition education, placing and filling
orders, and service of their community customers. They earn an income
from their sales of the product.

These two organizations have succeeded in creating an exceptional best
practices model for the integration of commercial food solutions with
NGO community based distribution of affordable nutritionally dense
products to households with HIV/AIDS.

Econocom Foods cc

Mr. Basil Kransdorff

Mobile Phone: 082-804-3818

29 8^th^ Avenue Melville, 2092

Johannesburg, SOUTH AFRICA

**Templates for Success #2**

*African Food Industry's Role in commercially viable nutrition
solutions*; ABCI, a US business & Spin Knit Dairy, a Kenyan business

In Kenya, these two organizations have joined forces to produce
*TRI-umph!* Nutritional Drink™

a nutritionally dense, affordable beverage for retail, institutional,
and food relief applications. This is a self-capitalized commercial
initiative motivated by consumer need: the extreme nutritional gaps in
the diets of many Kenyans including those with HIV/AIDS. Formulated from
Kenyan milk, cream, millet and US soy and whey protein concentrates, the
fortified product exemplifies a high quality, culturally appropriate,
widely affordable (priced like a soft drink) supplemental food produced
and distributed in the Kenya to increase access to superior nutrition in
East Africa. *TRI-umph!* will enter efficacy testing through the
University of Nairobi in February or 2004. Businesses, doing what they
do well, can contribute to filling the nutrition gap for people with
HIV/AIDS.

Spin Knit Dairy Ltd.

Mr. Bhupendra Shah

P.O. Box 78377 Viwandani, 00507

Nairobi, Kenya

Phone: 254-532411

**Templates for Success #3**

*Effective Alliances for Community Access to Drugs and Nutrition:* Child
Family Wellness Shops (with Spin Knit *TRI-umph!* Nutritional Drink,
Jambo Nutri-Biscuits, Insta-Products Power-Porridge (UNIMIX)

CFW Shops are efficiently managed mini-franchises that distribute
efficacious drugs to rural communities in Kenya through owner operated
pharmacy shops. They have so far served 297,000 patients.

The Sustainable Healthcare Enterprise Foundation (SHEF) is building a
retail micro-franchise distribution network for provision of essential
drugs and basic health services in Kenya, Africa. The network targets
the five to ten diseases causing 70-90 percent of morbidity and
mortality among children and their families while also providing basic
health services and other products. It combines proven
*micro-enterprise* and *franchise* principles to enable qualified
community health workers (CHWs) and nurses to own and operate drug shops
and medical clinics in underserved areas.

Legally qualified CHWs establish franchise CFWshops™ *drug shops* using
the franchise operating system that SHEF has developed. Nurses establish
*medical clinics* using a similar system. The franchise operating system
includes rules that CHWs and nurses must follow (diagnostic, treatment,
drug handling, etc.) The system is simple enough for CHWs and nurses to
operate, yet imposes disciplined practices to ensure that high quality
drugs and appropriate services are available to the community at
affordable prices

A short-list of inexpensive generic drugs can effectively treat 70-90%
of the children suffering and dying from infectious diseases in the
developing world. Prices are publicly posted and all operations are
strictly audited for ethical pricing and distribution of only approved
products.

Drug Therapy with Nutrition: As a further contribution to the health of
clients, CFW Shops is evaluating the additional distribution of
nutritious supplemental food products. If this proceeds as planned in
2004, three Kenyan food businesses will soon have fortified products
included in CFW Shop system, helping to close the serious nutritional
gap of clients who go there to purchase drug therapies.

Child & Family Wellness (CFW) Shops

Sustainable Healthcare Enterprise Foundation

Scott Hillstrom Esq.

Office Phone: (USA) 612 332 6003

Office Nairobi: 254 444 9467

Nairobi, Kenya

[^1]: HIV/AIDS: What are the implications for humanitarian action? A
    Literature Review ; July 2003; Paul Harvey

[^2]: United Nations Sub-Committee on Nutrition ("ACC/SCN"), Dr. Henrik
    Friis, Research Dept. of Human Nutrition, The Royal University,
    Denmark