HIV/AIDS and Other Epidemics
Background
Each year, millions of infants and children die needlessly due to simple infections, parasitic diseases and malnutrition. Conditions of poverty and malnutrition contribute to compromised immune function and increased susceptibility to infection. HIV/AIDS, tuberculosis (TB) and malaria are also having a serious public health impact in the developing world as diseases of poverty.
HIV/AIDS and TB have significant impact on nutrition at the level of the individual, household and nation (Read: Nutrition and HIV/AIDS: Evidence, Gaps and Priority Actions [PDF, 179KB]). At an individual level, HIV exacerbates the vicious circle of inadequate dietary intake and disease that leads to malnutrition, while malnutrition increases the risk of HIV transmission from mother-to-baby and the progression of the HIV infection. Research shows that the onset of disease and even death might be delayed in well-nourished HIV-positive individuals, and diets rich in protein, energy and micronutrients help to develop resistance to opportunistic infections. At the level of the household, asset depletion leads to decreased food consumption and a deteriorating nutritional situation for those infected and for the rest of the household. HIV is the leading cause of adult deaths in high-prevalence countries. It is linked to a decrease in agricultural productivity and food security, and an increased need for financial resources to handle demands for hospitalization, as well as high rates of morbidity and mortality, further depleting household resources and compromising the nutritional and health status of entire households. In many countries, HIV/AIDS is thus decimating the lives and productivity of many of the most critical members of society – parents, teachers and other professionals, farmers, and their children – compromising the present and future generations.
Tuberculosis causes two million deaths each year, especially among those who are malnourished and infected by HIV. TB is the leading cause of death among adult women in developing countries. It is estimated that three-quarters of those infected with both HIV and TB live in sub-Saharan Africa. The breakdown in health services, the spread of HIV/AIDS and the emergence of multi-drug resistant TB are contributing to the negative impact of this disease. Malnutrition is an important factor in the clinical progression of TB, as well as HIV/AIDS, and in the response to treatments. Research on TB is exploring the impact of various micronutrients on case conversion (prevention), as well as their efficacy as an adjunct to drug treatment.
Malaria exacts a heavy toll of illness and death throughout much of the tropics and subtropics, especially among children and pregnant women in sub-Saharan Africa. Malaria is an important cause of anemia, especially among individuals who have compromised or underdeveloped immunity, such as primigravidae women and children under age of 2 years. Treatment and control of malaria has suffered setbacks with the spread of drug-resistant and insecticide-resistant strains of the mosquito vectors, as well as the slow dissemination and adoption of insecticide-treated nets for use by vulnerable populations (women and children).
HIV, TB and malaria are deadly for children, while striking adults in their most productive years and resulting in loss of livelihoods, increased household expenditures for treatment, and compromised care of children. Thus, these diseases devastate entire families through their effects on household resources, food security and nutrition and health status of all family members.
USAID Response
In 1987, USAID launched a major initiative to address the global HIV/AIDS pandemic. In 2003, the U.S. Government committed $15 billion over a five-year period to the President's Emergency Plan for AIDS Relief, with a goal to provide treatment to 2 million HIV-infected people, prevent 7 million new HIV infections and provide care to 10 million people infected and affected by HIV/AIDS, including orphans and vulnerable children.
Despite the success to date in increasing knowledge about HIV/AIDS, much remains to be done from a nutrition perspective in developing and testing effective approaches to improving the care and treatment HIV-infected individuals and to mitigate the effects of HIV/AIDS on entire families.
Since 1997, USAID has substantially increased its efforts to address malaria and tuberculosis in developing countries. Interventions to combat malaria, such as early and effective treatment, insecticide-treated bed nets, and intermittent presumptive treatment as part of an integrated antenatal care package have been shown to reduce anemia and improve birth outcomes in women and reduce morbidity and mortality in young children. It has also been found that reductions in anemia are best achieved through programs that link malaria prevention and control with targeted supplementation of iron and folic acid, deworming, and expanding access to fortified foods. Within TB programs, there is evidence that food rations can be an effective incentive to ensure compliance of patients in Directly Observed Treatment, Short-Course (DOTS) programs. Food rations are therefore increasingly being added to DOTS programs.
Vision for the Future
Nutrition programs have much to contribute to HIV/AIDS, malaria and TB programming. Good nutrition and a diverse and adequate diet will delay the progression and severity of these diseases and minimize their health and economic consequences for individuals and families. The key to success will be ensuring that HIV/AIDS, malaria, and TB programs adequately address nutrition and food security as critical inputs to the prevention and treatment of these diseases, as well as being critical to mitigate the secondary, but devastating effects of these diseases on entire families.
Related Links
|
