Nutrition For HIV-Positive People Needs More Attention

HIV (Human immunodeficiency virus) is the virus that leads to causing AIDS; it threw mammoth challenges to the world with the most serious health and development consequences, which was subsequent to the identification of reported cases in 1981. It is estimated that approximately 84 million people have been infected with the virus so far. According to current estimates, there are approximately 38+ million people currently living with HIV (PLWH – people living with HIV), and tens of millions of people have died of AIDS related reasons since the onset of the epidemic.

Dr. Jai Prakash Narain, a leading epidemiologist, who works with the Global Health International Advisers, says, “Since the beginning of the HIV/AIDS epidemic in 1981, 84 million people have so far become infected globally, and 40.1 million have died." He is a former director, WHO South East Asia Region.

During 2021 alone, an estimated 650 000 people died of AIDS-related conditions, despite effective HIV treatment and tools to prevent, detect and treat associated opportunistic infections being available. Whereas the real burden of the HIV epidemic varies significantly between countries, Africa, especially sub-Saharan Africa remains the worst affected, followed by Asia and the Pacific. According to UNAIDS, discrimination against, stigmatization and criminalization of key populations are costing lives and preventing the world from achieving global targets. There are many more people living with HIV or at risk of becoming infected who still do not have access to prevention, treatment, care, and support.  It is estimated that 0.7% (0.6–0.8%) of the adult population between the ages of 15 and 49, globally, is living with HIV.  

Initial epidemiological research identified the HIV transmission routes before the virus was clinically discovered and analysed, which helped in developing focused prevention strategies. Early cases were found in the MSM (men having sex with men) groups, largely in the US and some parts of the Western Europe, yet the significant impact of this epidemic was documented in the sub-Saharan Africa where most of the HIV transmission occurred among the heterosexual population. 

Dr. Narain adds, “Despite carrying lower than 2% of the global population load, nine countries in the Southern Africa accounted for approximately one-third of the HIV infection burden”.  While most infections in Africa are transmitted through a heterosexual route, yet the risk factors may vary. The available surveillance studies demonstrate that in some countries, men who have sex with men (MSM), people who inject drugs (IDUs), sex workers (CSWs), transgender people, and prisoners are disproportionally affected by HIV/AIDS. These populations are often referred to as key populations which require interventions tailor-made to their needs. Besides the government programmes, other sectors particularly the community itself and community-based organisations have critical role to play.

Nutrition: Direct Bearing on health and being of People with HIV/AIDS

With the United Nations’ Sustainable Development Goals (SDGs), specifically within the context of SDG-3, the world leaders and communities agreed to target ending the HIV/AIDS epidemic by the year 2030. Although much of the ground is covered, yet the gains have been uneven. It is relatively less mentioned subject but nutrition has the direct bearing on the people living with the HIV. It has an intrinsic relationship, which includes utilizing food and to acquire food. These biological and social factors invariably lead to poor nutritional status and weight loss, which are critical factors for morbidities in individuals infected with HIV that apparently results in a poor quality of life. It is noteworthy that weight loss is a significant predictor of death from HIV. Therefore, people living with the virus have a strong correlation with the food intake, enabling immune system and nutrition. 

Dr. Narain emphasises, “Good nutrition should be considered an important part of HIV/AIDS management. HIV is a virus that attacks the immune system. While the treatment is effective in reducing the viral load thereby turning AIDS into a chronic manageable disease, people with HIV or AIDS can benefit from a healthy balanced diet in keeping themselves healthy and maintain their immune system. Such a diet can also help them cope with the symptoms of their conditions as well as the side effects of medications.”

People’s work and livelihoods are at-risk of being eroded through the ill effects of premature sickness and death on individual households’ labour power. In addition, community networks, social-relations and capacity to care are definitely put under enormous pressure by HIV/AIDS associated stigma, discrimination and exclusion, thus an increase in the number of orphans, and further reduced incentives for collective action. As a result, financial burden is enhanced as expenditures on health care and funerals increase, and whereas credit becomes much harder to access.

Dr. Narain, while explaining the closer interrelationship between the nutrition and people living with HIV/AIDS, says, “The people living with HIV/AIDS can benefit from consuming foods rich in vitamins and minerals. Similarly, eating fruits, vegetables and millets are excellent way of maintaining healthy weight and reduce the risk of disease. Due to possible impaired immunity following or as a result of HIV/AIDS, individuals should take precautions and avoid getting infections including foodborne diseases. Such diseases are likely to turn serious and last longer. They should try to avoid eating uncooked or partially cooked food. Eat food in right amounts and select those low in saturated fat, salt and sugar.”

COVID-19: Consequences on HIV/AIDS Programmes

It’s would not be inappropriate to term it ‘from one crisis to another’, especially in the context of struggle of people living with HIV/AIDS during the pandemic. The ongoing pandemic of COVID-19 created much havoc globally and still continues to spread worldwide. It adversely affected the epidemic of HIV/AIDS, which include serious disruptions of essential health services, i.e. testing, treatment, and prevention programs. Needless to emphasize, the dire consequences of the pandemic on HIV/AIDS still remains uncertain.

The start of COVID-19 worsened already rather precarious settings for people living with HIV. Not only has the pandemic amplified the difficulties of managing HIV care and treatment, but an added disadvantage of managing co-morbidities existing within the PLWH community also meant much higher vulnerability to COVID-19 and its equally adverse health outcomes. PLWH have also been found to be at a potentially higher risk of SARS-CoV-2 infection, partly also due to – as so far documented - higher rates of substance use, violence, stigma, discrimination, poverty and homelessness within this group.  Homelessness and congregate living among PLWH has been further amplified due to unemployment and loss of income due to economic aftermath of COVID-19.

On the issue of COVID-19, Dr Narain says, “During last three years, health systems in all countries of the world have been put under utmost stress ever in its history, as we strived to meet the socio-economic shocks brought about due to the COVID-19 pandemic. This caused disruption in supply chain and created barriers to access HIV prevention and care services, thereby pushing off-track progress towards targets set by UNAIDS." 

The ongoing COVID-19 pandemic is also a reminder that communities can provide vital support but can also be a source of stigmatization and discrimination. This is putting many people living with HIV at greater risk for HIV. As a result, HIV has begun to increase in many countries. The economic and social disparities and inequalities in access to diagnostic testing, antiretroviral treatment and clinical and laboratory follow-up remain and are widening due to COVID-19 and its transmission, creating a barrier to efforts to end the HIV pandemic.

Governments need to promote and build health systems and procedures that allow for equitable access to health and well-being, for all. In fact, the biggest lesson that we have learnt from the COVID-19 pandemic is the need to, as a matter of urgency, strengthen health system in all countries.

Looking Ahead and Beyond

In nutshell, the HIV/AIDS policy and programme responses need to persist and be well-grounded in the primary principles of prevention, care and treatment, and mitigation; however, such strategies must factor-in the integral role of food and nutrition. These new generation strategies also need to be more broad-based and better connected to match the scale, breadth, and interconnectedness of the pandemic’s causes and impacts.

(The author is Senior Consulting Adviser (Strategic Communication & Programmes), United Nations System, Asia & Pacific Regions)