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Thursday, August 9, 2012

Post: IAC (First Day of Panels, 1)

Monday, July 23rd, 2012

Food, Nutrition, & HIV

This early morning panel intrigued me based on the fact it had food in the title. Just Kidding! Actually, I was more interested on getting information to bring back to SMART Body since the e-cookbook is being prepared, and healthy eating is always high on SMART's list of priorities!
What I sat in on wasn't what I expected. Did I gain some new information? Yes, definitely. But this panel was research based and I couldn't really find a solution within the conclusions of each presentation.

Agnes Binagwaho (Rwanda) started the panel off with some logical points and facts.
"Good food is a HUMAN RIGHT. Malnutrition is a DISEASE."
This panel used the questions, "What are the best foods for those living with the disease (HIV)?, and how can we help people PRODUCE what they need to eat?" as the start to their research analyses.

Jim Sherry (USA): Service Integration as a strategy for improving access & retention in HIV & MNCH Services.

A lot of the language went over my head, but I tried my best to keep on track and mark down vocabulary that I should search later. For example what the acronym MNCH actually stood for, (Maternal, Newborn, & Child Health).

This presentation talked about integration of health care across different life cycles from pregnancy to adulthood in order to help the retention of HIV treatment.

In conclusion Sherry stated that, "Nutrition needs to be used as a quality [of life] improvement measure that includes the community and family."

Again, I learned new ideas and terms, but there seemed to be a lot more compare and contrast between Public Health models in order to improve nutrition and food access against a Medical model.

Christine Warke (USA): Optimizing Nutritional Status in HIV.

Warke listed the key factors of her research model and some background information on the biology of human beings.

The BMI (Body Mass Index) depends on Dietary Quality, which depends on Food Security (how easily food is accessible to someone). Then all of those factors create someones "nutritional status" (weight).

"Energy In" is charted as: Dietary intake, micro/macro nutrients, total energy intake, dietary quality and diversity.

"Energy Out" is charted as: Resting energy (HIV, fever, viral load, medications), infections, physical activity, dietary thermogenesis (food quality)

These definitions were the foundation in order to start research on the question: "What are the ENERGY requirements for HIV?" (And how does that translate into food and nutrition).

I have never really thought of HIV as being a factor for metabolic changes or energy requirements. After this presentation though it definitely made sense. ART (Anti-Retroviral Therapy) can be very harsh on the stomach and digestive system, also a lot of the medications need to be taken WITH food in order to decrease debilitating side effects.

Along with that, Food Security is also a major factor for food vs nutrition vs HIV treatment. I knew of the concept, but I finally encountered the word that is associated with this dilemma.

When research was conducted (Hanoi vs Chenai) the data collected helped to determine whether the people living with HIV were in need of food (in general) or nutrition (what foods to eat in order to help with medications).

In conclusion, there was no set conclusion, research is still being analyzed and conducted. The question of "What is the best COMBINATION of food to give [for people living with HIV]?" still stands. I'm still thinking about it today.

Louise Ivers (Partners in Health: HIV Equity Initiative): Nutrition in Haiti with HIV Care  

Ivers started out by giving background on the country of Haiti:
  • 10 million people
  • 1.9% prevalence rate of people living with HIV between the ages of 15-49
  • High cost of living, income insufficient (most/all income spent on food)
  • 20,000 with HIV in care, 7,300 on ART
  • HIV positive people are MORE likely to have food insecurity stress  
The research conducted by the Partner in Health: HIV Equity Initiative gave food as prescription (rations) to people who qualified for their study, (low CD4,  low income, household number).

Then at random different households who have someone living with HIV got one out of the two food baskets. Either Corn-Soy blend spread or Ready to Use Therapeutic Food (RUTF, high in protein and energy). Research is still being conducted based on which blend is better for the HIV positive person, or even if there is a difference.

An interesting study, but I was left a little confused by the ethical aspect of it all. If Haiti has a high food insecurity, how can a program that has food actually deny people who need it in general. Something just didn't sit well with me with this research. I know it is a more complex situation than I am making it out to be but something inside of me is slightly turned off about requirements for food to a certain group.

Sebastian Stricker (World Food Programme, Rome): Food and Nutrition Interventions to Improve Access for PWHIV 

This was the last presentation so there was a lot of overlap in the information being presented. (I will be honest I was started to lose my focus by the end, it did help that Stricker was an attractive Austrian with a nice accent... that is besides the point though, or is it?)

The information was mostly based on Zambia during the World Food Programme's intervention.

Stricker focused on the affects of food insecurity:
  • Increased hunger (seems obvious, but more in the sense that one meal will not suffice)
  • Exacerbated side effects (for those on medications)
  • Competing demands (over needs are necessary in third world countries, it becomes Hunger vs HIV, Transportation to clinic, medication, clothing, water, etc.)
There was a 48% increase with adherence when food/nutrition care and aid was provided in Zambia. That is a conclusion I like to hear, and obviously shows some sort of solution we can work towards.

Overall, this panel was an eye-opener to some new vocabulary and concepts. But these researchers should really work on trying NOT to make people just numbers and data in a project.

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