Speaking to wfp.org on the eve of World AIDS Day 2009, WFP's Chief of Nutrition and HIV/AIDS Martin Bloem highlights how good nutrition increases the effectiveness of the drugs used in HIV treatment.
Why has nutrition taken on a much greater importance in the treatment of people living with HIV recently?
Food has long been regarded as an important part of any comprehensive treatment plan but there has definitely been a critical shift in thinking recently – a shift that puts greater emphasis on the need for nutrition to be integrated into all HIV treatment programmes.
In the past, food was viewed primarily as a means of helping patients to adhere to treatment by helping them to cope with the side-effects of the anti-retroviral drugs. But gradually it has become clear that in the developing world, better nutrition plays a far more important role – by increasing the effectiveness of the treatment.
In the developing world, there is a higher mortality rate for people on ART (anti-retroviral therapy) than in the richer world – largely because people in developing countries first seek treatment when they are already malnourished and wasted.
In these cases, complementary food assistance increases the chances that the treatment will work and that the patient will survive. And that is why nutrition is now viewed as a critical complementary component of any effective treatment plan and why it has been written into protocols for the treatment of HIV for the very first time – because it helps people living with HIV to survive.
But the drugs do work on their own – so shouldn’t we be focusing on expanding drug provision rather than using scarce resources to provide food?
There is a need to continue expanding access to anti-retrovirals since government roll outs in recent years have proven so successful – and the primary focus should be on the drugs since they are the first and most essential part of any treatment programme.
But it is clear that a programme involving both drugs and well designed nutritional support does improve the chances of survival. There is also evidence that patients with a very low body mass index can survive on the drugs but without targeted food support, they struggle to improve their body mass index and grow strong enough to return to a full and productive life.
Is it clear yet what kind of food assistance works best?
We are learning very quickly and starting to develop guidelines and protocols but we do still need more evidence before we can say for sure what is best.
However, the basic outlines are clearer now. In the critical first six weeks to three months, malnourished patients require specialized and highly nutritious foods to improve their lean body mass, which helps their immune system to recover. But later on, food such as corn-soya blend could be used instead. And even later, the focus can switch to providing micronutrients rather than actual food commodities.
Beyond that there are possibilities to provide food assistance as part of social safety nets for the patients and their families and in the longer term, livelihood assistance as well so that people on treatment can once again take care of themselves and their families.
What exactly is WFP's role in HIV treatment programmes?
As one of the experts in the field of nutrition, we have a role to play in both practical and policy terms. In many parts of Africa, WFP is helping to provide vital nutritional support to people living with HIV and a much larger number of people affected by the pandemic – and we are refining our assistance all the time to make it even more effective. Working with governments, ministries of health and other partners, we are helping people to survive.
In other areas – such as Latin America and Asia – WFP is helping to build local capacity and provide technical expertise.
And globally, WFP is working with partners to develop the most effective treatment guidelines and protocols, including what are the best foods, how long should they be provided and how best to actually provide them.
But is traditional food aid the answer in the specific case of HIV treatment?
As an organization, WFP is rapidly moving away from traditional food aid towards food assistance – using innovative new methods to assist the most vulnerable. And this is certainly the case in relation to HIV treatment. We are experimenting with a range of new tools, including food vouchers and mobile transfer technology and seeking partnerships with the private sector. WFP is thinking far more broadly nowadays and this can only enhance our ability to help boost HIV treatment in some of the poorest and hardest hit parts of the world.