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2021 – Food Security and Nutritional Evaluation of People living with HIV (PLHIV) in Tunisia
To support data collection on malnutrition and food insecurity among PLHIV in Tunisia, WFP and the Tunisian government conducted a district-level assessment of food and nutrition security among PLHIV.

Data from the United Nations Programme on HIV/AIDS (UNAIDS) show that the number of people living with HIV (PLHIV) in Tunisia almost doubled last year with 6500 cases recorded in 2019 compared to only 2997 cases recorded in 2018.

In response to the lack of data on malnutrition and food insecurity among PLHIV in Tunisia, WFP and the Tunisian government conducted a district-level assessment of food and nutrition security among PLHIV. The results will help the government and all partners to develop effective food security and nutrition interventions for PLHIV as part of a comprehensive, multi-sectoral response to HIV. The results also aim to help the government build an evidence base, provide policy support for HIV-sensitive social protection, and technical support to government and national partners to address the food and nutrition security needs of PLHIV.

The results of the assessment show that food insecurity among PLHIV in Tunisia has reached 39 percent with significant to extreme food consumption gaps. One third of PLHIV resort to coping strategies such as begging, participation in illegal activities and homelessness to meet their food needs. More than half of PLHIV households are in debt and 58 percent are unemployed, reporting that food is the main household expense. Food insecurity is higher among the poorest PLHIV.

Poor adherence to antiretroviral therapy (ART) is strongly associated with poverty and food insecurity. Food insecurity is almost double among those who miss ART compared to those who adhere. PLHIV who miss ART tend to be in the poorest quintile, indicating the vulnerability status of this group.

Food and nutrition assistance is crucial in the form of health and social protection services to facilitate uptake of HIV counseling, testing, treatment and prevention interventions. 81 percent of PLHIV receive free ART and HIV testing through the government. However, the assessment shows a weak social protection response with only 3.7 percent of PLHIV receiving cash assistance, 21.8 percent receiving food vouchers and 8.4 percent receiving health and nutrition education.

Working with the government on the national HIV response and social protection plans and social and behavioral change communication (SBCC) activities are viable entry points for Tunisia to ensure the inclusion of PLHIV in the national social protection system.

Strengthening the social protection system for vulnerable PLHIV by the government can help mitigate significant social and economic impacts on households and PLHIV. By helping the government design and implement programmes that focus on transfer modalities, distribution channels will promote economic empowerment, treatment adherence, and reduce negative coping mechanisms.

Social and Behavioral Change Communication (SBCC) strategies could focus on appropriate dietary and nutritional practices for PLHIV with an emphasis on a balanced diet with adequate energy, protein and micronutrient intake. Providing adequate nutritional guidance to PLHIV on eating a healthy, balanced diet is vital to their health and survival, focusing on a balanced diet with adequate energy and micronutrient intake.

With these recommendations, WFP can work with the government and partners to address the HIV epidemic, ensuring adequate food consumption, increased access to livelihoods through social protection systems, as well as reduced negative coping mechanisms and increased care and protection activities for health and physical and human capital development in Tunisia.