Sometimes science catches up with common sense

WFP Executive Director James Morris spoke to Canada's Ottawa Citizen about the importance of good nutrition when taking antiretroviral drugs to combat HIV/AIDS.

WFP Executive Director James Morris spoke to Canada's Ottawa Citizen about the importance of good nutrition when taking antiretroviral drugs to combat HIV/AIDS.

Medical prescriptions sometimes come with an instruction to take medicine on a full stomach.

Doctors often counsel patients to pay attention to their diet as they recover from illness. It’s common sense.

Yet until recently, donor countries have poured billions of dollars into antiretrovirals and other medication to counter the growing impact of AIDS in Africa, Asia and Latin America with barely a thought for nutrition.

Deadly practice

A study published in the latest edition of HIV Medicine found that treating people with HIV who are malnourished might be deadly.

This study, conducted in Singapore, concluded that patients who start new antiretroviral therapy while they are malnourished are six times more likely to die than patients who are well nourished.

The reason, according to the study, may be that malnutrition reduces patients’ ability to absorb the potent triple-drug antiretroviral therapy and leaves the patient unable to benefit from the lifesaving medicine.

Ensuring good nourishment

Malnourished individuals also find it harder to cope with the therapy’s debilitating side-effects and may take longer to recover their body’s immunity to infection.

No North American doctor would provide AIDS-related treatment to someone without ensuring that they were sufficiently well nourished to withstand the side effects and absorb the medication.

Unfortunately, many of the countries hardest-hit by HIV also have some of the highest rates of malnutrition and micronutrient deficiencies. Even before people were HIV positive, they were hungry.

The study recommends the same remedy that local practitioners in the developing world have long advocated: nutritional support must be provided to malnourished patients starting treatment.

Small but effective portions

It's surprising what even small portions of the right foods can do.

Health workers tell us that in places like Kenya, Malawi and Haiti, the basic rations that WFP distributes - porridge fortified with vitamins and minerals, wheat or maize flour, beans and oil - not only relieve hunger and address malnutrition, but help ensure that people who've managed to begin a course of antiretroviral therapy can make the most of the expensive drugs.

Unlike the antiretroviral drugs, which are required for life, people don’t need the food forever.

With just six months of food rations, patients can regain their strength and get back on their feet.

Beefing up

“We provide the drugs, feed the family and then they can get meat on their bones and go back to the work they were doing before they got sick,” says Dr Joseph Mamlin, field director in a Kenyan AIDS clinic.

Feeding the whole family – not just the patient – is essential. When breadwinners fall sick, there is a high risk that others -especially women and children - will be forced into risky sexual activities to make ends meet.

WFP estimates that approximately one million of the 6.6 million people who will be enrolled in antiretroviral programmes in 2008 will need some kind of nutritional support.

The cost of providing them with assistance is just CAD $0.73 per patient per day – less than the price of this newspaper.

A car without gas

Funding antiretrovirals with no thought to food and nutrition is a little like paying a fortune to fix a car but not having money to pay for gas.

Food is a problem for many people whose lives have been struck by HIV, not just the few on antiretroviral therapy.

One African in three, for example, is chronically malnourished. Orphans and vulnerable children often need food assistance to stay off the streets and remain in school.

The many HIV-positive people who also have tuberculosis are more likely to complete the lengthy months of treatment needed to cure them if they and their families have enough to eat during the treatment.

"Essential package of care"

Political leaders are gradually becoming more aware of the need for food and nutritional support in the ‘essential package of care’ for people affected by HIV.

This was confirmed at recent meetings of the UN General Assembly and World Health Organization. Now it is time to put this into practice.

The Canadian Government is a staunch advocate of the importance of nutrition and continues to be a leader in the response to HIV and AIDS.

It is a major contributor to WFP’s operation in southern Africa, where the world’s highest HIV rates, grinding poverty and crumbling government services have pushed large swathes of the population to the brink of chronic starvation.

Now, as hosts of the XVI International AIDS Conference, Canada is in a prime position to assert its leadership on both issues - HIV and nutrition – to ensure that the treatment is a success – and patients thrive.

James Morris is Executive Director of the World Food Programme, and Special Representative of the UN Secretary-General for southern Africa. WFP assists people affected by AIDS in 51 countries worldwide.