Nutrition and HIV/AIDS Overview of agencies' work and Progress SCN Geneva, 14 March 2006 Randa Saadeh World Health Organization Nutrition for Health and Development

NHDNHD 2 Contribution to specific MDG goals: (1) eradicate extreme poverty and hunger (6) combat HIV/AIDS, malaria and other diseases. The three diseases "can be largely controlled through education, prevention and when illness strikes, treatment and care".

NHDNHD 3 What is the role of nutrition in the care and support of PLWHA?

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NHDNHD 5 The Goal of the consultation is to: Develop evidence- based strategies Review and disseminate latest scientific evidence and ensure integration Identify research agenda

NHDNHD 6 Scientific review on nutrition and HIV/AIDS 1. Micronutrients How HIV infection leads to micronutrients deficiency, and how deficiencies/supplementation may affect various transmission and progression- related outcomes 2.Macronutrients (Energy and Protein) How HIV infection affects energy/protein requirements, and how deficiencies/supplementation may affect various transmission and progression- related outcomes 3.Infant feeding and HIV transmission 4.Growth faltering and wasting in children 5.Maternal Nutrition or pregnant and lactating women 6.Nutrition and ARVs How nutrition may affect ARV efficacy and how ARVs may lead to better nutritional status on the one hand and dyslipidemia and insulin resistance on the other

NHDNHD 7 WHO website – click on Nutrition and HIV

NHDNHD 8 EXECUTIVE BOARD 116 TH Session EB116/ TH Session EB117/7 ____ _________________________________________________ WHO's progress  Nutrition and HIV/AIDS on EB agenda in 2005 & 2006  Resolution EB 117.R2 states our policy and framework for action

NHDNHD 9 In meeting the challenge, WHO is developing a comprehensive evidence- based strategic approach that will ensure full integration of nutritional care in response to the global AIDS treatment emergency

NHDNHD 10 5 pillars of WHO's strategic approach

NHDNHD 11 5 pillars of WHO's strategic approach (Contd) 1. Strengthening & integrating nutrition & HIV/AIDS policies, strategies & programmes  Build on existing efforts  Identify nutrition interventions for integration into HIV/AIDS programming  Advocacy tools – decision-makers  Multi-sectoral collaboration

NHDNHD 12 5 pillars of WHO's strategic approach (Contd) 2. Developing Norms & Strategies Support evidence-based findings including micro- nutrient & HIV/IF issues Nutrition assessment tool – stages of disease, sex & gender-specific

NHDNHD 13 5 pillars of WHO's strategic approach (Contd)  Guidelines Review existing ones and develop:  Generic for nutritional care & support for PLWHA  Children & HIV/AIDS  Severe malnutrition & HIV  IYCF Global Strategy (HIV/IF, BFHI)  Guidelines for providing food assistance in care and treatment programmes  Guidelines for resource mobilization efforts

NHDNHD 14 5 pillars of WHO's strategic approach (Contd) 3. Capacity Building Hospital & community-based health workers Accelerating training & use of guidelines/tools for infant feeding programmes & PMTCT of HIV Nutrition counselling courses Revision of curricula & pre-service training

NHDNHD 15 5 pillars of WHO's strategic approach (Contd) 4. Research  Developing and implement operational and clinical research to identify effective science-based interventions  Document, publish and disseminate results

NHDNHD 16 5 pillars of WHO's strategic approach (Contd) 5.Developing of appropriate M & E Indicators  Measuring progress  Measuring impacts  Build and complement existing efforts

NHDNHD 17 Partners In house – HIV/AIDS,CAH, RHR, FOS, LEG, HAC Other agencies – UNICEF, FAO, UNAIDS, UNHCR WFP, IAEA, ILO, UNDP NGOs/Institutions/Universities/National Groups/ Bilaterals/Donors

FAO, HIV/AIDS, Food Security and Nutrition HIV/AIDS leads to food insecurity, poverty and malnutrition through a number of known pathways at both farm and individual levels. And since good nutrition allows PLWHA to feel better and live longer.. Ensuring food and nutrition security and supporting livelihoods is central to any response.

NHDNHD 19 To mitigate the effects of HIV/AIDS, FAO strengthens local capacities for delivering nutritional care and support services “Living well with HIV/AIDS: A manual on nutritional care and support” and the associated Training course with WHO supports food security, livelihoods and nutrition of the infected and affected Guidelines on incorporating HIV/AIDS considerations into food security and livelihoods projects Guidelines for HIV/AIDS interventions in emergency settings HFS and nut projects ongoing in Lesotho and Malawi for orphans LWHA, and in Ethiopia, Mozambique and Zambia

NHDNHD 20 Food and Agriculture Sector Strategies Ensure access to food  Nutritional care and support  Labour and time-saving technologies and practices  Gender equality in access and control of resources  Capacity building  Agriculture Knowledge systems  Policies

NHDNHD 21 Overview and objectives of WFP’s nutrition and health related HIV/AIDS programmes Four main activity types: PMTCT: 13 countries ART: 16 countries Home based care: 13 countries Support to TB patients: 23 countries (also have activities supporting orphans, prevention education)

NHDNHD 22 WFP’s efforts to help build the evidence base related to nutrition, food support, HIV/AIDS INIPSA study: 3 country study in West Africa aimed at understanding the outcomes associated with food support to patients in treatment programs Collaborations underway with NGO’s and research institutions in Mozambique, Zambia, Uganda, other countries to answer questions of relevance to programming.

NHDNHD 23 UNICEF activities in nutrition and HIV *UN Framework for priority actions on HIV and IF- (13countries) *National policies on HIV and IF (72 countries) *Integrating nutrition interventions into PMTCT scale-up plan – joint technical missions in 5 countries *UNICEF joined WHO in the introduction of IYCF courses * Jointly with WHO, revised BFHI materials in HIV context * Support governments in working with OVCs * Collaborating with WHO in development of guidelines including micronutrient supplementation

NHDNHD 24 WHO/ The Global Fund Development of a "guidance note" to assist countries in incorporating nutrition into funding proposals Meeting of UN Agencies, GFATM, national representatives, other funders and bilaterals

NHDNHD 25 Funded HIV/AIDS Proposals

NHDNHD 26 Distribution of proposals by sub-region (n=42) Eastern Africa (n=14) Central/Middle Africa (n=6) Northern Africa (n=2) Southern Africa (n=5) Western Africa (n=15) Burundi Djibouti Eriteria Ethiopia Kenya Madagascar Malawi Mozambique Rwanda Somalia Uganda Tanzania Zambia Zimbabwe Angola Cameroon Central African Republic Chad Congo-DRC Gabon Morocco Northern Sudan Botswana Lesotho Namibia South Africa Swaziland Benin Burkina Faso Cote d’Ivoire Gambia Ghana Guinea Guinea- Bissau Liberia Mali Mauritania Niger Nigeria Senegal Sierra Leone Togo

NHDNHD 27 Distribution of food and nutrition activities by program area (n=32 countries) Note: 1 country requested support within all 4 program areas

NHDNHD 28 Process GFATM outlined process by which Board, Secretariat and Technical Review Panel issue call for applications, review and evaluate proposals and manage disbursement of funds Country presentations of needs re. Nutrition and HIV Potential nutrition interventions and frameworks for integration discussed in plenary and groups Indicators for individual subject and project performance monitoring and evaluation considered

NHDNHD 29 Outcomes A framework on how nutrition interventions can be included in prevention/care/treatment and mitigation activities in HIV programmes How (some of) these may be included in applications to the GFATM Planning for training/briefing of regional consultants involved with assisting countries in their applications

NHDNHD 30 Challenges Need to act now: balance the needs to fill knowledge gaps and implementing what we know Building the capacity to make it "universal" and sustainable Dissemination of information and good communication strategies Coordination between partners and different players Balance between production of normative work and country- community level activities Adequate human and financial resources to put our knowledge into practice.

NHDNHD 31 Thank you