“It is more than food; it is like an invisible family (my invisible family) who is taking care of me in tough times”

There are four major barriers that prevent People living with HIV in London from accessing good nutrition: Ill health Poverty Isolation (a reduced motivation) and Limited nutrition knowledge. Our new Personalised Nutrition Care Plans are designed by dietitians to provide tailored support that improves the health and/or quality of life of those most in need. What we do

Our practical services are delivered by over 700 skilled community volunteers supported by a team of just eight staff. In 2011, The food Chain: borrowed 4 kitchens to prepare and deliver over 30,000 tailored meals sent over 2,000 food hampers - containing a full week’s groceries to families in ill-health or poverty. taught practical skills to over 300 people living with HIV, so they can better self- manage their health piloted Eating Together, a project aiming to address social isolation. Most people we support have complex needs, so require a combination of services What we do

In the last year we have also: developed a clear new strategy to expand our work and restructure our services been given a grant of £1m from Elton John AIDS Foundation to help deliver our strategy embedded a new team of staff with the skills to deliver our strategy developed a new service model that will increase and clearly show the impact of our work piloted schemes to allow us to plan and procure food more efficiently scoped and funded Eating Together – a new communal eating project that aims to address social isolation. Achievements

Many central London boroughs experience high levels of deprivation and HIV infection Over 1,000 PLHIV accessing care Over 500 PLHIV accessing care Over 300 PLHIV accessing care Source: SOPHID 2006 Focus area for Food Chain Services

How we help Poverty as a result of unemployment, inability to work, debt, asylum issues Ill-health as a result of late diagnosis, or other short / long term complications Ability to maximise benefits of nutrition to self manage health long term Improved nutrition, short term alleviation of poverty, improved health, exit strategy Limited knowledge Lack of information / skills to make informed choices Regular contact opportunities to eat, learn, socialise and discuss problems Isolation as a result of discrimination, mental health, cultural barriers Improved nutrition, improved health, stronger immune system, exit strategy An appropriate package of food (meals & groceries) provided to PLHIV and their children/ carers/ dependents Pilot ‘Eating Together’ service Information and skills taught at nutrition and cookery classes supported by appropriate fact sheets Barriers to good nutrition Intervention (Food Chain) Expected outcomes

Poverty In 2009, 25% of those accessing our food services had a household food budget of less than £20pw We have seen a 550% surge in demand for our emergency hampers over the past four years 56% of people receiving our emergency hampers in 2010 had NO INCOME £0 The average weekly income for applicants to the Crusaid hardship fund fell from £99pw in 1999 to £63pw in 2008 (£22.78pw for an applicant with residency issues) 18% of applicants to the CWAC hardship fund are unable to provide their children with 3 meals a day We estimate that 15% of PLHIV in London (4,400 people) and their families are living in extreme poverty, and aim to reach 3,200 of them within 3 years. For families living in poverty, the food budget is often the most flexible household expense.

Ill-Health 7,000 people in the UK are newly diagnosed with HIV each year - half of these in London. One in three are diagnosed late when they are already unwell. We expect 20% of our new referrals to come from HIV clinics and healthcare professionals, looking to support patients following immediate discharge from hospital. The assurance that appropriate nutrition will be available to patients at home frees up hospital beds, and saves the state thousands of pounds annually in avoidable care costs. We estimate 1,167 PLHIV receive a late diagnosis in London each year, and aim to reach 800 of the most vulnerable within 3 years.

Isolation Eating Together will bring isolated PLHIV around a table to eat together and offer peer support. Living and eating alone diminishes appetite, food consumption and dietary quality. In many cases this isolation and deprivation can contribute towards worsening health. New arrivals in the UK can face additional barriers that contribute towards social isolation including language and cultural differences. The population of PLHIV is ageing and older people are more likely to be isolated. Nearly one in three people living with HIV in London has experienced discrimination as a result of HIV – often leading to social isolation where a persons condition is likely to deteriorate.

Limited knowledge Eating Positively cookery and nutrition classes allow us to share over 20 years of nutrition expertise face- to-face with service users. The classes offer practical skills and advice in a kitchen setting where we can discuss topics including food labels, budgeting or understanding ingredients. Tailored classes are run to support people with specific knowledge needs e.g. adapting diets to help manage diabetes or heart health. This knowledge adds a longer term benefits to the immediate food we deliver and allows people living with HIV to make better food choices in the future. The classes aim to reach 400 people in and are complimented by factsheets, recipes and bespoke dietetic advice where appropriate.

More people living with HIV : There are 3 x more PLHIV in the UK than in 2001 with over 7,000 newly diagnosed with HIV each year – half in London. Soaring food prices : Groceries cost 19% more than a year ago meaning more people struggle to access the food they need to stay well. To meet this increasing demand we need more resources, more capacity and to become more efficient. Responding to a growing need

Contact Please do not hesitate to contact me if you have any questions: Andrew Davies, General Manager Direct line Mobile Registered charity No

Barriers to healthy eating National and local policies Agriculture Trade Housing Employment Retailing Health Planning Welfare Food preparation Practices Cooking skills Ability and confidence to prepare healthier foods Cooking facilities Information Foods labelling Advertising and marketing Leaflets, contact with health professionals, schools Intra-household distribution Family food hierarchy Access Foods prices Relative costs of healthier food Money for food Shopping capacity: time, transport, physical care Food storage capacity Availability Foods stocked in shops used range, quality Location of shops Institutional food School, canteen, day centre, hospital, home Plots Gardens Allotment Choice Taste, preferences Family acceptability Social/cultural norms Nutritional knowledge Motivation Influence of promotions and advertising Eating patterns Foods households can buy Foods households and individuals choose to buy Eating/ meal patterns Food consumed by individual nutrients absorbed Frame work of the barriers to healthy eating - The Manual of Dietetic Practice (4 th edition)

Interventions to help PLHIV National and local policies Evidence shared with advocacy organisations to influence policy Food preparation Practices Practical cookery classes Information Nutrition classes, fact sheets and pathways to other care services Intra-household distribution Sufficient food for entire family Access Food packages home delivered for those in ill - health Availability Food packages provided for those in poverty Institutional food Pilot meal programme at Mildmay Choice Tailored. culturally appropriate meals and groceries Eating patterns Foods households can buy Foods households and individuals choose to buy Eating/ meal patterns Food consumed by individual nutrients absorbed Our direct interventions (green) Where our work influences decisions (yellow)