1. HIV, Livelihoods, Nutrition & Health Research Global Ministerial Forum on Research for Health Nov 2008, Bamako Mali By Robert Ochai Executive Director TASO Uganda www.tasouganda.org

2. Kampala – 8.5% 2.3% 3.5% 5.9% 6.9% 8.2% 5.3% 8.5% 6.5% Overall prevalence among those 15 to 49 years is 6.4% Uganda Overview: HIV Prevalence by Region

3. TASO – The AIDS Support Organisation TASO exists to contribute to the process of preventing HIV, restoring hope and improving the quality of life of persons, families and communities affected by HIV infection and disease. TASO complements the public health systems and is a key actor in the national response. It provides a holistic range of services that radiate from the index client, into their families, and to the general public. TASO actively involves people living with HIV/AIDS and local communities in its activities.

4. TASO 2008-2012 Goals HIV Prevention & Care Services GOAL 1 HIV Prevention GOAL 2 Care, Treatment & Mitigation GOAL 3 Training & Capacity Building GOAL 4 Advocacy, Ope. Res. & Modeling GOAL 5 Partnership & Collaboration GOAL 6 Mainstream Gender GOAL 7 HIV/AIDS services for conflict settings GOAL 8 Mainstream GIPA GOAL 9 Resources & Systems for 2008-2012

5. Core TASO Services This slide has some pictures so the attachment could not come; Ill bring the slide on flash drive!!!

6. The Dynamic Interactions of HIV, Nutrition, Livelihoods and Health

7. Livelihood/food insecurity HIV & AIDS Malnutrition Three coexisting/interacting crises Source: RENEWAL

8. Malnutrition and HIV disease progression Malnutrition is associated with immune function decline Degree of malnutrition is clearly linked to mortality risk Compromises efficacy & increases toxicity of ARVs Undesirable ARV side effects Threats of decline in ARV adherence Higher mortality in the first three months of ART initiation Studies show that high levels of vitamin B, C, E, and folate, slow the progression from HIV to AIDS and contribute to increased CD 4 counts and reduced viral loads.

9. HIV/AIDS and Food Insecurity Vulnerability to HIV infection results from multiple, entwined processes; a key one is food insecurity. Food security deteriorates when an adult family member becomes chronically ill. The illness results in loss of labor, reduces productivity, reduces income, increases expenditures on medication and on a futile search for a cure. Even the care-givers lose their productivity. The overall impacts of ill-health on agriculture/food production depend on several variables including: household demographics quantity, quality and mix of assets (household and community) labour demand (type, degree, seasonality) institutional context, social support (stigma) concurrent multiple shocks (e.g. drought)

10. Integrating nutrition security interventions Due to its impact on health, it is important to integrate food assistance into programs for people affected by HIV & AIDS. TASO, like many other organizations integrates livelihood/food security into its programming. Admittedly, the evidence base on effectiveness of the various possible interventions is still weak; however, due to the great need, we have build the boat while sailing; we can not afford to wait for all the answers.

11. TASO s commitment to evidence based nutrition security programming 1. Utilizing the data we have (2002-2007) Key questions: How does the provision of food assistance affect BMI and change in WHO staging? Preliminary Results: a) Food assistance had a positive impact on weight gain b) Food assistance helped slow transitions in WHO Stage c) Impacts varied by initial WHO stage at which food assistance is provided (earlier is better) (RENEWAL/IFPRI & Concern Worldwide, WFP, Univ. of Illinois and others)

12. TASO s evidence based nutrition security programming (contd..) 2. Impact evaluation and cost-effectiveness of nutrition supplementation to Pre-ART individuals and their households - This study is ongoing Key Outcomes Disclosure, stigma, high risk behaviors, access to care Clinical progression & nutrition outcomes Quality of life Household welfare (food security, assets, expenditures patterns) Intra-household outcomes (labor allocation, nutritional status and schooling) Cost-effectiveness (RENEWAL/IFPRI, WFP, Concern Worldwide, Univ. of Illinois and others)

13. Research Gaps Health: the forms and models of implementing HIV initiatives influences the following components of health systems strengthening: service delivery health workforce information medical products, vaccines and technologies financing leadership and governance Understanding the nature and magnitude of this effect is a key research area.

14. Research Gaps - II Livelihoods: the impact of HIV on individuals, households and communities influences the following components of livelihoods programming: premature illness and deaths of adults who provide the bulk of family labor power rupture of customary intergenerational knowledge transfers Proper understanding the macro-economic impacts of HIV/AIDS remains an important policy issue.

15. Research Gaps - III Nutrition: As HIV impacts on households and families and communities, food production gets distorted: Difficulties in food production lead to poor nutrition (protein-energy malnutrition and deficiencies in micronutrients e.g. zinc, iron and vitamins) Poor nutrition leads to compromised immune systems (individuals become more prone to infection) Understanding the mechanisms here would improve programming. TASO is currently partnering with IAEA and WFP in a study aimed at throwing more light on these questions.

16. Conclusions Food security is critical to health; especially in HIV/AIDS care. The linkages are scientifically documented. While some efforts have been taken to improve nutrition, the need is still enormous; more work needs to be done urgently. Good research has been done, but there is need for more in order to improve understanding of the interactions between HIV, nutrition, and health; this will improve programming and advocacy. Research findings must be transformed into practical benefits; i.e. better policies and programs for health!

17. Acknowledgements TASO staff and clients RENEWAL/IFPRI Concern Worldwide