hiV/AidS nutrition,

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A SyntheSiS o# internAtionAl guidAnce hiV / AidS , nutrition, And #ood Security: what we can do S?=NCIH ii. | A.1 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do A SyntheSiS o# internAtionAl guidAnce hiV / AidS , nutrition, And #ood Security: what we can do 4 © 2007 t30 I9?0r9,?i:9,l B,9k 1:r R0.:9s?ru.?i:9 ,9/ d0v0l:pm09?/t30 w:rl/ B,9k 1818 h S?r00? nw w,s3i9g?:9 dc 20433 t0l0p3:90: 202-473-1000 I9?0r90?: BBB.B:rl/b,9k.:rg e-m,il: 100/b,.k@B:rl/b,9k.:rg all rig3?s r0s0rv0/ t30 9/i9gs, i9?0rpr0?,?i:9s, ,9/ .:9.lusi:9s 0Cpr0ss0/ 30r0i9 ,r0 ?3:s0 :1 ?30 ,u?3:r(s) ,9/ /: 9:?

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t30 w:rl/ B,9k 09.:ur,g0s /iss0mi9,?i:9 :1 i?s B:rk ,9/ Bill 9:rm,lly gr,9? p0rmissi:9 ?: r0pr:/u.0 p:r?i:9s :1 ?30 B:rk pr:mp?ly. all :?30r qu0ri0s :9 rig3?s ,9/ li.09s0s, i9.lu/i9g subsi/i,ry rig3?s, s3:ul/ b0 ,//r0ss0/ ?: ?30 o1 .0 :1 ?30 Publis30r, t30 w:rl/ B,9k, 1818 h S?r00? nw, w,s3i9g?:9, dc 20433, USa; 1,C: 202-522-2422; 0-m,il: pubrig3?s@B:rl/b,9k.:rg. d0sig9: P,?ri.i, h:r/.Gr,p3ik d0sig9 t3is /:.um09? 3,s b009 pri9?0/ :9 100% P:s?-c:9sum0r R0.y.l0/ p,p0r. 1 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do tabF? I@ cIHN?HNs Pre#Ace 3 AcKnoWledgementS 5 AcronymS And ABBreViAtionS 6 i. imProVing hiV And AidS outcomeS through nutrition SuPPort 7 ii. treAtment, cAre, And SuPPort 8 A. nutrition SuPPort #or AdultS liVing With hiV (PlhiVS) 8 A.1. nONLC?HN r?qOCL?G?HNs 8 A.2. nONLCNCIHaF Ass?ssG?HN 9 A.3. dC?NaLS r?=IGG?H>aNCIHs aH> caL? PLa=NC=?s 10 A.4. Art aH> oNB?L m?>C=aNCIHs 11 A.5. maHaA?G?HN I@ WasNCHA aH> S?v?L? maFHONLCNCIH 12 A.6. PLIvCsCIH I@ #II> SOppF?G?HNs @IL PlhiVs 12 A.7. nONLCNCIH, #II>, aH> h?aFNB e>O=aNCIH aH> cIOHs?FCHA 13 A.8. h?aFNBS lC@?sNSF? e>O=aNCIH aH> cIOHs?FCHA 14 B. nutrition SuPPort #or hiV-PoSitiVe PregnAnt And lActAting Women 15 B.1. nONLC?HN r?qOCL?G?HNs 15 B.2. nONLCNCIHaF Ass?ssG?HN 17 B.3. dC?NaLS r?=IGG?H>aNCIHs aH> caL? PLa=NC=?s 18 B.4. Art aH> oNB?L m?>C=aNCIHs >OLCHA PL?AHaH=S aH> la=NaNCIH 19 B.5. maHaA?G?HN I@ WasNCHA IL S?v?L? maFHONLCNCIH 19 B.6. PLIvCsCIH I@ #II> SOppF?G?HNs @IL hiV-PIsCNCv? PL?AHaHN aH> la=NaNCHA WIG?H 19 B.7. cIOHs?FCHA issO?s >OLCHA PL?AHaH=S aH> la=NaNCIH 19 B.8. h?aFNB e>O=aNCIH aH> tL?aNG?HN @IL hiV-PIsCNCv? PL?AHaHN aH> la=NaNCHA WIG?H 20 c. nutrition SuPPort #or in#AntS And young children (0 to 24 monthS) Born to hiV-PoSitiVe Women 21 c.1. iH@aHN #??>CHA r?=IGG?H>aNCIHs 21 c.2. cIOHs?FCHA hiV-PIsCNCv? WIG?H NI mak? aH> caLLS oON iH@aHN #??>CHA d?=CsCIHs 23 c.3. #??>CHA iH@aHNs (6 NI 24 mIHNBs) BILH NI hiV-PIsCNCv? mINB?Ls 25 c.4. PLIvCsCIH I@ #II> SOppF?G?HNs 27 c.5. iH@aHN #??>CHA cIOHs?FCHA 28 d. nutrition SuPPort #or hiV-PoSitiVe in#AntS And young children (0 to 24 monthS) 30 d.1. nONLCNCIHaF r?qOCL?G?HNs aH> caL? @IL hiV-PIsCNCv? cBCF>L?H 30 d.2. nONLCNCIHaF Ass?ssG?HN, gLIwNB mIHCNILCHA, aH> cIOHs?FCHA @IL NB? hiV-PIsCNCv? cBCF> 31 d.3. dC?NaLS maHaA?G?HN I@ AidS-r?FaN?> SSGpNIGs, m?>C=aNCIHs, aH> #II> - dLOA iHN?La=NCIHs CH cBCF>L?H 32 d.4. PLIvCsCIH I@ #II> SOppF?G?HNs 32 d.5. tL?aNG?HN @IL S?v?L?FS maFHIOLCsB?> hiV-PIsCNCv? cBCF>L?H 33 d.6. h?aFNB iHN?Lv?HNCIHs @IL hiV-PIsCNCv? cBCF>L?H 33 e. nutrition SuPPort #or PlhiVS on Art 34 e.1. ArV tL?aNG?HN aH> nONLCNCIH 34 e.2. iHN?La=NCIHs b?Nw??H Art aH> #II> aH> nONLCNCIH 34 e.3. nONLCNCIHaF Ass?ssG?HN 35 e.4. #II>, nONLCNCIH, aH> h?aFNB e>O=aNCIH cIOHs?FCHA 35 tABle o# contentS 2 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do iii. #ood ASSiStAnce AS hiV And AidS treAtment SuPPort 38 iV. #ood, #ood Security, hiV, And AidS 40 A. #ood-BASed SuPPort 40 V. hiV, AidS, nutrition, And #ood in An emergency conteXt 43 A. in#Ant #eeding 44 B. hiV And #ood diStriBution 44 c. #ood And liVelihood Security in emergencieS 45 Vi. concluSion 46 AnneXeS AHH?x i: PObFCsB?> hiV/AidS, nONLCNCIH, aH> #II> S?=OLCNS gOC>?FCH?s 47 AHH?x ii: caLCHA @IL SSGpNIGs aH> iFFH?ss?s AssI=CaN?> wCNB hiV CH A>OFNs 49 AHH?x iii: mI>?LH m?>C=aNCIHs aH> SC>? e@@?=Ns 52 AHH?x iV: tLa>CNCIHaF WaSs I@ d?aFCHA wCNB cIGGIH iFFH?ss?s aH> SSGpNIGs I@ AidS 54 AHH?x V: #II> Sa@?NS, hSAC?H?, aH> SaHCNaNCIH tIpC=s @IL hiV aH> AidS e>O=aNCIH 56 AHH?x Vi: r?=IGG?H>?> W?CABN gaCH dOLCHA PL?AHaH=S 58 AHH?x Vii: d? HCNCIH I@ A#ASS: A==?pNabF?, #?asCbF?, A@@IL>abF?, SOsNaCHabF?, aH> Sa@? 59 AHH?x Viii: exaGpF?s I@ #II> AssCsNaH=? iHN?ALaN?> CHNI hiV aH> AidS PLIALaGs 60 AHH?x iX: exaGpF?s I@ NB? us?s I@ #II> AC> NI SOppILN hiV-A@@?=N?> PIpOFaNCIHs 61 AHH?x X: Who cIHsOFNaNCIH IH nONLCNCIH aH> hiV/AidS CH A@LC=a 62 gloSSAry 66 re#erenceS 74 tABleS And BoXeS tabF? 1. esNCGaN?> cBaHA?s CH NB? daCFS eH?LAS iHNak?s I@ a 28-y?aL-oF>, mI>?LaN?FS A=NCv?, hiV-PIsCNCv? WIGaH aH> a nIH-hiV-iH@?=N?> WIGaH 15 tabF? 2. nONLCNCIHaF r?qOCL?G?HNs @IL hiV-PIsCNCv? cBCF>L?H 30 tabF? 3. SOGGaLS: taLA?N PIpOFaNCIHs, nONLCNCIH iHN?Lv?HNCIHs, aH> AHNC=CpaN?> r?sOFNs 36 tabF? 4. #II> iHN?Lv?HNCIHs aH> hiV aH> AidS tL?aNG?HN 39 BIx 1. BLC?@ d? HCNCIH I@ A#ASS: A==?pNabF?, #?asCbF?, A@@IL>abF?, SOsNaCHabF?, aH> Sa@? 23 BIx 2. iHN?ALaNCHA hiV, #II>, aH> nONLCNCIH A=NCvCNC?s CH a r?@OA?? S?NNCHA 43 tabF? I@ cIHN?HNs 3 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do PL?@a=? hiV aH> AidS aL? BavCHA a >?vasNaNCHA ?@@?=N CH SOb-SaBaLaH A@LC=a. o@ NB? 10.8 GCFFCIH >?aNBs ?sNCGaN?> NI Bav? I==OLL?> CH NB? S?aL 2000, hiV =aOs?> Iv?L 20 p?L=?HN I@ NB?G (JaGCsIH ?N aF. 2006). tB? aHHOaF NIFF I@ AidS >?aNBs CH SOb-SaBaLaH A@LC=a =IHNCHO?s NI ALIw, >?spCN? pLIAL?ss CH sIG? =IOHNLC?s. WBCF? GILNaFCNS LaN?s Bav? b??H L?>O=?> NBLIOAB pL?v?HNCIH CHN?Lv?HNCIHs, =IOHs?FCHA, N?sNCHA, sOppILN, aH> NL?aNG?HN, NB? pIN?HNCaF @IL HONLCNCIH NI =IHNLCbON? NI a >?=FCH? CH hiV- aH> AidS-L?FaN?> GILbC>CNS aH> GILNaFCNS Bas H?CNB?L k?pN pa=? HIL FCv?> Op NI CNs pIN?HNCaF. iH NB? pasN s?v?LaF S?aLs aH CH=L?asCHA bI>S I@ ?vC>?H=? Bas >?GIHsNLaN?> NB? FCHks b?Nw??H GaFHONLCNCIH, hiV, aH> AidS aH> NB? =OGOFaNCv? ?@@?=N NB?S Bav? IH ?=IHIGC= ALIwNB. tB?L? Cs FCNNF? >?baN? as NI NB? CHN?ALaF LIF? NBaN HONLCNCIH pFaSs CH hiV pL?v?HNCIH, NL?aNG?HN, aH> GCNCAaNCIH IL NI CNs CGpILNaH=? CH =aLCHA @IL hiV-pIsCNCv? CH>CvC>OaFs, a@@?=N?> BIOs?BIF>s, aH> =IGGOHCNC?s. SCH=? 2000 NB? WILF> BaHk Bas HaH=?> 34 hiV/AidS pLIj?=Ns, CH=FO>CHA v? sOb-L?ACIHaF pLIj?=Ns, wCNB =IGGCNG?HNs CH ?x=?ss I@ uS$1.3 bCFFCIH. tB? appLIa=B Bas b??H NI pLIvC>? assCsNaH=? @IL pL?v?HNCIH, =aL? aH> sOppILN, NL?aNG?HN, aH> =apa=CNS bOCF>CHA, wCNB a FaLA? pILNCIH I@ NB? L?sIOL=?s =BaHH?F?> NBLIOAB =CvCF sI=C?NS ILAaHCzaNCIHs (wCNB GIL? NBaH 50,000 sO=B CHN?Lv?HNCIHs). A>>CNCIHaFFS, NBLIOAB NB? PIv?LNS r?>O=NCIH SNLaN?AS pLI=?ss aH> >?bN- @ILACv?H?ss, L?sIOL=?s aL? b?CHA GaCHsNL?aG?> NI =IHNCHO? NB? ABN aAaCHsN hiV aH> AidS. As NB? BaHk 9s pLIALaG Bas ?vIFv?>, aH> wCNB CH=L?as?> kHIwF?>A? abION NB? CGpILNaH=? I@ HONLCNCIH NI ?@@?=NCv? L?spIHs?s NI hiV aH> AidS, NB? BaHk Bas L?=IAHCz?> NB? H??> NI b?NN?L OH>?LsNaH> BIw NI CHN?ALaN? HONLCNCIH CHNI pLIALaGs @IL hiV aH> AidS (aH> BIw NI CHN?ALaN? =IHsC>?LaNCIHs abION hiV aH> AidS CHNI HONLCNCIH pLIALaGs). maHS ILAaHCzaNCIHs Bav? pLI>O=?> ?x=?FF?HN sNaN?-I@-NB? aLN pap?Ls aH> AOC>?FCH?s IH >C@@?L?HN N?=BHC=aF asp?=Ns I@ HONLCNCIH L?spIHs?s NI hiV aH> AidS, bON NB? GaN?LCaFs Bav? HIN H?=?ssaLCFS @IOH> NB?CL waS CHNI NB? wILk aH> L?sIOL=? aFFI=aNCIHs I@ HaNCIHaF hiV aH> AidS =IGGCssCIHs IL s?=L?NaLCaNs IL INB?L HaNCIHaF paLNH?Ls, CH NB? pObFC= s?=NIL IL ?Fs?wB?L?. mIL?Iv?L, GaHS I@ NB?s? GaN?LCaFs >I HIN @I=Os ?x=FOsCv?FS IH NB? HONLCNCIHaFFS L?F?vaHN asp?=Ns I@ pL?v?HNCIH aH> NL?aNG?HN I@ hiV aH> AidS. iH@ILGaNCIH Bas b??H sIG?wBaN s=aNN?L?> a=LIss aH> wCNBCH vaLCIOs >I=OG?HNs. tBOs a sSHNB?sCs I@ ?xCsNCHA N?=BHC=aF AOC>aH=? IH hiV aH> AidS, HONLCNCIH, aH> @II> s?=OLCNS was s??H as a vaFOabF? =IHNLCbONCIH NI ?@@ILNs NI CHN?ALaN? HONLCNCIH pLIj?=Ns aH> pLIALaGs @IL hiV aH> AidS. WCNB @OH>CHA @LIG NB? BaHk-n?NB?LFaH>s PaLNH?LsBCp PLIALaG (BnPP), NB? WILF> BaHk CHCNCaN?> a wC>? =IHsOFNaNCv? pLI=?ss NI pLI>O=? sO=B a sSHNB?sCs, NI =IFFaN? aH> sOGGaLCz? ?xCsNCHA N?=BHC=aF kHIwF?>A? aH> AOC>aH=? aN AFIbaF aH> L?ACIHaF F?v?Fs. tB? sSHNB?sCs aCGs NI pLIvC>? >?=CsCIHGak?Ls aH> s?LvC=? pLIvC>?Ls, ?sp?=CaFFS NBIs? wBI >?sCAH aH> GaHaA? pLIALaGs, wCNB AOC>aH=? IH BIw HONLCNCIH GaS b? CHN?ALaN?> CHNI hiV pL?v?HNCIH aH> AidS NL?aNG?HN. A GaCH pOLpIs? I@ NB? sSHNB?sCs Cs NI pLIvC>? AOC>aH=? NI HaNCIHaF AidS pLIALaGs CH SOb-SaBaLaH A@LC=a (?sp?=CaFFS NBIs? sOppILN?> NBLIOAB NB? WILF> BaHk mOFNC-cIOHNLS hiV/ AidS PLIALaG, IL mAP, pLIj?=Ns). tB?L?@IL?, NB? >I=OG?HN was >?v?FIp?> aH> ?F>-N?sN?> @IL Os? CH NB? A@LC=a L?ACIH. hIw?v?L, GIsN I@ NB? L?=IGG?H>aNCIHs >Law IH CHN?LHaNCIHaF AOC>?FCH?s aH> sBIOF> aFsI b? appFC=abF? CH INB?L hiV-a@@?=N?> L?ACIHs CH NB? wILF> wB?L? pObFC= L?sIOL=?s aL? =IHsNLaCH?>. Pre#Ace 4 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do PL?@a=? tB? CHCNCaF >La@N sSHNB?sCs was L?vC?w?> aH> >Cs=Oss?> CH AOAOsN 2006 aN a =IHsOFNaNCv? G??NCHA CHvIFvCHA a bLIa> LaHA? I@ un, bCFaN?LaF, L?s?aL=B, aH> HIH-AIv?LHG?HNaF ILAaHCzaNCIHs. PaLNC=CpaHNs aN NB? =IHsOFNaNCIH aAL??> NBaN NB? sSHNB?sCs, IH=? HaFCz?>, sBIOF> b? wC>?FS >Css?GCHaN?> as a A?H?LC= AOC>? aH> HIN L?sNLC=N?> NI WILF> BaHk pLIALaGs. tB? sSHNB?sCs >Laws @LIG avaCFabF? CHN?LHaNCIHaF AOC>?FCH?s aH> INB?L L?FaN?> >I=OG?HNs pL?paL?> bS Aed/#AntA, #Ao, i#Pri, PAth, unAidS, unhcr, unice#, uSAid, W#P aH> Who. #IL NBIs? NIpC=s IH wBC=B NB?L? w?L? FCGCN?> IL HI I@ =CaF CHN?LHaNCIHaF AOC>?FCH?s, NB? >I=OG?HN aFsI L?@?Ls NI AOC>aH=? @LIG INB?L HaNCIHaF aH> CHN?LHaNCIHaF ILAaHCzaNCIHs (s?? AHH?x i). tB? HONLCNCIH aH> hiV/AidS =IGGOHCNS pLIvC>?> B?Fp@OF =IGG?HNs aH> CHpONs NBLIOABION, CH paLNC=OFaL Aed/#AntA, i#Pri, PAth, SArA, unAidS, unice#, uSAid, W#P, aH> Who. tBCs sSHNB?sCs Cs aH IONpON I@ NB? LsN pBas? I@ a NwI-paLN ?@@ILN @OH>?> bS BnPP, NB? ciHN?ALaNCIH I@ nONLCNCIH CHNI hiV/AidS PLIALaGs: SNL?HANB?HCHA op?LaNCIHaF capa=CNS CH easN?LH aH> SIONB?LH A@LC=a. d iH NB? s?=IH> pBas?, NB? BaHk aH> CNs paLNH?Ls aL? a>apNCHA NBCs AFIbaF AOC>aH=? NI @I=Os IH Ip?LaNCIHaF asp?=Ns CH sp?=C = =IOHNLS =IHN?xNs. cOLL?HNFS NB? BaHk Cs pCFINCHA a>apNaNCIH aH> >Css?GCHaNCIH a=NCvCNC?s I@ NB? sSHNB?sCs CH NwI A@LC=aH =IOHNLC?s, mIzaGbCqO? aH> NB? r?pObFC= I@ cIHAI. W? BIp? NB? L?sOFNCHA N?=BHC=aF AOC>aH=? B?Fps A?H?LaN? a IH?-sNIp L?sIOL=? >I=OG?HN @IL pLIALaG GaHaA?Ls aH> >?=CsCIHGak?Ls CH SOb-SaBaLaH A@LC=a aH> ?Fs?wB?L?. SNCFF, w? L?=IAHCz? GIL? Bas NI b? >IH?. #IL ?xaGpF?, NB? >I=OG?HN >I?s HIN @OFFS >C@@?L?HNCaN? b?Nw??H sCNOaNCIHs wCNB A?H?LaFCz?> ?pC>?GC=s aH> NBIs? wB?L? ?pC>?GC=s aL? BCABFS =IH=?HNLaN?>. PIFC=SGak?Ls wIOF> pLIbabFS FCk? NI Bav? GIL? CH@ILGaNCIH IH =OFNOLaF =IHsC>?LaNCIHs, CHsNCNONCIHaF =IHsNLaCHNs, aH> Os? I@ appLIpLCaN? pIFC=S @LaG?wILks. tB?S wIOF> FCk? NI kHIw GIL? abION BIw NI pON L?=IGG?H>aNCIHs aH> pLINI=IFs CHNI pLa=NC=? aH> abION NB? =IsN aH> ?@@?=NCv?H?ss I@ vaLCIOs pLIALaG IpNCIHs. tBCs wIOF> CH=FO>? a>>CNCIHaF CH@ILGaNCIH IH Ip?LaNCIHs aH> CGpF?G?HNaNCIH, CH=FO>CHA CGpFC=aNCIHs @IL sNa@ HA, NLaCHCHA, GaHaA?G?HN, sOppFS H??>s, aH> assI=CaN?> =IsNs. W? ?HvCsCIH NBCs as a @ONOL? ?@@ILN, wCNB ?xp?LC?H=?s @LIG mIzaGbCqO?, NB? r?pObFC= I@ cIHAI, aH> INB?L =IOHNLC?s a LsN sN?p. #OLNB?LGIL?, ACv?H NB? >SHaGC=s I@ hiV aH> AidS aH> HONLCNCIH, H?w kHIwF?>A? aLCs?s L?AOFaLFS, aH> L?=IGG?H>aNCIHs aL? b?CHA L?vC?w?> =IHsNaHNFS as H?w kHIwF?>A? ?G?LA?s. tBOs NBCs sSHNB?sCs Cs a cFCvCHA >I=OG?HN d IH wBC=B NI bOCF> as GIL? Cs F?aLH?>. oOL AIaF Cs NI >CsNLCbON? NBCs AOC>? wC>?FS, aH> AaOA? CNs Os?@OFH?ss. PF?as? sBaL? SIOL ?xp?LC?H=?s CH OsCHA NBCs NIIF, aH> F?N Os kHIw BIw CN GCABN b? CGpLIv?>. yIO GaS s?H> =IGG?HNs NI CH>CvC>OaF paLNH?L ILAaHCzaNCIHs IL NI NB? WILF> BaHk, aN HONLCNCIH@wILF>baHk.ILA. 5 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do A=kHIwF?>A?G?HNs tBCs Iv?LaFF ?@@ILN NI CHN?ALaN? HONLCNCIH CHNI NB? BaHk 9s hiV/AidS CHv?sNG?HNs Cs F?> bS m??La SB?kaL (hOGaH d?v?FIpG?HN n?NwILk) wCNB rC=BaL> S?C@GaH (AidS caGpaCAH t?aG @IL A@LC=a) @LIG NB? WILF> BaHk. tB? CHCNCaF >La@N >I=OG?HN was pL?paL?> bS WILF> BaHk =IHsOFNaHN AFCsIH gaL>H?L, wCNB CHpONs @LIG Sa Haz eF taBCL aH> S?basNCaHa gCaH=C, aH> AOC>aH=? @LIG WILF> BaHk hiV/AidS Nask N?aG F?a>?Ls. JaG?s gaLL?NN, aFsI aN NB? WILF> BaHk, assCsN?> wCNB NB? GaHaA?G?HN I@ NB? ?>CNCHA, pObFC=aNCIH, aH> >Css?GCHaNCIH I@ NBCs >I=OG?HN. tB? wILk was =IGpF?N?> wCNB Iv?LaFF AOC>aH=? @LIG NB? WILF> BaHk 9s hOGaH d?v?FIpG?HN maHaA?G?HN t?aG, ?sp?=CaFFS K?C KawabaNa (S?=NIL maHaA?L, h?aFNB, nONLCNCIH, aH> PIpOFaNCIH, hOGaH d?v?FIpG?HN n?NwILk) aH> eFCzab?NB lOF? (maHaA?L, AidS caGpaCAH t?aG @IL A@LC=a). maHS B?Fp@OF CHsCABNs, =IGG?HNs, aH> sOAA?sNCIHs IH ?aLFC?L >La@Ns I@ NBCs >I=OG?HN w?L? pLIvC>?> bS paLNH?Ls aH> =IFF?aAO?s. W? aL? paLNC=OFaLFS ALaN?@OF NI eFF?H PCwIz, @ILG?LFS I@ Aed aH> HIw I@ NB? gaN?s #IOH>aNCIH, wBI pLIvC>?> ?xp?LN sOppILN aH> L?vC?w NBLIOABION NB? >I=OG?HN >?v?FIpG?HN pLI=?ss. W? aFsI ?sp?=CaFFS NBaHk tIHS casNF?GaH aH> #L?>?LC=k gLaHN (Aed/#AntA); tCHa SaHABvC (Aed); SNOaLN gCFF?spC? aH> SOH??NBa Ka>CSaFa (i#Pri); AH>L?w tIGkCHs (iHsNCNON? I@ cBCF> h?aFNB); KaNB?LCH? KLasIv?= (PAth); PaNLC=k W?bb (tO@Ns uHCv?LsCNS, #LC?>GaH S=BIIF I@ nONLCNCIH); nOH? maHAasaLSaH, mIazz?G hIssaCH, aH> AHCLbaH cBaNN?Lj?? (unice#); BLO=? cIACFF (unice#, @ILG?LFS Aed/#AntA); lCFCa g?Lb?LA aH> tCGINBS QOC=k (uSAid); rIbCH Ja=ksIH, maLNCH BFI?G, aH> AH>L?w tBILH?-lSGaH (W#P); aH> d?HCs? cIsNa cICNCHBI aH> raH>a JaLO>C Saa>?B (Who). maHS INB?L pLI@?ssCIHaFs @LIG SArA, unice# ?F> I@ =?s, =CvCF sI=C?NS, AIv?LHG?HN, aH> >?v?FIpG?HN aFsI =IHNLCbON?> NI NB? >I=OG?HN. AN NB? WILF> BaHk, w? aL? ALaN?@OF @IL NB? sOppILN I@ d?bL?wILk Z?w>C? (dCL?=NIL, gFIbaF hiV/AidS PLIALaG); NB? AidS caGpaCAH t?aG @IL A@LC=a; aH> NB? A@LC=a r?ACIH nONLCNCIH N?aG. W? L?=?Cv?> ?x=?FF?HN =IGG?HNs @LIG IOL p??L L?vC?w?Ls wCNBCH NB? BaHk: maLCaG cFa?sIH, maLCNI gaL=Ca, BCHa VaFaS>IH, aH> AFb?LNOs VI?NbOLA. tBaHks aL? aFsI >O? NI cassaH>La >? SIOza, ra? gaFFIwaS, m?HHI mOF>?L-SCbaH>a, ok PaHH?HbILA, aH> WILF> BaHk A@LC=a sNa@@ @IL NB?CL vaFOabF? sObsNaHNCv? =IHNLCbONCIHs. iH NB? A@LC=a L?ACIH, paLNC=OFaL NBaHks AI NI hOGb?LNI cIssa, J?aH J. d? SN. AHNICH?, mC=Ba?F mCFFs, isab?F mONaGb?, BCHa VaFaS>IH, aH> AFb?LNOs VI?Nb?LA. Ja=qO?s WLCABN AL?aNFS assCsN?> wCNB ?>CNCHA aH> @ILGaNNCHA NBCs >I=OG?HN aH> v?LC@SCHA L?@?L?H=?s. rC@aN hasaH, m?FCH>a eFCas, J?ssC=a SN. JIBH, aH> ASaHHa AH>?LsIH-B?FFaL> I@ NB? WILF> BaHk 9s h?aFNB, nONLCNCIH, aH> PIpOFaNCIH OHCN pLIvC>?> vaFOabF? assCsNaH=? wCNB L?s?aL=B, ?>CNCHA, wIL>-pLI=?ssCHA, pObFC=aNCIH, aH> >Css?GCHaNCIH. W? aL? v?LS pF?as?> NI Bav? W#P, Who, unAidS, unhcr, PeP#Ar, uSAid, Aed/#AntA, PAth/iycn, aH> i#Pri/reneWAl as =I-spIHsILs I@ NBCs >I=OG?HN. #OH>CHA @IL NBCs ?@@ILN pLIvC>?> bS NB? BaHk-n?NB?LFaH>s PaLNH?LsBCp PLIALaG ( BnPP ) Cs >OFS a=kHIwF?>A?>. AcKnoWledgementS 6 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do A=LIHSGs & AbbL?vCaNCIHs AcronymS & ABBreViAtionS AED A=a>?GS @IL e>O=aNCIHaF d?v?FIpG?HN AFASS a==?pNabF?, @?asCbF?, a@@IL>abF?, sOsNaCHabF?, aH> sa@? AIDS A=qOCL?> iGGOH? d? =C?H=S SSH>LIG? ANC aHN?HaNaF =aL? ART aHNCL?NLIvCLaF NB?LapS ARV aHNCL?NLIvCLaF >LOA AZT azC>INBSGa>CH? IL zC>IvC>OH? (ZdV) BMI bI>S Gass CH>?x d >aS EFV ?@avCL?Hz FANTA #II> aH> nONLCNCIH t?=BHC=aF AssCsNaH=? PLIj?=N FAO #II> aH> AALC=OFNOL? oLAaHCzaNCIH I@ NB? uHCN?> naNCIHs HIV hOGaH iGGOHI>? =C?H=S VCLOs IASC iHN?L-AA?H=S SNaH>CHA cIGGCNN?? IBFAN iHN?LHaNCIHaF BabS #II> A=NCIH n?NwILk IFPRI iHN?LHaNCIHaF #II> PIFC=S r?s?aL=B iHsNCNON? IMCI iHN?ALaN?> maHaA?G?HN I@ cBCF>BII> iFFH?ss IYCN iH@aHN aH> yIOHA cBCF> nONLCNCIH PLIj?=N IU CHN?LHaNCIHaF OHCNs Kcal kCFI=aFILC? LBW FIw bCLNB w?CABN MTCT GINB?L-NI-=BCF> NLaHsGCssCIH MUAC GC>-Opp?L aLG =CL=OG@?L?H=? NCHS naNCIHaF c?HN?L @IL h?aFNB SNaNCsNC=s OVC ILpBaHs aH> vOFH?LabF? =BCF>L?H PAHO PaH-AG?LC=aH h?aFNB oLAaHCzaNCIH PATH PLIALaG @IL AppLIpLCaN? t?=BHIFIAC?s CH h?aFNB PCR pIFSG?Las? =BaCH L?a=NCIH PEM pLIN?CH-?H?LAS GaFHONLCNCIH PEPFAR PL?sC>?HN 9s eG?LA?H=S PFaH @IL AidS r?FC?@ PLHIV p?LsIH FCvCHA wCNB hiV PLWHA p?LsIH FCvCHA wCNB hiV/AidS PMTCT pL?v?HNCIH I@ GINB?L-NI-=BCF> NLaHsGCssCIH RDA L?=IGG?H>?> >C?NaLS aFFIwaH=?s RENEWAL r?ACIHaF n?NwILk IH AidS, lCv?FCBII>s, aH> #II> S?=OLCNS SARA SOppILN @IL AHaFSsCs aH> r?s?aL=B CH A@LC=a TB NOb?L=OFIsCs UNAIDS JICHN uHCN?> naNCIHs PLIALaGG? IH hiV/AidS UNGASS uHCN?> naNCIHs g?H?LaF Ass?GbFS Sp?=CaF S?ssCIH IH hiV/AidS UNHCR uHCN?> naNCIHs hCAB cIGGCssCIH?L @IL r?@OA??s UNICEF uHCN?> naNCIHs cBCF>L?H 9s #OH> USAID uS AA?H=S @IL iHN?LHaNCIHaF d?v?FIpG?HN VCT vIFOHNaLS =IOHs?FCHA aH> N?sNCHA WFP WILF> #II> PLIALaGG? WHO WILF> h?aFNB oLAaHCzaNCIH PF?as? s?? gFIssaLS @IL >? HCNCIHs I@ a>>CNCIHaF N?LGs. 7 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH i. evC>?H=? Bas sBIwH CGpILNaHN FCHks b?Nw??H CGpLIv?> hiV aH> AidS ION=IG?s aH> HONLCNCIH. A>?qOaN? HONLCNCIH Cs H?=?ssaLS NI GaCHNaCH NB? CGGOH? sSsN?G, GaHaA? IppILNOHCsNC= CH@?=NCIHs, IpNCGCz? L?spIHs? NI G?>C=aF NL?aNG?HN, sOsNaCH B?aFNBS F?v?Fs I@ pBSsC=aF a=NCvCNS, aH> sOppILN IpNCGaF qOaFCNS I@ FC@? @IL a p?LsIH FCvCHA wCNB hiV (PlhiV). gII> HONLCNCIH GaS =IHNLCbON? NI sFIwCHA NB? pLIAL?ssCIH I@ NB? >Cs?as? (casNF?GaH ?N aF. 2004). nONLCNCIH CHN?Lv?HNCIHs =aH aFsI B?Fp NI IpNCGCz? NB? b?H? Ns I@ aHNCL?NLIvCLaF >LOAs (ArVs) aH> GaS CH=L?as? =IGpFCaH=? wCNB NL?aNG?HN L?ACG?Hs, bINB I@ wBC=B aL? ?ss?HNCaF NI pLIFIHACHA NB? FCv?s I@ PlhiVs aH> NI pL?v?HNCHA NB? NLaHsGCssCIH I@ hiV @LIG GINB?L NI =BCF>. nONLCNCIH =IOHs?FCHA Bas b??H sBIwH NI b? ?@@?=NCv? CH CGpLIvCHA bI>S w?CABN aH> bI>S =?FF Gass CH PlhiVs (dIwFCHA ?N aF. 1990; m=KCHF?S ?N aF. 1994; rab?H?=k ?N aF. 1998). iN Bas aFsI b??H sBIwH NI B?Fp GCNCAaN? NB? ?@@?=Ns I@ hiV- aH> AidS-L?FaN?> sSGpNIGs sO=B as >CaLLB?a, HaOs?a, vIGCNCHA, aH?GCa, ILaF NBLOsB, FIss I@ app?NCN?, aH> @?v?L (#AntA 2004). #IL hiV-pIsCNCv? wIG?H, IpNCGaF HONLCNCIH >OLCHA pL?AHaH=S CH=L?as?s w?CABN AaCH aH> CGpLIv?s GaN?LHaF HONLCNCIH wBC=B, CH NOLH, CGpLIv?s bCLNB ION=IG?s. #IL hiV-?xpIs?> CH@aHNs, a>?qOaN? HONLCNCIH =IOHs?FCHA aH> sOppILN =aH FIw?L NB? LCsk I@ hiV NLaHsGCssCIH @LIG GINB?L NI =BCF> aH> CH=L?as? hiV-@L?? sOLvCvaF I@ CH@aHNs (Who 2005a). #IL hiV-pIsCNCv? =BCF>L?H, sa@? @??>CHA pLa=NC=?s aH> CGpLIv?> >C?NaLS CHNak? aL? =LCNC=aF NI L?AaCH w?CABN FIsN >OLCHA IppILNOHCsNC= CH@?=NCIHs. P?LCI>C= vCNaGCH A sOppF?G?HNaNCIH CH hiV-pIsCNCv? =BCF>L?H L?>O=?s CFFH?ss aH> >?aNB aH> CGpLIv?s ALIwNB (PCwIz 2004a). tB? bLIa>?L L?FaNCIHsBCps aH> CHN?La=NCIHs b?Nw??H hiV, AidS, @II> s?=OLCNS, aH> HONLCNCIH aL? =IGpF?x. #II> CHs?=OLCNS aH> pIv?LNS GaS F?a> NI BCAB-LCsk s?xOaF b?BavCILs aH> GCALaNCIH, CH=L?asCHA NB? LCsk I@ a=qOCLCHA hiV. AN NB? saG? NCG?, hiV w?ak?Hs a BIOs?BIF> 9s abCFCNS NI pLIvC>? @IL basC= H??>s. WB?H a PlhiV =aHHIN wILk, @II> pLI>O=NCIH IL ?aLHCHAs GaS >?=L?as?. h?aFNBS @aGCFS G?Gb?Ls GaS H??> NI sNIp wILk NI =aL? @IL sC=k @aGCFS G?Gb?Ls. hIOs?BIF> FabIL =IHsNLaCHNs =aH F?a> NI L?>O=NCIHs CH =OFNCvaN?> FaH>, sBC@Ns CH =LIps, aH> >?pF?NCIH I@ FCv?sNI=k. #IL BIOs?BIF>s NBaN aL? @II> CHs?=OL? pLCIL NI a G?Gb?L 9s @aFFCHA CFF, NB? ?@@?=Ns =aH b? >?vasNaNCHA. As NB? ?pC>?GC= pLIAL?ss?s CH BCABFS a@@?=N?> aL?as, =IGGOHCNC?s aL? w?ak?H?> as NLa>CNCIHaF sa@?NS H?Ns aL? sNL?N=B?> (gCFF?spC? aH> Ka>CSaFa 2005; PCwIz 2004a). PIsNpIHCHA CHN?Lv?HNCIHs OHNCF PlhiVs IL NB?CL @aGCFC?s b?=IG? GaFHIOLCsB?> IL @II> CHs?=OL? =aH b? =IOHN?LpLI>O=NCv? aH> =IsNFS. tBOs, GaCHNaCHCHA a>?qOaN? HONLCNCIH aH> @II> s?=OLCNS =aH b? CHsNLOG?HNaF CH GCNCAaNCHA NB? CGpa=N I@ hiV aH> =aLCHA @IL PlhiVs, NB?CL a@@?=N?> BIOs?BIF>s, aH> =IGGOHCNC?s (WILF> BaHk 2006). nONLCNCIHaF =IH=?LHs sBIOF> NB?L?@IL? b? Nak?H CHNI a==IOHN CH NB? pL?paLaNCIH I@ hiV aH> AidS sNLaN?AC?s aH> a=NCIH pFaHs aN HaNCIHaF aH> sOb-HaNCIHaF F?v?Fs. tB?s? pFaHs sBIOF> b? ?vC>?H=?- bas?>, wCNB a=NCIHs aH> CHN?Lv?HNCIHs NBaN aL? pLCILCNCz?> aH> =IsN?>. tB? =BIC=? I@ NB? appLIpLCaN? HONLCNCIH L?spIHs? wCFF b? =IOHNLS-sp?=C =. WCNBCH a ACv?H =IOHNLS, NBaN L?spIHs? wCFF b? >?N?LGCH?> bS NB? HaNOL? I@ NB? ?pC>?GC=, NB? ?xN?HN NI wBC=B H?=?ssaLS pIFC=C?s aL? aFL?a>S CH pFa=?, aH> NB? BOGaH, CHsNCNONCIHaF, aH> HaH=CaF =apa=CNC?s I@ sNak?BIF>?Ls. iN wCFF aFsI >?p?H> IH NB? ?xN?HN NI wBC=B NBIs? kHIwF?>A?abF? abION NB? FCHkaA?s b?Nw??H hiV, AidS, aH> HONLCNCIH aLNC=OFaN? NBCs H?xOs NI >?=CsCIHGak?Ls aN aFF F?v?Fs. I. imProVing hiV And AidS outcomeS through nutrition SuPPort 8 S?=NCIH ii. | A.1 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do A. NUTRITION SUPPORT FOR ADULTS LIVING WITH HIV (PLHIVS) goal : tB? AIaF I@ HONLCNCIH sOppILN @IL PlhiVs not yet in need o0 ART Cs NI CGpLIv? NB?CL Iv?LaFF B?aFNB aH> HONLCNCIHaF sNaNOs, pL?v?HN GaFHONLCNCIH, aH> sOppILN L?=Iv?LS @LIG IppILNOHCsNC= CH@?=NCIHs. tB? AIaF I@ HONLCNCIH sOppILN @IL PlhiVs in need o0 ART Cs NI sNabCFCz? HONLCNCIHaF sNaNOs pLCIL NI aH> >OLCHA NL?aNG?HN, B?Fp p?IpF? L?AaCH sNL?HANB, aH> =IHNLCbON? NI CGpLIvCHA HONLCNCIHaF sNaNOs >OLCHA NL?aNG?HN. iH pFa=?s wB?L? @II> CHs?=OLCNS pL?v?HNs p?IpF? @LIG a==?ssCHA IL a>- B?LCHA NI NL?aNG?HN L?ACG?s, @II> sOppILN =aH pFaS aH CGpILNaHN LIF? CH CH=L?asCHA OpNak? aH> a>B?L?H=? NI NL?aNG?HN (m?AazzCHC ?N aF. 2006). A.1. Nutrient Re<uirements tI pL?v?HN w?CABN FIss IL GaCHNaCH w?CABN, ABN CH@?=NCIH, aH> bOCF> aH> GaCHNaCH GOs=F? Gass, CN Cs CGpILNaHN NI Bav? sO@ =C?HN HONLC?HN CHNak? aN aFF NCG?s. PlhiVs H??> a >C?N NBaN pLIvC>?s aFF NB? ?ss?HNCaF HONLC?HNs NI G??N CH=L?as?> HONLCNCIHaF H??>s. energy requirements : PlhiVs Bav? a>>CNCIHaF ?H?LAS L?qOCL?G?HNs >O? NI hiV, IppILNOHCsNC= CH@?=NCIHs, HONLC?HN GaFabsILpNCIH, aH> aFN?L?> G?NabIFCsG. eH?LAS H??>s >?p?H> IH wB?NB?L NB? PlhiV Cs sSGpNIG- aNC= (?.A., @?v?L, wasNCHA, >CaLLB?a, w?CABN FIss) IL asSGpNIGaNC=. n WB?H asSGpNIGaNC= (Who sNaA? 1), hiV-pIsCNCv? a>OFNs H??> NI CH- =L?as? ?H?LAS CHNak? bS 10 p?L=?HN Iv?L NB? F?v?F I@ ?H?LAS CHNak? L?=IGG?H>?> @IL B?aFNBS HIH-hiV-CH@?=N?> p?LsIHs I@ NB? saG? aA?, s?x, aH> pBSsC=aF a=NCvCNS F?v?F (#AntA 2004; Who 2003a). iH NB? pL?s?H=? I@ sSGpNIGs (Who sNaA? 2 aH> abIv?), hiV-pIsCNCv? a>OFNs H??> NI CH=L?as? n ?H?LAS CHNak? bS 20 NI 30 p?L=?HN Iv?L NB? F?v?F I@ ?H?LAS CHNak? L?=IGG?H>?> @IL B?aFNBS HIH-hiV-CH@?=N?> p?LsIHs I@ NB? saG? aA?, s?x, aH> pBSsC=aF a=NCvCNS F?v?F (Who 2003a). protein requirements : evC>?H=? sOAA?sNs NBaN hiV-pIsCNCv? p?LsIHs L?qOCL? NB? saG? F?v?F I@ pLIN?CH as B?aFNBS n HIH-hiV-CH@?=N?> p?LsIHs I@ NB? saG? aA?, s?x, aH> pBSsC=aF a=NCvCNS F?v?F, aFNBIOAB @?w sNO>C?s I@ pLIN?CH L?qOCL?G?HNs Bav? b??H >IH?. tB? L?=IGG?H>?> pLIN?CH CHNak? @IL a B?aFNBS HIH-hiV-CH@?=N?> a>OFN Cs 12 NI 15 p?L=?HN I@ NINaF ?H?LAS H??>s, IL 0.8A/kA bI>S w?CABN @IL @?GaF?s aH> 0.85A/kA bI>S w?CABN @IL GaF?s (Who 2003a). n hiV-pIsCNCv? p?IpF? I@N?H Bav? pL?-?xCsNCHA pLIN?CH-?H?LAS GaFHONLCNCIH (Pem) L?sOFNCHA @LIG CHa>?qOaN? CHNak? IL pIIL ONCFCzaNCIH I@ @II> aH> ?H?LAS (#AntA 2004). nONLCNCIH sOppILN pLIALaGs GaS H??> NI a>>L?ss NBCs bS ?H=IOLaACHA CH=L?as?s CH @II> =IHsOGpNCIH NI G??N L?=IGG?H>?> CHNak?s. II. treAtment, cAre, And SuPPort c a/0qu,?0 9u?ri?i:9, B3i.3 is b0s? ,.3i0v0/ ?3r:ug3 .:9sump?i:9 :1 , b,l,9.0/ 30,l?3y /i0?, is vi?,l 1:r 30,l?3 ,9/ surviv,l 1:r ,ll i9/ivi/u,ls r0g,r/l0ss :1 hIV s?,?us. d Nutrient Requirements 0or People Living with HIV/AIDS: Report o0 a technical consultation. Who, g?H?va, SwCNz?LFaH>, maS 13-15, 2003. ca/0qu,?0 9u?ri?i:9 .,99:? .ur0 hIV i910.?i:9, bu? i? is 0ss09?i,l ?: m,i9?,i9 ?30 immu90 sys?0m ,9/ sus?,i9 p3ysi.,l ,.?ivi?y, ,9/ ?: ,.3i0v0 :p?im,l qu,li?y :1 li10. d Participants 9 Statement, WHO Consultation on Nutrition and HIV/AIDS in A0rica, dOLbaH, SIONB A@LC=a, ApLCF 10-13, 2005. 9 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | A.2 fat requirements : n tB? L?=IGG?H>?> @aN CHNak? @IL aH hiV-pIsCNCv? p?LsIH Cs NB? saG? as @IL a B?aFNBS HIH- hiV-CH@?=N?> p?LsIH, C.?., 30 3 35 p?L=?HN I@ NINaF ?H?LAS H??>s (Who 2003a). #IL PlhiVs, =?LNaCH ArVs, IL CH@?=NCIH sSGpNIGs sO=B as >CaLLB?a, GaS L?qOCL? =BaHA?s n CH NB? NCGCHA IL qOaHNCNS I@ @aN CHNak?. micronutrient requirements : mC=LIHONLC?HN >? =C?H=C?s aL? =IGGIH CH aL?as wB?L? hiV Cs pL?vaF?HN. PlhiVs I@N?H sO@@?L @LIG GC=LIHONLC?HN >? =C?H=C?s, wBC=B pIN?HNCaFFS =IGpLIGCs? NB?CL CGGOH? @OH=NCIH aH>, CH NOLH, NB?CL abCFCNS NI ABN CH@?=NCIH (#AntA 2004). tI ?HsOL? GC=LIHONLC?HN CHNak?s aN >aCFS L?=IGG?H>?> F?v?Fs, n hiV-pIsCNCv? a>OFNs aL? ?H=IOLaA?> NI =IHsOG? a>?qOaN? >C?Ns (Who 2003a). dC?N aFIH? GaS HIN b? sO@ =C?HN NI =ILL?=N HONLCNCIHaF >? =C?H=C?s. n i@ a PlhiV Bas sCAHs I@ a GC=LIHONLC?HN >? =C?H=S, CN sBIOF> b? NL?aN?> a==IL>CHA NI sNaH>aL> pLINI=IFs (#AntA 2004). r?=?HN ?vC>?H=? sOAA?sNs NBaN a PlhiV wCNB GOFNCpF? HONLC?HN >? =C?H=C?s GaS L?qOCL? GIL? NBaH IH? L?=IGG?H>?> >C?NaLS aFFIwaH=? (rdA) p?L >aS NI L?v?Ls? NB?s? >? =C?H=C?s (Who 2004). tB?L? Cs =IHfC=NCHA ?vC>?H=? L?AaL>CHA NB? L?FaNCIHsBCps b?Nw??H BCAB->Is? GC=LIHONLC?HN sOppF?G?HNs aH> >Cs?as? pLIAL?ssCIH aH> GILNaFCNS @IL PlhiVs. tB? L?s?aL=B =OLL?HNFS OH>?LwaS wCFF pLIvC>? @OLNB?L AOC>aH=? IH GC=LIHONLC?HN sOppF?G?HNaNCIH aH> IH NB? NB?Lap?ONC= aH> pL?v?HNCv? Os? I@ GOFNCvCNaGCHs (Who 2003a). A.2. Nutritional Assessment 1 iHCNCaF HONLCNCIHaF s=L??HCHA aH> ass?ssG?HN AaNB?Ls CH@ILGaNCIH IH NB? =OLL?HN HONLCNCIHaF sNaNOs I@ PlhiVs, NB? a>?qOa=S I@ NB?CL >C?N, NB?CL @II> BabCNs, aH> NB?CL >C?NaLS =IHsNLaCHNs. S=L??HCHA aH> ass?ssG?HN =aH C>?HNC@S pIIL ?aNCHA b?BavCILs aH> waSs NI CGpLIv? NB? >C?N. iH a>>CNCIH, HONLCNCIHaF ass?ssG?HN pLIvC>?s NB? basCs @IL appLIpLCaN? =IOHs?FCHA aH> >?=CsCIH GakCHA abION NB? H??> @IL CHN?Lv?HNCIHs sO=B as @II> sOppILN. nONLCNCIHaF s=L??HCHA aH> ass?ssG?HN CH=FO>?s a bas?FCH? pBSsC=aF ?xaG NI C>?HNC@S aHS =IH>CNCIHs L?qOCLCHA NL?aNG?HN NBaN GaS a@@?=N HONLCNCIHaF sNaNOs. AHNBLIpIG?NLC= G?asOL?G?HNs, C.?., G?asOL?G?HN I@ bI>S sCz?, sO=B as w?CABN aH> B?CABN, =aH b? Os?> NI =aF=OFaN? Bmi (bI>S Gass CH>?x). Bmi =aH b? Os?> NI ass?ss HONLCNCIHaF sNaNOs (OH>?Lw?CABN, HILGaF, IL Iv?Lw?CABN) aH> aHS =BaHA?s Iv?L NCG?. 2 tB? Os? I@ GC>-Opp?L aLG =CL=OG@?L?H=? (muAc) Cs L?=IGG?H>?> @IL G?asOLCHA HONLCNCIHaF sNaNOs CH pL?AHaHN wIG?H (s?? S?=NCIH ii. B.2) aH> GaS aFsI b? =IHsC>?L?> wB?H s=aF?s aH> B?CABN-G?asOLCHA ?qOCpG?HN aL? HIN avaCFabF?. cMi.r:9u?ri09? i9?,k0s ,? /,ily r0.:mm09/0/ l0v0ls 900/ ?: b0 ,ssur0/ i9 hIV-i910.?0/ ,/ul?s ,9/ .3il/r09 ?3r:ug3 .:9sump?i:9 :1 /iv0rsi 0/ /i0?s, 1:r?i 0/ 1::/s, ,9/ mi.r:9u?ri09? suppl0m09?s ,s 900/0/. d Participants 9 Statement, WHO Consultation on Nutrition and HIV/AIDS in A0rica, dOLbaH, SIONB A@LC=a, ApLCF 10-13, 2005. ca .:mpl0?0 b,s0li90 9u?ri?i:9 ,ss0ssm09? s3:ul/ b0 p0r1:rm0/ ,s p,r? :1 ?30 mul?i/is.ipli9,ry .,r0 pl,9 /0v0l:pm09?, Bi?3 r0gul,r 1:ll:B up ,s i9/i.,?0/. d PIsCNCIH I@ NB? AG?LC=aH dC?N?NC= AssI=CaNCIH aH> dC?NCNCaHs I@ caHa>a: nONLCNCIH iHN?Lv?HNCIH wCNB hOGaH iGGOHI>? =C?H=S VCLOs iH@?=NCIH, J Am Diet Assoc., 2004. 1. tBCs s?=NCIH Cs bas?> IH #C?F>s-gaL>H?L aH> #?LAOssIH 2004; Who 2004; Who 2006a; ZaGbCa 2004. 2. WBCF? NBIs? wILkCHA CH HONLCNCIH L?=IAHCz? NB? vaFO? I@ OsCHA Bmi @IL HONLCNCIHaF ass?ssG?HN, CN Cs HIN S?N wC>?FS Os?> CH hiV aH> AidS pLIALaGs. 10 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | A.3 A HONLCNCIHaF s=L??HCHA aH> ass?ssG?HN sBIOF>: evaFOaN? =OLL?HN >C?N, ?aNCHA paNN?LHs, ILaF B?aFNB, aH> INB?L @a=NILs CHfO?H=CHA @II> n CHNak?. tBCs CHvIFv?s ass?ssCHA CH>CvC>OaF- aH> BIOs?BIF>-F?v?F @II> s?=OLCNS, CH paLNC=OFaL NB? =IHsNLaCHNs NI @II> a==?ss aH> =IHsOGpNCIH. #IL wIG?H I@ L?pLI>O=NCv? aA?, =IHsC>?L L?pLI>O=NCv? sNaNOs n (pL?AHaHN, Fa=NaNCHA, pL?AHaHN aH> Fa=NaNCHA, HIH-pL?AHaHN HIH- Fa=NaNCHA) sCH=? HONLCNCIHaF L?qOCL?G?HNs >C@@?L @IL NB?s? ALIOps. evaFOaN? NB? PlhiV 9s sOppILN sSsN?G (@LC?H>s, @aGCFS, aH> n sOppILN ALIOps). r?vC?w NB? PlhiV 9s FC@?sNSF? pLa=NC=?s, sO=B as sGIkCHA, aF=IBIF, n aH> >LOA abOs?, as NB?S GaS CHfO?H=? @II> aH> HONLC?HN CHNak? aH> aL? =IHNLaCH>C=aN?> wCNB sIG? G?>C=aNCIHs. Ass?ss NB? FCvCHA ?HvCLIHG?HN I@ NB? PlhiV, CH=FO>CHA NB? =F?aHFCH?ss aH> saHCNaNCIH I@ n NB? PlhiV 9s FCvCHA aL?a, @II> BSAC?H?, aH> NB? Os? I@ sa@? aH> =F?aH waN?L. #CH> ION wBaN G?>C=aNCIHs, HONLCNCIHaF sOppF?G?HNs, aH> NLa>CNCIHaF NB?LapC?s NB? PlhiV n =OLL?HNFS Os?s. cIH>O=N FabILaNILS N?sNs NI =IH LG hiV-CH@?=NCIH sNaNOs; G?asOL? B?GIAFIbCH aH> cd4 n =IOHNs wB?L? pIssCbF?; aH> s=L??H @IL NOb?L=OFIsCs aH> GaFaLCa, wCNB >CaAHIsNC= N?sNCHA @IL INB?L =ICH@?=NCIHs aH> IppILNOHCsNC= >Cs?as?s wB?L? =FCHC=aFFS CH>C=aN?>. t?sN @IL pL?AHaH=S CH wIG?H C@ CHCNCaNCIH I@ ?@avCL?Hz (e#V) Cs b?CHA =IHsC>?L?>. tak? G?asOL?G?HNs L?AOFaLFS NI a>?qOaN?FS ass?ss aH> GIHCNIL bI>S w?CABN. lIss I@ n bI>S w?CABN Cs aH ?aLFS CH>C=aNIL I@ B?aFNB aH> sI=CaF pLIbF?Gs aH> sBIOF> H?=?ssCNaN? @OLNB?L @IFFIw-Op =aL?. A.3. Dietary Recommendations and Care Practices 3 A >Cv?Ls? aH> baFaH=?> >C?N, LC=B CH Ga=LI- aH> GC=LIHONLC?HNs, pFaSs aH CGpILNaHN LIF? CH GaCHNaCHCHA a B?aFNBS FC@?sNSF? aH> bI>S. A HONLCNCIOs >C?N =aH B?Fp GaCHNaCH NB? pLIp?L @OH=NCIHCHA I@ NB? CGGOH? sSsN?G aH> pLIvC>? NB? ?H?LAS, pLIN?CH, aH> GC=LIHONLC?HNs H??>?> >OLCHA aFF sNaA?s I@ hiV CH@?=NCIH. dC?NaLS GaHaA?G?HN I@ hiV- aH> AidS-L?FaN?> sSGpNIGs =aH pL?v?HN GaFHONLCNCIH aH> CGpLIv? NB? Iv?LaFF B?aFNB aH> HONLCNCIHaF sNaNOs I@ PlhiVs. gII> @II> aH> >C?NaLS pLa=NC=?s =aH >?=L?as? NB? ?@@?=Ns I@ AidS-L?FaN?> sSGpNIGs IH @II> CHNak? aH> HONLC?HN absILpNCIH, CGpLIv? =IG@ILN wBCF? ?aNCHA, aH> pL?v?HN >?BS>LaNCIH >O? NI >CaLLB?a aH> @?v?L. iH a>>CNCIH, NB?S =aH B?Fp GaCHNaCH bI>S w?CABN, pLIvC>? HONLC?HNs NI =IGp?HsaN? @IL FIss?s, aH> sNL?HANB?H NB? CGGOH? sSsN?G. tB?S =aH aFsI B?Fp GaHaA? =?LNaCH sSGpNIGs, sO=B as HaOs?a aH> =IHsNCpaNCIH, aH> L?>O=? NB? s?v?LCNS I@ sSGpNIGs bS pLIvC>CHA sp?=C = HONLC?HN H??>s (#AntA 2004). cdi0?,ry ,9/ 9u?ri?i:9,l ,ss0ssm09? is ,9 0ss09?i,l p,r? :1 .:mpr0309siv0 hIV .,r0 b:?3 b01:r0 ,9/ /uri9g aRV ?r0,?m09?. d Participants 9 Statement, WHO Consultation on Nutrition and HIV/AIDS in A0rica, dOLbaH, SIONB A@LC=a, ApLCF 10-13, 2005. 3. tBCs s?=NCIH Cs bas?> IH #AntA 2004; #Ao aH> Who 2002. 11 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | A.4 PlhiVs sBIOF> ?aN a baFaH=?> aH> >Cv?Ls? >C?N wCNB @II>s CH sO@ =C?HN qOaHNCNC?s NI G??N NB?CL ?H?LAS, pLIN?CH, aH> GC=LIHONLC?HN H??>s. AHH?x?s ii aH> iV =IHNaCH >C?NaLS L?=IGG?H>aNCIHs aH> =aL? pLa=NC=?s @IL sSGpNIGs aH> CFFH?ss?s assI=CaN?> wCNB hiV CH a>OFNs. cIOHNLS- sp?=C = HONLCNCIH AOC>?FCH?s aH> @II> ALIOp L?=IGG?H>aNCIHs @IL a>OFNs sBIOF> b? >?v?FIp?> NI pLIvC>? GIL? >?NaCF?> >C?NaLS AOC>aH=?. general dietary recommendations : opNCGaFFS, PlhiVs sBIOF> =IHsOG? a baFaH=?> aH> >Cv?Ls? >C?N, n CH=FO>CHA sNapF? @II>s, =IIk?> F?AOG?s, HONs aH> HON bONN?Ls, aHC- GaF @II>s, GCFk pLI>O=Ns, @aNs aH> ICFs, aH> @LOCNs aH> v?A?NabF?s. As CH NB? A?H?LaF pIpOFaNCIH, PlhiVs sBIOF> =IHsOG? 30 NI 35 n p?L=?HN I@ NINaF ?H?LAS CH NB? @ILG I@ @aNs IL ICFs, paLNC=OFaLFS ICFs @LIG v?A?NabF?s aH> sB NBaN pLIvC>? IG?Aa-3 @aNNS a=C>s. PlhiVs wCNB @aN GaFabsILpNCIH aH> NBIs? IH ArV >LOAs NBaN sBIw ?vC>?H=? I@ G?NabIFC= abHILGaFCNC?s (?.A., BCAB bFII> NLCAFS=?L- C>?s) GaS H??> NI =IHsOG? F?ss ?H?LAS @LIG @aNs. PaLNC=OFaLFS CH s?NNCHAs wB?L? a==?ss NI a >Cv?Ls? >C?N Cs FCGCN?>, >C?Ns sBIOF> CH=FO>? n GC=LIHONLC?HN-@ILNC ?> @II>s as a waS I@ G??NCHA GC=LIHONLC?HN L?qOCL?G?HNs, CH=FO>CHA NBIs? @IL CI>CH?, CLIH, aH> vCNaGCH A. iH>CvC>OaFs sBIOF> GaCHNaCH a>?qOaN? BS>LaNCIH wCNB aN F?asN ?CABN =Ops I@ sa@?, =F?aH n waN?L a >aS. tI G??N NB?CL CH=L?as?> ?H?LAS H??>s aH> avIC> w?CABN FIss, PlhiVs H??> NI: iH=L?as? NB? aGIOHN aH> vaLC?NS I@ @II>s NB?S ?aN. n eaN GIL? I@N?H NBLIOABION NB? >aS, BavCHA sGaFF, @L?qO?HN G?aFs aH> sHa=ks. n eaN GIL? HONLC?HN->?Hs? @II>s wCNB ?a=B G?aF. n A.4. ART and Other Medications 4 AHNCL?NLIvCLaF NB?LapS (Art) bas?> IH =IGbCHaNCIHs I@ aHNCL?NLIvCLaF >LOAs Cs pL?s=LCb?> NI PlhiVs wCNB CGGOH? sOppL?ssCIH, sCAHs aH> sSGpNIGs I@ AidS bas?> IH =FCHC=aF sNaACHA =LCN?LCa, IL bINB. tB?s? >LOAs sOppL?ss vCLaF L?pFC=aNCIH, aFFIwCHA NB? CGGOH? sSsN?G NI L?sNIL? CNs?F@ aH> B?FpCHA NI sFIw hiV >Cs?as? pLIAL?ssCIH. WB?H?v?L pIssCbF?, paNC?HNs wBI aL? HIN S?N ?FCACbF? @IL Art sBIOF> b? GIHCNIL?> @IL =FCHC=aF pLIAL?ssCIH aH> bS cd4 =IOHN G?asOL?G?HN ?v?LS sCx GIHNBs IL GIL? I@N?H, C@ =FCHC=aFFS CH>C=aN?> (Who 2006a). cFCHC=aF ?vaFOaNCIH sBIOF> CH=FO>? NB? saG? paLaG?N?Ls as CH bas?FCH? ?vaFOaNCIHs, CH=FO>CHA w?CABN AaCH IL FIss aH> >?v?FIpG?HN I@ =FCHC=aF sCAHs aH> sSGpNIGs I@ ca br:,/ .:9s09sus 0m0rg0/ 1r:m ?30 durb,9 .:910r09.0 :9 ?30 900/ ?: k00p ?30 1:.us :9 ?3r00 :v0rl,ppi9g ,9/ i9?0r,.?i9g s0?s :1 pr:bl0ms: hIV/aIdS, 1::/ i9s0.uri?y, ,9/ m,l9u?ri?i:9. I9?0r,.?i:9s b0?B009 ?30s0 pr:bl0ms m,y r0quir0 .0r?,i9 m:/i .,?i:9s ?: i9?0rv09?i:9s, ?: m,Cimiz0 ?30ir 0110.?iv090ss i9 ?30 .:9?0C? :1 hIV/aIdS. d gCFF?spC?, S (?>) 2006. Highlights o0 the IFPRI Con0erence on HIV/AIDS and Food and Nutrition Security, Durban, 14-16 April 2005. 4. tBCs s?=NCIH Cs bas?> IH casNF?GaH ?N aF. 2004; #AntA 2004; Who 2004. 12 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | A.5, A.6 pLIAL?ssCv? hiV >Cs?as?. tB?s? =FCHC=aF paLaG?N?Ls aH> NB? cd4 =?FF =IOHN sBIOF> b? Os?> NI Op>aN? NB? Who >Cs?as? sNaA? aN ?a=B vCsCN aH> NI >?N?LGCH? wB?NB?L paNC?HNs Bav? b?=IG? ?FCACbF? @IL =I-NLCGIxazIF? pLIpBSFaxCs IL Art (Who 2006a). #II> GaS B?Fp IL CHN?L@?L? wCNB ArV OpNak?, a@@?=NCHA absILpNCIH aH> ?@@?=NCv?H?ss. tB?L?@IL?, CN Cs CGpILNaHN NI kHIw wB?H NI Nak? NB? >LOAs, wB?NB?L NI Nak? NB?G wCNB IL wCNBION @II>, aH> NI b? =aONCIOs wCNB G?aF =IGpIH?HNs. SIG? >LOAs Bav? sC>? ?@@?=Ns, sO=B as HaOs?a, vIGCNCHA, aH> >CaLLB?a, wBC=B =aH a@@?=N @II> CHNak?. iHCNCaNCHA ArV NL?aNG?HN GaS aFsI b? a==IGpaHC?> bS aH CH=L?as? CH app?NCN?, as paNC?HNs b?ACH NI @??F b?NN?L. AFF I@ NB?s? =IH>CNCIHs Bav? CGpFC=a- NCIHs @IL PlhiVs. tBOs, =IOHs?FCHA NI sOppILN appLIpLCaN? HONLCNCIH a=NCIHs pFaSs a =LCNC=aF LIF? CH NB? sa@?NS aH> ?@ =a=S I@ ArVs aH> INB?L G?>C=aNCIHs =IGGIHFS Nak?H bS PlhiVs. nONLCNCIH =IOHs?FCHA Cs L?=IGG?H>?> (wCNB L?AOFaL @IFFIw-Op) NI pLIvC>? CH@ILGaNCIH IH n wB?NB?L >LOAs sBIOF> b? Nak?H wCNB IL wCNBION @II>, aH> NI GIHCNIL =BaHA?s CH HONLCNCIHaF sNaNOs aH> bI>S =IGpIsCNCIH a@N?L NL?aNG?HN Cs CHCNCaN?> (#AntA 2004). h?aFNB ?>O=aNCIH CH GaHaACHA NB? =IGGIH sC>? ?@@?=Ns I@ ArVs aH> INB?L G?>C=aNCIHs n Cs a>vCs?>. i@ G?NabIFC= abHILGaFCNC?s aL? >?N?=N?> aH> aL? GCHCGaF, HONLCNCIH =IOHs?FCHA Cs aFsI n H?=?ssaLS NI GCHCGCz? NB? =IHs?qO?H=?s aH> CGpLIv? NL?aNG?HN ION=IG?s aH> paNC?HN w?FF-b?CHA. i@ G?NabIFC= abHILGaFCNC?s aL? sCAHC =aHN, NB? paNC?HN sBIOF> b? L?@?LL?>. A.5. Management o1 Wasting and Severe Malnutrition PlhiVs aL? aN AL?aN?L LCsk @IL GaFHONLCNCIH NBaH HIH-hiV-CH@?=N?> a>OFNs. AN pL?s?HN, BIw?v?L, NB?L? aL? HI sp?=C = AOC>?FCH?s @IL GaHaA?G?HN I@ s?v?L? GaFHONLCNCIH CH hiV-pIsCNCv? a>OFNs, aH> NBOs L?=IGG?H>aNCIHs @IL GaHaA?G?HN I@ s?v?L? GaFHONLCNCIH CH NB? A?H?LaF a>OFN pIpOFa- NCIH appFS NI NBIs? FCvCHA wCNB hiV (Who 1999). Who (2004) pLIvC>?s NB? @IFFIwCHA a>vC=? @IL hiV-pIsCNCv? wIG?H: r?@?L @IL =IHsC>?LaNCIH I@ =IGG?H=?G?HN I@ ArV NL?aNG?HN. n r?@?L @IL a>>CNCIHaF =aL?, CH=FO>CHA NBIs? pLIALaGs NBaN =aH pLIvC>? s=L??HCHA @IL @II> n s?=OLCNS aH> @II> assCsNaH=? sOppILN, wB?H H??>?>. A>vCs? IH NB? pIN?HNCaF LIF? I@ pBSsC=aF a=NCvCNS CH CH=L?asCHA sNL?HANB aH> GOs=F? Gass. n A.6. Provision o1 Food Supplements 1or PLHIVs As a>?qOaN? @II> aH> GC=LIHONLC?HN CHNak? =IHNLCbON? NI CGpLIv?> HONLCNCIHaF sNaNOs, NL?aNG?HN aH> sOppILN pLIALaGs I@N?H pLIvC>? @II> sOppF?G?HNs a==IL>CHA NI >? H?> pLINI=IFs. mIsN I@ NB?s? CHvIFv? pLIvC>CHA @II> NI p?IpF? bas?> IH sI=CI-?=IHIGC= IL bCIFIAC=aF =LCN?LCa, IL bINB. PlhiVs NBaN >I HIN Bav? sO@ =C?HN @II> CHNak? >O? NI @II> CHs?=OLCNS sBIOF> b? pLIvC>?> 13 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | A.7 @II> sOppF?G?HNs NI B?Fp =Iv?L NB?CL >? =CN (PCwIz 2004a; uAaH>a 2003; W#P 2004). SO=B sOppILN sBIOF> b? FCHk?> NI HONLCNCIHaF ass?ssG?HNs. tB?Lap?ONC= @??>CHA CH paLNC=OFaL =aH pFaS a vCNaF LIF? CH sNabCFCzCHA paNC?HNs pLCIL NI aH> >OLCHA Art; BIw?v?L, pLIALaGs sBIOF> Nak? CHNI a==IOHN NB? pIssCbCFCNS NBaN LaNCIHs >?sNCH?> @IL CH>CvC>OaF =FC?HNs GaS ?H> Op b?CHA sBaL?> wCNB INB?L BIOs?BIF> G?Gb?Ls. #IL NBCs L?asIH, CH GaHS sCNOaNCIHs, BIOs?BIF> LaNCIHs =aH b? aH CGpILNaHN sNLaN?AS @IL sOppILNCHA NB? H??>s I@ paLNC=OFaLFS vOFH?LabF? @aGCFC?s. PLIALaGs Bav? >?v?FIp?> vaLCIOs LaNCIHs @IL PlhiVs OsCHA avaCFabF? =IGGI>CNC?s. tI a>>L?ss HONLCNCIHaF LCsks, I@N?H NB? @II>s pLIvC>?> aL? @ILNC ?> wCNB GC=LIHONLC?HNs IL aL? GIL? HONLC?HN >?Hs? NBaH avaCFabF? sNapF? @II>s. PLIALaGGaNC= Ibj?=NCv?s, aH> pIN?HNCaF IppILNOHCNC?s aH> FCGCNaNCIHs (sO=B as NB? @a=N NBaN @II> sOppILN Cs HIN pLIvC>?> CH>? HCN?FS), as w?FF as CH@ILGaNCIH IH =FC?HNs 9 >C?N >? =C?H=C?s, @II> BabCNs, L?FaNCv? =IsNs, aH> paNN?LHs I@ @II> s?=OLCNS sBIOF> CH@ILG NB? >?v?FIpG?HN I@ appLIpLCaN? a=NCIHs. A.7. Nutrition, Food, and Health Education and Counseling 5 tI GaHaA? AidS-L?FaN?> sSGpNIGs aH> CGpLIv? >C?Ns, HONLCNCIH, aH> B?aFNB ?>O=aNCIH aH> =IOHs?FCHA sBIOF> @ILG aH CHN?ALaF =IGpIH?HN I@ PlhiV NL?aNG?HN, =aL?, aH> sOppILN. nONLCNCIH =IOHs?FCHA sBIOF> b? CH=ILpILaN?> CHNI NL?aNG?HN pLINI=IFs. nONLCNCIH =IOHs?FCHA aH> sOppILN sBIOF> ?HAaA? =FC?HNs CH >CaFIAO? abION @II> aH> >C?NaLS =IHsNLaCHNs, pLa=NC=?s, aH> pL?@?L?H=?s, aH> ONCFCz? NB? OH>?LsNaH>CHA AaCH?> NI B?Fp PlhiVs CGpLIv? NB?CL >C?N. cIOHs?FCHA aH> sOppILN sBIOF> pLIvC>? CH@ILGaNCIH IH: dC?NaLS L?=IGG?H>aNCIHs. iN Cs aFsI a>vCs?> NI =IH>O=N a s?ssCIH wCNB NB? =FC?HN NBaN NLaHs- n FaN?s NB? L?=IGG?H>aNCIHs CHNI a >aCFS IL w??kFS G?aF/sHa=k pFaH CHvIFvCHA FI=aF @II>s, sO@ =C?HN waN?L =IHsOGpNCIH, aH> Ga=LI- aH> GC=LIHONLC?HN sOppF?G?HNs as H??>?> (s?? aFsI S?=NCIH ii. A.3). dLOA-HONLC?HN CHN?La=NCIHs @IL aHS =OLL?HNFS pL?s=LCb?> G?>C=aNCIHs aH> BIw NI GaHaA? n NB?G (s?? AHH?x iii @IL sp?=C = CH@ILGaNCIH IH >LOA-HONLC?HN CHN?La=NCIHs). maHaA?G?HN I@ ILaF aH> >CA?sNCv? NLa=N pLIbF?Gs aH> INB?L L?FaN?> sSGpNIGs NBaN GaS n a@@?=N NB? =IHsOGpNCIH IL ONCFCzaNCIH I@ @II> (s?? AHH?x?s ii aH> iV). tLa>CNCIHaF NB?LapC?s, as H??>?>. tLa>CNCIHaF appLIa=B?s aL? HIN w?FF >I=OG?HN?>. tB?CL n HONLCNCIHaF ?@@?=Ns aH> BIw NB?S CHN?La=N wCNB >LOAs aL? GIsNFS OHkHIwH. iH a>>CNCIH, NB? ?vC>?H=? I@ NB?CL ?@ =a=S Cs FCGCN?>, aH> sIG? Bav? OHpF?asaHN sC>? ?@@?=Ns (s?? AHH?x iV @IL sIG? NLa>CNCIHaF waSs I@ >?aFCHA wCNB =IGGIH CFFH?ss?s aH> sSGpNIGs I@ AidS). cnu?ri?i:9 .:u9s0li9g .,9 impr:v0 30,l?3 :u?.:m0s ,9/ is ,9 i9?0gr,l p,r? :1 hIV .,r0 ,? ,9y s?,g0 :1 ?30 /is0,s0, 1r:m 30lpi9g 90Bly i910.?0/ p0:pl0 ?: s?,y 30,l?3y ?: ,ssis?i9g p0:pl0 ?,ki9g aRVs ?: m,9,g0 ?30ir ?30r,py, ?: ,ll:Bi9g p0:pl0 Bi?3 09/- s?,g0 aIdS ?: /i0 Bi?3 /ig9i?y. d PIsCNCIH I@ NB? AG?LC=aH dC?N?NC= AssI=CaNCIH aH> dC?NCNCaHs I@ caHa>a: nONLCNCIH iHN?Lv?HNCIH wCNB hOGaH iGGOHI>? =C?H=S VCLOs iH@?=NCIH, J Am Diet Assoc. , 2004. 5. tBCs s?=NCIH Cs bas?> IH #AntA 2004; #C?F>s-gaL>H?L aH> #?LAOssIH 2004; uAaH>a 2003; ZaGbCa 2004. 14 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | A.8 i@ Fa=k I@ @II> IL GC=LIHONLC?HNs Bas b??H C>?HNC ?> as a pLIbF?G, L?@?LLaF NI pLIALaGs NBaN pLIvC>? @II>, GC=LIHONLC?HNs, NLaCHCHA, IL INB?L appLIpLCaN? assCsNaH=? GaS b? H??>?>. P?LCI>C= @IFFIw-Op IH sp?=C = C>?HNC ?> CssO?s aH> IHAICHA =IOHs?FCHA aL? a>vCs?>. A.8. Healthy Li1estyle Education and Counseling 6 h?aFNBS FC@?sNSF? ?>O=aNCIH =aH B?Fp pL?v?HN CH@?=NCIHs aH> CGpLIv? NB? qOaFCNS I@ FC@? @IL PlhiVs. e>O=aNCIH sBIOF> CH=FO>? CH@ILGaNCIH IH: hSAC?H?, sO=B as @II> aH> waN?L sa@?NS, saHCNaNCIH, aH> p?LsIHaF BSAC?H? (s?? AHH?x V n @IL a FCsN I@ pIN?HNCaF NIpC=s). lC@?sNSF? BabCNs, sO=B as sGIkCHA, aF=IBIF, aH> >LOA abOs?, aH> NB?CL >?NLCG?HNaF ?@@?=Ns n IH @II> CHNak?, absILpNCIH, aH> Os?. tB? CGpILNaH=? aH> pLIGINCIH I@ a>?qOaN? aGIOHNs I@ pBSsC=aF a=NCvCNS as CN GaCHNaCHs n GOs=F? Gass, sNCGOFaN?s app?NCN?, aH> ?HBaH=?s NB? @??FCHA I@ w?FF-b?CHA. iH>CvC>OaFs wBI aL? v?LS IL Iv?LFS a=NCv? GaS H??> NI L?>O=? NB?CL F?v?F I@ pBSsC=aF a=NCvCNS. tB? CGpILNaH=? I@ a>?qOaN? sF??p aH> ?xNLa L?sN. n tB? CGpILNaH=? aH> pLIGINCIH I@ sa@? s?x pLa=NC=?s CH IL>?L NI avIC> NLaHsGCNNCHA hiV NI n INB?Ls aH> NI pL?v?HN L?CH@?=NCIH. PsS=BIsI=CaF sOppILN as CN >?=L?as?s >?pL?ssCIH, sNCAGa, aH> sNL?ss, aH> CGpLIv?s qOaFCNS n I@ FC@?, I@N?H wCNB pIsCNCv? CGpa=Ns IH app?NCN? aH> HONLCNCIHaF CHNak?. tB? L?=IAHCNCIH aH> pLIGpN NL?aNG?HN I@ CFFH?ss?s, as w?FF as C>?HNC =aNCIH I@ appLIpLCaN? n aH> a==?ssCbF? sIOL=?s I@ =aL?. SCH=? PlhiVs I@N?H b?=IG? sC=k, wCNB CFFH?ss?s a@@?=NCHA @II> CHNak? aH> HONLCNCIHaF sNaNOs, aHS CFFH?ss sBIOF> b? NL?aN?> qOC=kFS. 6. tBCs s?=NCIH Cs bas?> IH #Ao aH> Who 2002; uAaH>a 2003; ZaGbCa 2004. 15 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do B. NUTRITION SUPPORT FOR HIV-POSITIVE PREGNANT AND LACTATING WOMEN goal : tI pL?s?Lv? GaN?LHaF HONLCNCIHaF sNaNOs aH> CGpLIv? bCLNB ION=IG?s NBLIOAB NB? pLIvCsCIH I@ qOaFCNS HONLCNCIH =aL? aH> sOppILN NI hiV-pIsCNCv? pL?AHaHN aH> Fa=NaNCHA GINB?Ls aH> NI CH=L?as? hiV-@L?? sOLvCvaF LaN?s I@ CH@aHNs. PLIvC>CHA appLIpLCaN? HONLCNCIH sOppILN NI hiV-pIsCNCv? pL?AHaHN wIG?H Cs =IHNCHA?HN IH wIG?H kHIwCHA NB?CL hiV sNaNOs wBC=B, CH NOLH, >?p?H>s IH CH=L?asCHA a==?ss NI vIFOHNaLS =IOHs?FCHA aH> N?sNCHA (Vct) s?LvC=?s aGIHA NB? A?H?LaF pIpOFaNCIH aH>, sp?=C =aFFS, pL?AHaHN aH> Fa=NaNCHA wIG?H. B.1. Nutrient Re<uirements energy requirements : nI >aNa =OLL?HNFS ?xCsN IH NB? CGpa=N I@ hiV aH> AidS IH ?H?LAS H??>s >OLCHA pL?AHaH=S aH> Fa=NaNCIH. tBOs, NB? L?=IGG?H>?> CH=L?as?> ?H?LAS CHNak? @IL hiV-pIsCNCv? a>OFNs a==IL>CHA NI >Cs?as? sNaA? sBIOF> b? a>>?> NI NB? pL?AHaHN wIGaH 9s av?LaA? >aCFS ?H?LAS CHNak?. dOLCHA NB? asSGpNIGaNC= pBas?, aH hiV-pIsCNCv? wIGaH L?qOCL?s aH a>>CNCIHaF 10 p?L=?HN I@ ?H?LAS CHNak? p?L >aS as =IGpaL?> wCNB a HIH-hiV-CH@?=N?> wIGaH, aH> aH a>>CNCIHaF 20 p?L=?HN aH> 30 p?L=?HN >OLCHA ?aLFS sSGpNIGaNC= aH> sSGpNIGaNC= pBas?s, L?sp?=NCv?FS (s?? tabF? 1). #IL ?xaGpF?, a HIH-hiV-CH@?=N?>, GI>?LaN?FS a=NCv? 28-S?aL-IF> wIGaH wBI Cs HIN pL?AHaHN IL Fa=NaNCHA L?qOCL?s 2140 k=aF/>aS. SB? sBIOF> L?=?Cv? aH a>>CNCIHaF 285 k=aF/>aS C@ sB? Cs pL?AHaHN aH> 500 k=aF/>aS GIL? C@ Fa=NaNCHA (#AntA 2004). WB?H NBCs wIGaH Cs hiV- pIsCNCv? B?L H??>s CH=L?as? a==IL>CHAFS, sI NBaN, @IL ?xaGpF?, aH hiV-pIsCNCv? wIGaH CH NB? sSGpNIGaNC= sNaA? wBI Cs Fa=NaNCHA sBIOF> L?=?Cv? 1,142 k=aF/>aS GIL? NBaH a wIGaH wBI Cs HIN CH@?=N?> wCNB hiV, pL?AHaHN, IL Fa=NaNCHA. S?=NCIH ii. | B, B.1 * Daily energy intake for a 28-year-old moderately active woman: Multiply Basal Metabolic Rate (BMR) by adjustment factor for the activity level = 1305 x 1.64 = 2140 kcal ** 10 percent daily energy intake increase during the asymptomatic phase = 2140 x .10 = 214; 20 percent daily energy intake i ncrease at the early symptomatic phase = 2140 x .20 = 428; and 30 percent daily energy intake increase during the symptomatic phase = 2140 x .30 = 642. tABle 1. Estimated Changes in the Daily Energy Intakes o0 a 28-Year-Old, Moderately Active, HIV-Positive Woman and a Non-HIV-In0ected Woman, By Disease Stage and Li0ecycle 7 7. tabF? 1 a>apN?> @LIG #AntA 2004. tBCs Cs aH ?xaGpF? IHFS aH> NBIs? wCNB sSGpNIGaNC= CH@?=NCIH GaS Bav? a FIw?L a=NCvCNS F?v?F. nIH-CH@?=N?> IL sNaA? I@ NB? >Cs?as? r?=IGG?H>?> >aCFS ?H?LAS CHNak? @IL GI>?LaN?FS a=NCv?* a>OFN wIG?H (kcal) A>>CNCIHaF ?H?LAS >O? NI hiV** (kcal) A>>CNCIHaF >aCFS ?H?LAS L?qOCL?> bS pL?AHaH=S (kcal) tINaF (kcal) wCNB pL?AHaH=S A>>CNCIHaF >aCFS ?H?LAS L?qOCL?> bS Fa=NaNCIH (kcal) tINaF (kcal) wCNB Fa=NaNCIH nIH-CH@?=N?> 2140 4 + 285 2425 + 500 2640 hiV-pIsCNCv? AsSGpNIGaNC= 2140 + 214 + 285 2639 + 500 2854 hiV-pIsCNCv? eaLFS SSGpNIGaNC= 2140 + 428 + 285 2853 + 500 3068 hiV-pIsCNCv? SSGpNIGaNC= 2140 + 642 + 285 3067 + 500 3282 16 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | B.1 protein requirements : PLIN?CH L?qOCL?G?HNs >OLCHA pL?AHaH=S aL? NB? saG? @IL hiV-pIsCNCv? wIG?H as @IL HIH- n CH@?=N?> wIG?H. PL?AHaHN wIG?H L?qOCL? 1.1 A/kA p?L >aS as IppIs?> NI 0.8A/kA p?L >aS @IL HIH-pL?AHaHN wIG?H (#AntA 2004). micronutrient requirements : iron AH?GCa Cs =IGGIH aGIHA aFF pL?AHaHN wIG?H, aH> CLIH >? =C?H=S Cs I@N?H a =aOs?. AGIHA hiV-pIsCNCv? pL?AHaHN wIG?H, aH?GCa Cs GIL? p?LvasCv? aH> I@N?H GIL? s?v?L? NBaH CH HIH-hiV- CH@?=N?> wIG?H. S?v?L? aH?GCa CH=L?as?s NB? LCsk @IL pL?-N?LG >?FCv?LS, FIw bCLNB w?CABN CH@aHNs, aH> GaN?LHaF GILNaFCNS. iH hiV-pIsCNCv? wIG?H, aH?GCa Cs aH CH>?p?H>?HN pL?>C=NIL I@ GIL? LapC> hiV pLIAL?ssCIH aH> GILNaFCNS (Who 2004). tI a>>L?ss NB? pLIbF?G I@ CLIH >? =C?H=S aH?GCa, GIsN AIv?LHG?HNs Bav? a>IpN?> a pLINI=IF @IL CLIH aH> @IFC= a=C> sOppF?G?HNaNCIH @IL aFF pL?AHaHN wIG?H NBaN sBIOF> b? @IFFIw?>. Who =OLL?HNFS L?=IGG?H>s >aCFS CLIH aH> @IFC= a=C> sOppF?G?HNaNCIH (400OA @IFaN? aH> n 60 GA CLIH) @IL aN F?asN sCx GIHNBs I@ pL?AHaH=S NI pL?v?HN aH?GCa, aH> NwC=? >aCFS sOppF?- G?HNs CH IL>?L NI NL?aN s?v?L? aH?GCa (B?GIAFIbCH < 70 A/F ) (Who 2003a; Who 2004). tI CGpLIv? CLIH CHNak? aH> ?HBaH=? absILpNCIH, CH=L?as? @II>s LC=B CH bCI-avaCFabF? CLIH, n sO=B as G?aN, IL =IHsOGpNCIH I@ vCNaGCH c-LC=B @II>s NIA?NB?L wCNB HIH-G?aN sIOL=?s I@ CLIH. vitamin a PL?AHaHN wIG?H CH >?v?FIpCHA =IOHNLC?s I@N?H sO@@?L @LIG vCNaGCH A >? =C?H=S, wBC=B GaS H?AaNCv?FS a@@?=N NB? =IHN?HN I@ bL?asN GCFk aH>, CH NOLH, CH@aHN sNIL?s. iH GIsN =IOHNLC?s, AIv?LHG?HNs Bav? pLINI- =IFs @IL sOppF?G?HNCHA pIsNpaLNOG wIG?H aH> CH@aHNs. #IL hiV-pIsC- NCv? wIG?H, w?FF->?sCAH?> LaH>IGCz?> =IHNLIF NLCaFs Bav? sBIwH NBaN >aCFS as w?FF as sCHAF? BCAB->Is? vCNaGCH A sOppF?G?HNaNCIH >I?s HIN L?>O=? mtct aH> NBaN, CH sIG? sCNOaNCIHs, CN GaS CH=L?as? NB? LCsk I@ hiV NLaHsGCssCIH. tBOs, NB? >aCFS vCNaGCH A CHNak? >OLCHA pL?AHaH=S aH> Fa=NaNCIH sBIOF> HIN ?x=??> NB? rdA. eH=IOLaA? NB? =IHsOGpNCIH I@ vCNaGCH A-LC=B @II>s >OLCHA n pL?AHaH=S. iodine iI>CH? >? =C?H=S Bas b??H FCHk?> NI GCs=aLLCaA?, sNCFFbCLNBs, FIw?L iQ, aH> =L?NCHCsG CH CH@aHNs CH HIH-hiV-CH@?=N?> pIpOFaNCIHs. tI a>>L?ss NBCs, AIv?LHG?HNs Bav? pLINI=IFs IH NB? OHCv?LsaF =IHsOGpNCIH I@ CI>Cz?> saFN. PL?AHaHN wIG?H wCNB hiV, FCk? NB? A?H?LaF pIpOFaNCIH, sBIOF> b? ?H=IOLaA?> NI =IHsOG? n CI>CH?-@ILNC ?> saFN (#AntA 2004). i@ CI>Cz?> saFN Cs HIN avaCFabF?, pL?AHaHN wIG?H sBIOF> b? pLIvC>?> CI>Cz?> ICF sOppF?G?HNs. c S?u/i0s 3,v0 s3:B9 ?3,? s:m0 mi.r:- 9u?ri09? suppl0m09?s m,y pr0v09? ,/v0rs0 pr0g9,9.y :u?.:m0s& hIV i910.?0/ pr0g9,9? B:m09 0Cp0ri09.0 m:r0 1r0qu09? mi.r:9u?ri09? /0 .i09.i0s. d Participants 9 Statement, WHO Consultation on Nutrition and HIV/AIDS in A0rica, dOLbaH, SIONB A@LC=a, ApLCF 10-13, 2005. 17 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | B.2 other micronutrients eH=IOLaA? ?aNCHA a baFaH=?> aH> vaLC?> >C?N, CH=FO>CHA FI=aF @LOCNs aH> v?A?NabF?s, n aHCGaF pLI>O=Ns, sNapF?s, aH> @ILNC ?> @II>s wB?H?v?L avaCFabF?, @?asCbF?, aH> a@@IL>abF?. WB?H =IHsOGCHA aH a>?qOaN? >C?N Cs HIN pIssCbF? IL CH aL?as wB?L? GOFNCpF? GC=LIHONLC- n ?HN >? =C?H=C?s aL? =IGGIH, pLIvC>? a >aCFS sOppF?G?HN NI hiV-pIsCNCv? pL?AHaHN aH> Fa=NaNCHA wIG?H, as CN GaS CGpLIv? GaN?LHaF HONLCNCIHaF sNaNOs aH> bCLNB ION=IG?s (Who 2004). hiv - positive pregnant women with increased nutrient requirements : A>IF?s=?HNs, OH>?Lw?CABN wIG?H, wIG?H wCNB CHa>?qOaN? w?CABN AaCH >OLCHA pL?AHaH=S, aH> wIG?H p?L@ILGCHA pBSsC=aFFS >?GaH>CHA wILk aFF Bav? BCAB?L HONLC?HN aH> ?H?LAS L?qOCL?G?HNs NBaH INB?L wIG?H >OLCHA pL?AHaH=S, CH a>>CNCIH NI NB? CH=L?as?> ?H?LAS H??>s assI=CaN?> wCNB hiV. nONLCNCIH =IOHs?FCHA aH> sOppILN sBIOF> =IHsC>?L NB?s? a>>CNCIHaF HONLCNCIHaF L?qOCL?G?HNs. lactation energy , protein , and micronutrient requirements : 8 la=NaNCIH ?H?LAS aH> pLIN?CH L?qOCL?G?HNs @IL hiV-pIsCNCv? wIG?H aL? NB? saG? as @IL n B?aFNBS HIH-CH@?=N?> wIG?H. la=NaNCIH L?qOCL?s aH a>>CNCIHaF 500 =aFILC?s p?L >aS aH> 1.1 ALaGs I@ pLIN?CH p?L kA I@ GaN?LHaF w?CABN p?L >aS (as IppIs?> NI 0.8 A/kA @IL HIH-Fa=NaNCHA wIG?H). la=NaNCIH GC=LIHONLC?HN L?qOCL?G?HNs @IL hiV-pIsCNCv? wIG?H aL? NB? saG? as @IL B?aFNBS n HIH-CH@?=N?> wIG?H, wCNB Fa=NaNCIH GC=LIHONLC?HN L?qOCL?G?HNs CH=L?as?> >O? NI NB? NLaHs@?L NI bL?asN GCFk. nONLCNCIH =IOHs?FCHA sBIOF> pLIGIN? ?aNCHA a vaLC?NS I@ @LOCNs, v?A?NabF?s, aH> aHCGaF pLI>O=Ns, CH=FO>CHA >aCLS @II>s. WB?L? vCNaGCH A >? =C?H=S Cs ?H>?GC=, Who L?=IGG?H>s a sCHAF? BCAB >Is? I@ vCNaGCH n A (200,000 iu) @IL wIG?H as sIIH as pIssCbF? a@N?L >?FCv?LS aH> HIN FaN?L NBaH 6-8 w??ks a@N?L >?FCv?LS (Who 2003a). B.2. Nutritional Assessment 9 iH IL>?L NI AaNB?L CH@ILGaNCIH abION B?L =OLL?HN HONLCNCIHaF sNaNOs, >C?N, aH> ?aNCHA BabCNs, a bas?FCH? HONLCNCIHaF aH> >C?NaLS ass?ssG?HN sBIOF> b? =IH>O=N?> wB?H a wIGaH Cs LsN s??H >OLCHA pL?AHaH=S aH> >OLCHA pIsNpaLNOG @IFFIw-Op. tB? Ibj?=NCv? I@ NB?s? ass?ssG?HNs, CH a>- >CNCIH NI AaNB?LCHA CH@ILGaNCIH L?AaL>CHA B?L =OLL?HN HONLCNCIHaF sNaNOs aH> NL?H>s, Cs NI C>?HNC@S LCsk @a=NILs @IL >?v?FIpCHA @ONOL? HONLCNCIHaF =IGpFC=aNCIHs (s?? S?=NCIH ii. A.2 @IL CH@ILGaNCIH IH wBaN >aNa sBIOF> b? CH=FO>?> CH a HONLCNCIHaF ass?ssG?HN). WBaN @IFFIws aL? GI>C ?> IL a>>CNCIHaF L?=IGG?H>aNCIHs NBaN p?LNaCH NI pL?AHaHN aH> Fa=NaN- CHA hiV-pIsCNCv? wIG?H. #IL pL?-pL?AHaHN, pIsNpaLNOG, aH> Fa=NaNCHA wIG?H, G?asOL? B?CABN aH> w?CABN sI NBaN n BI>S mass iH>?x (Bmi) =aH b? =aF=OFaN?> aH> GaN?LHaF HONLCNCIHaF sNaNOs >?N?LGCH?>. hIw?v?L, @IL pL?AHaHN wIG?H, muAc s=L??HCHA Cs L?=IGG?H>?>. h?CABN G?asOL?G?HNs 8. tBCs s?=NCIH Cs bas?> IH #AntA 2004; Who 2004. 9. tBCs s?=NCIH Cs bas?> IH Who 2004. 18 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | B.3 =aH b? Os?> NI >?N?LGCH? sBILN sNaNOL? (<145 =G) as CN Cs a LCsk @a=NIL @IL IbsN?NLC= =IGpFC=aNCIHs (Who 1995). W?CAB pL?AHaHN wIG?H aN ?a=B aHN?HaNaF vCsCN aH> L?=IL> NB?CL w?CABN IH aH aHN?HaNaF n =aL>. tBCs CH@ILGaNCIH Cs Os?> NI >?N?LGCH? C@ NB? pL?AHaHN wIGaH Cs AaCHCHA sO@ =C?HN w?CABN. iHsO@ =C?HN w?CABN AaCH Cs assI=CaN?> wCNB FIw bCLNB w?CABN (lBW) aH> sGaFF-@IL- A?sNaNCIHaF-aA? CH@aHNs. #IL wIG?H wCNB HILGaF w?CABN pLCIL NI pL?AHaH=S, a w?CABN AaCH I@ 12.5 kA >OLCHA n pL?AHaH=S Cs L?=IGG?H>?>; BIw?v?L, @IL OH>?Lw?CABN pL?-pL?AHaHN wIG?H (Bmi < 19.8), a BCAB?L w?CABN AaCH Cs a>vCs?>. tB? L?=IGG?H>?> w??kFS w?CABN AaCH >OLCHA NB? s?=IH> aH> NBCL> NLCG?sN?Ls I@ pL?AHaH=S Cs 0.3 NI 0.5 kA (#AntA 2004). A w?CABN AaCH I@ 1 kA p?L GIHNB IL F?ss CH NB? FasN NwI NLCG?sN?Ls I@ pL?AHaH=S Cs =aOs? @IL s?LCIOs =IH=?LH aH> a=NCIH (s?? AHH?x Vi @IL a =BaLN NBaN CH=FO>?s NB? L?=IGG?H>?> NINaF aH> w??kFS w?CABN AaCH >OLCHA pL?AHaH=S bS pL?-pL?AHaH=S Bmi). i@ pIIL A?sNaNCIHaF w?CABN AaCH IL FIss I==OLs, NB? wIGaH sBIOF> b? s=L??H?> @IL OH>?LFS- n CHA >Cs?as?s. A >C?NaLS aH> HONLCNCIHaF ass?ssG?HN sBIOF> aFsI b? =aLLC?> ION NI C>?HNC@S INB?L pIssCbF? =aOs?s aH> >?v?FIp aH a=NCIH pFaH wCNB NB? wIGaH NI CGpLIv? B?L w?CABN AaCH. #aGCFS G?Gb?Ls IL a>>CNCIHaF IONsC>? assCsNaH=? (@II> sOppF?G?HNaNCIH, =IGGOHCNS IL BIOs?BIF> sOppILN) GaS H??> NI b? ?HFCsN?> NI ?HsOL? sO==?ss@OF NL?aNG?HN aH> @IFFIw- Op. A @IFFIw-Op s=B?>OF? sBIOF> b? ?sNabFCsB?> aH> L?sp?=N?> NI ?HsOL? NBaN NB? a=NCIH pFaH Cs @IFFIw?> aH> w?CABN AaCH Cs CGpLIv?>. nILGaFFS, wIG?H FIs? w?CABN pIsNpaLNOG. A Fa=NaNCHA wIGaH wCNB hiV sBIOF> Nak? sN?ps n NI GCHCGCz? pIsNpaLNOG w?CABN FIss. i@ sB? FIs?s NII GO=B w?CABN, =IOHs?FCHA NI pLIGIN? w?CABN GaCHN?HaH=?/AaCH sBIOF> b? pLIvC>?>, aFIHA wCNB G?>C=aF s=L??HCHA @IL >Cs?as?. AH a=NCIH pFaH, sCGCFaL NI NB? IH? >?s=LCb?> abIv?, sBIOF> b? >?v?FIp?>, GaCHNaCH?>, aH> GIHCNIL?> =aL?@OFFS. B.3. Dietary Recommendations and Care Practices 10 tB? >C?NaLS L?=IGG?H>aNCIHs @IL hiV-pIsCNCv? pL?AHaHN wIG?H sBIOF> b? bas?> IH NB? n CH@ILGaNCIH pLIvC>?> CH S?=NCIH ii. A.3 aH> AHH?x?s ii aH> iV. tI G??N NB? a>>CNCIHaF HONLCNCIHaF H??>s I@ pL?AHaH=S, aHCGaF sIOL=? @II>s, CH=FO>CHA n G?aN, sB, ?AAs aH> >aCLS pLI>O=Ns, FI=aF @II>s LC=B CH CLIH aH> =aF=COG, aH> @ILNC ?> @II>s, sBIOF> b? ?GpBasCz?>, wB?H?v?L @?asCbF? aH> =OFNOLaFFS appLIpLCaN?. A>apN aFF L?=IGG?H>aNCIHs NI =BaHACHA p?LsIHaF =CL=OGsNaH=?s as CH@ILGaNCIH Cs AaNB?L?> n >OLCHA NB? ass?ssG?HN aH> @IFFIw-Op vCsCNs. iH@ILGaNCIH IH GaHaACHA hiV- aH> AidS-L?FaN?> sSGpNIGs GaS b? paLNC=OFaLFS B?Fp@OF @IL hiV- pIsCNCv? pL?AHaHN wIG?H, as NBCs a>vC=? GaS b? H??>?> NI >?=L?as? NB? ?@@?=Ns I@ pL?AHaH=S sSGpNIGs, as w?FF as aHS L?FaN?> NI >Cs?as?s. 10. tBCs s?=NCIH Cs bas?> IH uAaH>a 2003; ZaGbCa 2004. 19 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | B.4, B.5, B.6, B.7 B.4. ART and Other Medications during Pregnancy and Lactation 11 hiV-pIsCNCv? pL?AHaHN wIG?H GaS Nak? ArV G?>C=aNCIHs NI pL?v?HN mtct (L?@?LL?> NI as ArV pLIpBSFaxCs) IL NI NL?aN NB?CL hiV >Cs?as?. Who AOC>?FCH?s IONFCH? wB?H NI CHCNCaN? ArV NL?aNG?HN, wCNB sp?=CaF =IHsC>?LaNCIH I@ pL?AHaHN aH> Fa=NaNCHA wIG?H. tB? F?HANB aH> NSp? I@ ArV L?ACG?Hs wCFF CHfO?H=? NB?CL CGpa=N IH @II> aH> >LOA CHN?La=NCIHs (s?? S?=NCIH ii. A.4). B.5. Management o1 Wasting or Severe Malnutrition Sp?=C = AOC>aH=? IH NB? GaHaA?G?HN I@ wasNCHA IL s?v?L? GaFHONLCNCIH >I?s HIN ?xCsN @IL hiV-pIsCNCv? pL?AHaHN IL Fa=NaNCHA wIG?H. S?=NCIH ii. A.5 IONFCH?s L?=IGG?H>aNCIHs @IL NB? GaHaA?G?HN I@ wasNCHA CH hiV-pIsCNCv? wIG?H. B.6. Provision o1 Food Supplements 1or HIV- Positive Pregnant and Lactating Women gCv?H NB? CH=L?as?s CH ?H?LAS aH> HONLC?HN L?qOCL?G?HNs I@ pL?A- HaH=S aFIHA wCNB NB? a>>CNCIHaF ?H?LAS L?qOCL?G?HNs assI=CaN?> wCNB hiV, pLIvC>CHA a @II> sOppF?G?HN NI wIG?H wBI aL? @II> CHs?=OL? =aH b? aH CGpILNaHN CHN?Lv?HNCIH @IL CGpLIvCHA GaN?LHaF HONLCNCIHaF sNaNOs aH> pL?AHaH=S w?CABN AaCHs, wBC=B CH NOLH, =aH F?ss?H >Cs?as? pLIAL?ssCIH, pL?v?HN hiV NLaHsGCssCIH aH> CGpLIv? bCLNB ION=IG?s. makCHA a @II> sOppF?G?HN avaCFabF? NI hiV-pIsCNCv? pL?AHaHN aH> Fa=NaNCHA wIG?H >?N?LGCH?> NI b? CH H??> GaS aFsI CH=L?as? s?LvC=? OpNak? aH> CGpLIv? aNN?H>aH=? CH Pmtct s?LvC=?s (W#P 2004). iN Cs paLNC=OFaLFS =LCNC=aF wB?H s?LvCHA hiV-pIsCNCv? pL?AHaHN wIG?H NBaN NB? @II>s pLIvC>?> a>>L?ss NB? HONLC?HN aH> ?H?LAS >? =CNs CH a =OFNOLaFFS appLIpLCaN? GaHH?L, aH> NBaN NB?S aL? =ILL?=NFS NaLA?N?> aH>, CH NOLH, =IHsOG?> bS NB? CHN?H>?> b?H? =CaLS. o@N?H sO=B pLIALaGs Gak? NB? GIsN s?Hs? CH s?NNCHAs wB?L? @II> Cs aFsI pLIvC>?> NBLIOAB mch, Anc, IL hiV/AidS =FCHC=aF =aL? aH> NL?aNG?HN =?HN?Ls, NB?L?bS GCHCGCzCHA NB? pIN?HNCaF @IL >Cs=LCGCHaNCIH IH NB? basCs I@ hiV sNaNOs. B.7. Counseling Issues during Pregnancy and Lactation 12 S?=NCIHs ii. A.7, ii. A.8, aH> AHH?x V L?vC?w CH@ILGaNCIH IH wBaN =IOHs?FCHA NIpC=s NI CH=FO>?. WBaN @IFFIws aL? GI>C =aNCIHs IL a>>CNCIHs NI L?=IGG?H>aNCIHs NBaN p?LNaCH NI pL?AHaHN aH> Fa=NaNCHA hiV-pIsCNCv? wIG?H. WB?H pLIvC>CHA HONLCNCIH =IOHs?FCHA, =IHsC>?L =OFNOLaF @II>s, NLa>CNCIHaF NB?LapC?s, @II> n NabIIs, aH> pLa=NC=?s NBaN aL? b?H? =CaF IL BaLG@OF >OLCHA pL?AHaH=S aH> Fa=NaNCIH. A>vCs? IH >C?NaLS GaHaA?G?HN I@ aH> appLIpLCaN? NL?aNG?HN @IL >CaLLB?a, HaOs?a, n vIGCNCHA, GaFabsILpNCIH, FIss I@ app?NCN?, aH> ILaF NBLOsB, as NB?s? =IH>CNCIHs GaS pL?v?HN w?CABN AaCH aH> H?AaNCv?FS CGpa=N HONLCNCIHaF sNaNOs. cnu?ri?i:9 ,/vi.0, .:u9s0li9g, .,r0, ,9/ supp:r? 1:r hIV-i910.?0/ B:m09 ,r0 0sp0.i,lly imp:r?,9? b0.,us0 :1 ?30 /u,l bur/09s :1 hIV ,9/ r0pr:/u.?i:9 (pr0g9,9.y ,9/ br0,s?100/i9g) :9 9u?ri?i:9,l vul90r,bili?y. d Nutrition Counseling, Care and Support 0or HIV- In0ected Women: Guidelines on HIV-related Care, Treatment and Support 0or HIV-In0ected Women and their Children in Resource-Constrained Settings, Who, 2004. 11. tBCs s?=NCIH Cs bas?> IH #AntA 2004; Who 2004. 12. tBCs s?=NCIH Cs bas?> IH uAaH>a 2003; ZaGbCa 2004. 20 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | B.8 PLIvC>? LIONCH? =IOHs?FCHA aH> sOppILN NI pL?AHaHN aH> pIsNpaLNOG wIG?H IH CH@aHN n @??>CHA (s?? S?=NCIH ii. c). PLIvC>? CH@ILGaNCIH IH @II> aH> waN?L sa@?NS aH> BSAC?H? NI B?Fp avIC> @II>-bILH? CFFH?ss?s. n dCs=Oss NB? ?@@?=N I@ BCAB pBSsC=aF a=NCvCNS wILkFIa>s. n B.8. Health Education and Treatment 1or HIV-Positive Pregnant and Lactating Women 13 iH a>>CNCIH NI HONLCNCIH aH> CH@aHN @??>CHA sOppILN, aHN?HaNaF =aL?, CH=FO>CHA B?aFNB ?>O=aNCIH, sBIOF> pLIvC>? CH@ILGaNCIH IH NB? @IFFIwCHA NIpC=s aH> I@@?L NB? NL?aNG?HNs sp?=C ?> (aFsI s?? S?=NCIHs ii. A.7 aH> ii. A.8): A>vCs? pL?AHaHN/Fa=NaNCHA wIG?H NI s??k CGG?>CaN? NL?aNG?HN @IL aFF CH@?=NCIHs, sO=B as n @?v?L aH> >CaLLB?a, IL aHS sOsp?=N?> FIss I@ w?CABN. r?@?L @IL ArV =aL? aH> NL?aNG?HN C@ =IH>CNCIHs CH>C=aN? NL?aNG?HN ?FCACbCFCNS. n eH=IOLaA? pLIGpN NL?aNG?HN @IL GaFaLCa aH> NOb?L=OFIsCs, CH=FO>CHA pL?sOGpNCv? NL?aNG?HN n aH> pL?v?HNCIH NBLIOAB NB? Os? I@ CHs?=NC=C>?-NL?aN?> GIsqOCNI H?Ns, aH> tB pL?v?HNCIH aH> dCL?=NFS-obs?Lv?> tL?aNG?HN, SBILN-cIOLs? (dotS). PLIvC>? a>vC=? IH BIIkwILG CH@?sNaNCIHs aH> >?-wILGCHA. n eH=IOLaA? hiV-pIsCNCv? pL?AHaHN wIG?H NI L?AOFaLFS a==?ss aHN?HaNaF =aL? sI NBaN NB?S n =aH GaCHNaCH NB?CL B?aFNB aH> HONLCNCIHaF sNaNOs >OLCHA pL?AHaH=S aH> sI NBaN =IGpFC=a- NCIHs =aH b? GaHaA?>, sBIOF> NB?S aLCs?. eH=IOLaA? hiV-pIsCNCv? pL?AHaHN wIG?H NI >?FCv?L wCNB a skCFF?> bCLNB aNN?H>aHN aN a n B?aFNB @a=CFCNS NI B?Fp ?HsOL? sa@? bCLNBCHA pLa=NC=?s aH> pLIp?L GaHaA?G?HN I@ bFII> aH> INB?L pLI>O=Ns. PLIGIN? pIsNpaLNOG @aGCFS pFaHHCHA aH> >OaF pLIN?=NCIH (Os? I@ =IH>IGs) NI ?HsOL? n B?aFNBS CH@aHNs aH> =BCF>L?H aH> pL?v?HN CH@?=NCIH IL L?CH@?=NCIH. 13. tBCs s?=NCIH Cs bas?> IH uAaH>a 2003; ZaGbCa 2004. 21 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | c, c.1 C. NUTRITION SUPPORT FOR INFANTS AND YOUNG CHILDREN (0 TO 24 MONTHS) BORN TO HIV-POSITIVE WOMEN goal : tI pL?v?HN GaFHONLCNCIH, CGpLIv? NB? HONLCNCIHaF sNaNOs I@ CH@aHNs aH> SIOHA =BCF>L?H, NI L?>O=? NB? NLaHsGCssCIH I@ hiV CH@?=NCIH @LIG NB? GINB?L NI =BCF> a@N?L >?FCv?LS, aH> NI CH=L?as? hiV-@L?? sOLvCvaF I@ CH@aHNs. WIG?H GOsN kHIw NB?CL hiV sNaNOs NI L?=?Cv? appLIpLCaN? =IOHs?FCHA NI B?Fp NB?G Gak? aH> =aLLS ION CH@ILG?> CH@aHN @??>CHA >?=CsCIHs. cIOHs?FCHA aH> N?sNCHA I@ =IOpF?s sBIOF> b? ?H=IOLaA?> NBLIOAB CH=L?as?> a==?ss NI Vct s?LvC=?s aGIHA NB? A?H?LaF pIpOFaNCIH aH> sp?=C =aFFS aGIHA pL?AHaHN aH> Fa=NaNCHA wIG?H. C.1. In1ant Feeding Recommendations iH A?H?LaF, wB?H hiV Cs HIN a =IHsC>?LaNCIH, Who L?=IGG?H>s NB? @IFFIwCHA L?AaL>CHA CH@aHN @??>CHA (Who ?N aF. 2003b): iH@aHNs sBIOF> b? ?x=FOsCv?FS bL?asN@?> @IL NB? LsN 6 GIHNBs I@ FC@? NI a=BC?v? IpNCGaF n ALIwNB, >?v?FIpG?HN, aH> B?aFNB. tB?L?a@N?L, CH@aHNs sBIOF> L?=?Cv? HONLCNCIHaFFS a>?qOaN? aH> sa@? =IGpF?G?HNaLS n @II>s wBCF? bL?asN@??>CHA =IHNCHO?s Op NI 24 GIHNBs IL b?SIH>. tBCs CH=FO>?s BOGaH bL?asN IL INB?L aHCGaF GCFk, wCNB a>?qOaN? s?LvCHAs I@ ?H?LAS aH> GC=LIHONLC?HN->?Hs? =IGpF?G?HNaLS @II>s. infant feeding and hiv : iH aL?as wB?L? hiV Cs a pObFC= B?aFNB pLIbF?G, aFF wIG?H aH> NB?CL paLNH?Ls sBIOF> b? ?H=IOLaA?> NI F?aLH NB?CL hiV sNaNOs. Who L?=IGG?H>s NB? @IFFIwCHA @IL CH@aHN @??>CHA @IL hiV-pIsCNCv? wIG?H (Who 2006=): 14 tB? GIsN appLIpLCaN? CH@aHN @??>CHA IpNCIH @IL aH hiV-pIsCNCv? GINB?L >?p?H>s IH B?L CH- n >CvC>OaF =CL=OGsNaH=?s, CH=FO>CHA B?L B?aFNB sNaNOs, NB? FI=aF sCNOaNCIH, B?aFNB s?LvC=?s, aH> avaCFabCFCNS I@ =IOHs?FCHA aH> sOppILN. ex=FOsCv? bL?asN@??>CHA Cs L?=IGG?H>?> @IL hiV-pIsCNCv? wIG?H @IL NB? LsN 6 GIHNBs I@ n FC@? OHF?ss L?pFa=?G?HN @??>CHA Cs a==?pNabF?, @?asCbF?, a@@IL>abF?, sOsNaCHabF?, aH> sa@? (A#ASS) @IL NB?G aH> NB?CL CH@aHNs b?@IL? NBaN NCG? (s?? BIx 1 @IL a bLC?@ >? HCNCIH I@ A#ASS; s?? AHH?x Vii @IL GIL? >?NaCF). WB?H L?pFa=?G?HN @??>CHA Cs A#ASS, avIC>aH=? I@ aFF bL?asN@??>CHA bS hiV-pIsCNCv? n wIG?H Cs L?=IGG?H>?>. iN Cs paLNC=OFaLFS CGpILNaHN NI ?GpBasCz? NB? >aHA?Ls I@ GCx?> @??>CHA (C.?., bL?asN@??>CHA aH> @ILGOFa) NI hiV-pIsCNCv? GINB?Ls wBI =BIIs? L?pFa=?G?HN @??>CHA. tBCs Cs b?=aOs? NIk?H IL paLNCaF bL?asN@??>CHA (C.?., a sGaFF aGIOHN I@ bL?asN@??>CHA CH pL?>IGCHaHNFS @ILGOFa-@?> 14. #OLNB?L Who/unice# L?=IGG?H>aNCIHs IH hiV aH> CH@aHN @??>CHA =aH b? IbNaCH?> @LIG GaN?LCaFs I@ NB? BabS-#LC?H>FS hIspCNaF iHCNCaNCv? (B#hi). tB? 2006 L?vCsCIH I@ B#hi GaN?LCaFs CH=FO>?s GI>OF?s IH hiV aH> CH@aHN @??>CHA aH> GINB?L-@LC?H>FS =aL?. B#hi L?pL?s?HNs a AFIbaF ?@@ILN NI CGpF?G?HN pLa=NC=?s NBaN pLIN?=N, pLIGIN?, aH> sOppILN bL?asN@??>CHA. S?? BNNp://www. wBI.CHN/HONLCNCIH/NIpC=s/b@BC/?H/CH>?x.BNGF. 22 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | c.1 CH@aHNs) =aLLC?s a paLNC=OFaLFS BCAB LCsk I@ hiV NLaHsGCssCIH =IGpaL?> NI pL?>IGCHaHNFS IL H?aLFS ?x=FOsCv?FS bL?asN@?> CH@aHNs (#AntA 2004). 15 AN 6 GIHNBs, C@ L?pFa=?G?HN @??>CHA Cs sNCFF HIN A#ASS, =IHNCHOaNCIH I@ bL?asN@??>CHA wCNB n a>>CNCIHaF =IGpF?G?HNaLS @II>s Cs L?=IGG?H>?>, wBCF? NB? GINB?L aH> babS =IHNCHO? NI b? L?AOFaLFS ass?ss?>. AFF bL?asN@??>CHA sBIOF> sNIp IH=? a HONLCNCIHaFFS a>?qOaN? aH> sa@? >C?N wCNBION bL?asN GCFk =aH b? pLIvC>?>. WBaN?v?L NB? @??>CHA >?=CsCIH, B?aFNB s?LvC=?s sBIOF> @IFFIw n Op aFF hiV-?xpIs?> CH@aHNs, aH> =IHNCHO? NI I@@?L CH@aHN @??>CHA =IOHs?FCHA aH> sOppILN, paLNC=OFaLFS aN k?S pICHNs wB?H @??>CHA >?=CsCIHs GaS b? L?=IHsC>?L?>, sO=B as NB? NCG? I@ ?aLFS CH@aHN >CaAHIsCs aH> aN 6 GIHNBs I@ aA?. gIv?LHG?HNs aH> INB?L sNak?BIF>?Ls sBIOF> L?vCNaFCz? bL?asN- n @??>CHA pLIN?=NCIH, pLIGINCIH, aH> sOppILN CH NB? A?H?LaF pIpOFaNCIH. tB?S sBIOF> aFsI a=NCv?FS sOppILN hiV-pIsCNCv? GINB- ?Ls wBI =BIIs? NI ?x=FOsCv?FS bL?asN@??>, aH> Nak? G?asOL?s NI Gak? L?pFa=?G?HN @??>CHA sa@?L @IL hiV-pIsCNCv? wIG?H wBI =BIIs? NBaN IpNCIH. naNCIHaF pLIALaGs sBIOF> pLIvC>? aFF hiV-?xpIs?> CH@aHNs aH> n NB?CL GINB?Ls wCNB a pa=kaA? I@ =BCF> sOLvCvaF aH> L?pLI>O=NCv? B?aFNB CHN?Lv?HNCIHs (Who 2005b aH> Who 2006b) wCNB ?@@?=NCv? FCHkaA?s NI hiV pL?v?HNCIH, NL?aNG?HN, aH> =aL? s?LvC=?s. iH a>>CNCIH, B?aFNB s?LvC=?s sBIOF> Gak? sp?=CaF ?@@ILNs NI sOppILN pLCGaLS pL?v?HNCIH @IL wIG?H wBI N?sN H?AaNCv? CH aHN?HaNaF aH> >?FCv?LS s?NNCHAs. gIv?LHG?HNs aH> GaH>aN?> un aA?H=C?s sBIOF> ?HsOL? NBaN NB? pa=kaA? I@ CHN?Lv?HNCIHs n L?@?L?H=?> abIv?, as w?FF as NB? =IH>CNCIHs >?s=LCb?> CH =OLL?HN AOC>aH=?, Cs avaCFabF? b?@IL? aHS >CsNLCbONCIH I@ @L?? =IGG?L=CaF CH@aHN @ILGOFa Cs =IHsC>?L?>. 16 gIv?LHG?HNs aH> >IHILs sBIOF> AL?aNFS CH=L?as? NB?CL =IGGCNG?HN NI aH> L?sIOL=?s @IL n CGpF?G?HNaNCIH I@ Who/unice# 9s Global Strategy 0or In0ant and Young Child Feeding (2003) aH> Who 9s HIV and In0ant Feeding Framework 0or Priority Action (2003b) CH IL>?L NI ?@@?=NCv?FS pL?v?HN pIsNHaNaF hiV CH@?=NCIHs, CGpLIv? hiV-@L?? sOLvCvaF, aH> a=BC?v? L?F?vaHN ungASS AIaFs. Who ?N aF. (2003a) pLIvC>? =LCN?LCa @IL >?N?LGCHCHA wB?NB?L ?x=FOsCv? L?pFa=?G?HN @??>CHA Cs A#ASS. tB?s? =LCN?LCa OsOaFFS H??> L? HCHA aN =IOHNLS F?v?F. AHH?x Vii ACv?s GIL? >?NaCF. c eC.lusiv0 br0,s?100/i9g is r0.:mm09/0/ 1:r hIV-i910.?0/ B:m09 1:r ?30 rs? 6 m:9?3s :1 li10 u9l0ss r0pl,.0m09? 100/i9g is ,..0p?,bl0, 10,sibl0, ,11:r/,bl0, sus?,i9,bl0 ,9/ s,10 [aFaSS] 1:r ?30m ,9/ ?30ir i91,9?s b01:r0 ?3,? ?im0 d. Consensus Statement. WHO HIV and In0ant 0eeding Technical Consultation held on behal0 o0 the Inter- agency Task Team (IATT) on Prevention o0 HIV In0ections in Pregnant Women, Mothers and their In0ants. g?H?va, o=NIb?L 25-27, 2006. 15. nIN? NBaN bL?asN@??>CHA aH> ACvCHA s?GC-sIFC> aH>/IL sIFC> @II>s aFsI =aLLC?s BCAB LCsk I@ hiV NLaHsGCssCIH =IGpaL?> NI pL?>IGCHaHNFS IL H?aLFS ?x=FOsCv?FS bL?asN@??>CHA. 16. S?? BNNp://www.wBI.CHN/=BCF>-a>IF?s=?HN-B?aFNB/ nutrition/hiV_CH@aHN.BNG. 23 hiV/AidS, nutrition, And #ood Security: WhAt We cAn do S?=NCIH ii. | c.2 BoX 1. Brie0 Defnition o0 AFASS: Acceptable, Feasible, A00ordable, Sustainable, and Sa0e C.2. Counseling HIV-Positive Women to Make and Carry Out In1ant Fe

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