HIV, Livelihoods, Nutrition & Health Research

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

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

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

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

7. 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 • Vulnerabilityto 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 • 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: • Food assistance had a positive impact on weight gain • Food assistance helped slow transitions in WHO Stage • 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..) • 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