Saturday

ARVs overshadowing alternatives in HIV/AIDS management

By Henry Neondo

As the global drive to provide anti-AIDS drugs to Africa's HIV-positive citizens gains momentum, antiretrovirals (ARVs) are now taking centre stage, overshadowing all other treatment efforts.

It has long been recognised that good nutrition is essential for strengthening the immune systems of people living with HIV/AIDS, but nutrition remains a source of confusion and controversy on the continent.

People living with HIV/AIDS have been swamped by a flood of nutritional supplements, immune boosters and herbal remedies - some even claiming to cure the disease.

With little guidance on the impact of multivitamins and supplements on the virus, and limited scientific research into traditional and herbal medicines, the confusion has grown deeper.

In South Africa and parts of Eastern Africa, in particular, the issue of nutrition has been marginalised by political debates that tend to frame it as an alternative to ARV drugs.

A high-profile media campaign by the US-based Rath Foundation, claiming that vitamins and nutrition therapy alone could prevent AIDS deaths, and that ARVs were toxic, has fallen on fertile ground.

The World Health Organisation (WHO) held a four-day consultation with health experts in South Africa's port city of Durban this week to look at the issues around nutrition and HIV/AIDS.

At the end of the meeting, a consensus statement and recommendations for immediate action to improve the nutrition and health of HIV-infected people in southern and east Africa will be used to inform WHO's global strategy.

Over the past few days, however, it has become clear that many countries still have a long way to go towards integrating nutrition into their HIV/AIDS programmes.

According to Dr Robert Mwadime, regional HIV/AIDS specialist for the Food and Nutrition Technical Assistance Project (FANTA), most countries were in the process of reviewing and developing policies on nutrition, but this was still being done haphazardly.

"There are still very few plans and strategies on implementing these policies, and not enough long-term commitment in terms of funds and technical assistance," he noted.

Dan Raiten, a researcher with the National Institute of Child Health at the US Department of Health and Human Services, said a close relationship existed between food and ARVs. "ARVs are essential to save lives and halt the spread of the epidemic, while food is essential to all life."

The challenge, he said, was to ensure that both components were integrated into programmes providing long-term clinical care for people living with the virus, including pregnant HIV-positive women, and children living with, and orphaned by, HIV/AIDS.

The participants' statement at the end of the WHO meeting acknowledged that "there is a need for national governments to have a very strong political commitment on the positioning of nutrition, HIV and AIDS at the national level".

However, translating the scientific evidence and policies into practical action remains difficult.

"There's been a lot of focus on policies, but nothing on what's happening at the clinic level and the lessons learned there," Dr Mickey Chopra from South Africa's Medical Research Council says.

During the meeting, Zambia's recently completed nutrition guidelines were presented as a best practice example of a successful plan of work for nutrition and HIV/AIDS.

But it was still unclear as to how this new policy would impact on the influx of dodgy food products and nutrition supplements for HIV-positive Zambians, Beatrice Kawana, a nutrition and AIDS focal person at Zambia's Food and Nutrition Commission, said.

FANTA's Mwadime said not much would be achieved without adequately trained staff. "We need to be hiring more nutritionists and dieticians for our national AIDS programmes, and creating model sites to show us how it's done," he pointed out.

With Africa in the treatment era, all the participants agreed that integrating nutrition into HIV/AIDS programmes, particularly treatment guidelines, was crucial.

Nigel Rollins, chair of the WHO technical advisory group on nutrition and AIDS, called for the participants to "recover the lost time and implement what we already know works".

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