HIV-related Stigma Research With Nursing Students

HIV Related Stigma Survey Among Nursing Students In Cameroon Takes Off
James Achanyi-Fontem,
Cameroon Link
Dr. Neal Rosenburg of Goldfarb School of Nursing, Barnes Jewish College and Pr. Donna Taliaferro of the Washington University at St. Louis, USA started working in Douala, Cameroon on March 1, 2009 on a planned HIV-related stigma survey among nursing students in Cameroon.
During the academic working visit, Dr. Neal Rosenburg and Pr. Donna Taliaferro are visiting nursing colleges in Douala, Nkongsamba, Buea and Limbe to collect data on stigma among nursing students. The data will be analyzed and compared with a similar operation at the Washington University at St. Louis. An investigation on how to ameliorate on the care for HIV orphans will be conducted with the objective of encouraging nursing students in the USA to work out strategies for supporting orphans in Cameroon.
The visiting medical professionals gave a conference at the Complexe Universitaire EFPSA, INSAM, ISSAS at Ndokoti, Douala on Friday, March 6, 2009 and audiences were accorded leaders of associations in Cameroon working for the improvement of the well being of HIV orphans the audiences aim at the exchange of experiences for research of areas of capacity building care delivery and support tothe vulnerable childred of Cameroon. The activities were conducted with the technical support of the University of Buea and Cameroon Link Human Assistance Programme in Douala.
Objectives:
1. Identify different aspects of experiences among culturally diverse populations of HIV positive individuals.
2. Understand circumstances affecting culturally appropriate care for HIV positive clients.
3. Analyze the impact of perceptions among nursing students on global healthcare issues surrounding HIV nursing.
4. Describe the impact of associated stigma relating to nurses caring for HIV positive populations.
5. Explain the intention to deliver quality patient care to HIV positive clients.
Stigma as a concept is associated with various societal and personal attributes and attitudes. The deficit of a clearly accepted definition contributes to the prblematic nature of measuring the impact and outcomes of stigma in the research setting. A repetitive element in the definition of stigma is that of a mark, or a well defined stain on or associated with an individual. This proposes a stain on the individual’s character which may transcend to the interpersonal and societal levels. However, the common usages of the definition exclude a redundant usage of the term in the context of behavior, culture, and physical attributes that are also associated with stigma.
Historically, the Greeks utilized the term stigma in the context of a physical blemish designated to identify something morally curious about a member of society. In the Greek culture, the identifiable mark was cut or burned into the physical body. This form of representation clearly identified a marked individual within a particular societal text (Goffman, 1963). The dominant or unmarked members of society could easily differentiate themselves by being free from the mark or stain which suggested a violation of a code or a representation of societal status such as a slave or a criminal. Goffman (1963) has explained stigma in terms of a tainted or discounted individual. The negative connotations of these attributes equate to the differences between what society presumes in terms of common or acceptable characteristics of a person. The problematic nature of this definition arises as the attribute itself is not discrediting, rather it is the variance between the individual and the societal influence.
The contemporary usage of this concept relies heavily on the original meaning; however, today the individual’s stigmatizing identifier may indeed be invisible to the rest of society, such as with the case of the human immunodeficiency virus (HIV). According Goffman (1963), three abundantly different types of stigma exist. The first, he referred as abominations of the body that account for physical defects identified to an individual.
Next, Dr. Neal Rosenburg described the blemishes of individual character. These traits are possessed by weak individuals as well as individuals with unnatural desires. Lastly, he proposed tribal stigma. This category of individuals share unique characteristics acquired via lineage such as race, ethnicity, and religion. Stigma is present throughout all societies. The nature and harm of stigma are uniform; however, the degree and circumstances of stigma vary among societies and cultural groups. Regardless of the context, the concept of stigma produces destructive effects. Blame, shame, fear, personal injury, violence, and death account for potential effects of stigma. The potential for both physical and emotional damage to the individual underscores the importance of this concept. In addition, the efforts of changing the defining attitudes of stigma pose unique challenges. Many attitudes attached to contemporary stigma are deeply engrained in the societal norms, the familial values, and the cultural mores of an individual. The changing tapestry of the American society requires a shift in attention to that of multiculturism. Regarding multi-cultural groups, HIV, and stigma, Burrage & Rocchiociolli (2003) reported that the understanding of multiculturism and stigma within the context of interventions accessible to the various groups of people infected with HIV is paramount.
The act of discrimination against an individual or group discerned to be deviant, unacceptable, or inferior is enacted stigma (Scambler & Hopkins, 1986). The critical attribute of enacted stigma is prejudice. Prejudice is defined as “preconceived opinion that is not based on reason or actual experience” (Concise Oxford Dictionary, 2006, p. 697). An essential aspect of the phenomenon of prejudice includes a social orientation towards whole groups of people and/or towards individuals because of their association is a member of a particular group (Brown, 1995).
Methods for measuring this concept are available but restrictive. The outcomes of stigma are merely identified, questionnaires offer a rank-order aspect of the degree of certain pieces of stigma within select populations, and finally a limited number of studies have been published to determine other components or constructs involved with this complex concept. A workable instrument with proven reliability and validity would strengthen the studies on stigma as well as properly place this concept in the forefront of attention with an instrument that can be utilized across various populations and translated into many languages to gauge the scope and impact of stigma among nursing students.
Study Design
This cross sectional research design will be implemented among nursing students at the University of Douala, the University of Dschang in Cameroon, West Africa and Goldfarb School of Nursing at Barnes Jewish College in St. Louis, MO, USA. Nursing students enrolled in the eighth semester (last semester of nursing clinicals) will be sampled by convenience method. The nursing students will complete the HASI-NS (HIV/AIDS Stigma Instrument – Nursing Students). This researcher modified instrument is intended as a pilot implementation as it appears to be unused within the student nursing population. This instrument is a modified version on the HASI-N (HIV/AIDS Stigma Instrument – Nurse) developed Uys, Holzemer, Chirwa, Dlamini, Greeff, Kohi, et al. with supported funds from the NIH and the Fogarty International Center. This instrument utilizes 20 items concerning behaviors, communication, and perceptions addressed to
nursing students in the clinical setting. The data will be cleaned, coded and analyzed using SPSS v.16. The results of this study will acknowledge the perceptions of Cameroonian and American nursing students who provide patient care or will be faced with delivering patient care to the growing population of diverse HIV positive patients. The results of this study will be disseminated at national conferences as well as provide the framework for manuscript submission to peer-reviewed journals. Most notably, the data from this pilot study will begin the rigorous process of establishing reliability and validity within new instrument development with the intent to expand to larger studies gauging HIV related stigma among nursing students across both continents.
Nurses are an integral part of the global health care picture as we rapidly move into an era of multi-cultures, multi-languages, and multiple illnesses that reinforce the acts of stigma. Most notably, it is important to remember that nurses are not excluded from harboring and delivering the devastating acts of stigma. In increase in awareness and education will serve as the weapons of choice for nurses of the twenty-first century to combat the destructive forces of stigmatization. As nurse researchers, the nursing science will accelerate the process via methods devoted to exploring strategies at the intervention levels with an ultimate outcome of diminishing current levels of stigma while greatly ameliorating the quality of delivered nursing care when working with marginalized groups facing the many faces of stigma
Timeline
April – June, 2009: data management/analyze data in St. Louis, MO, USA.
June – August, 2009: dissemination of study findings.
References
Brown, R. (1995). Prejudice: Its social psychology. Oxford: Blackwell.
Burrage, J., & Rocchiociolli, J. (2003). HIV related stigma: Implications for multicultural nursing. Journal of Multicultural Nursing and Health, 9(1), 13-17.
Concise Oxford American dictionary, (2006). New York: Oxford Press.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.
Scambler, G., & Hopkins, A. (1986). Being epileptic: Coming to terms with stigma. Sociology of Health and Illness, 8, 26-43.

Breastfeeding Guidelines

Breastfeeding Guidelines Now Available on US Gov’t Website
By Karla Shepard Rubinger,
Executive Director, Academy of Breastfeeding Medicine,
Tel:(914) 740-2100, ext. 2153,
Email: abm@bfmed.org
The Academy of Breastfeeding Medicine’s (ABM) clinical protocols for the care of breastfeeding mothers and infants are now available for physicians, nurses, and other healthcare professionals on the US National Guideline Clearinghouse (NGC) website.
The US NGC, an initiative of the Agency for Healthcare Research and Quality, the federal agency responsible for improving the quality, safety, efficiency, and effectiveness of healthcare, offers providers a comprehensive database of clinical practice guidelines covering a wide range of diseases and conditions, from “animal diseases” to “viral diseases.” Essentially these guidelines serve as prescriptions to assist providers in the delivery of healthcare.
Now, with the twelve newly listed ABM protocols on the NGC website, providers have breastfeeding recommendations, strategies, and other information at their fingertips, contributing to appropriate and standardized postpartum care. It is well-documented that optimal breastfeeding practices are associated with health benefits for both infant and mother.
“ABM are excited to be involved and associated with NGC, and ABM looks forward to continuing to serve the community of healthcare professionals by providing tools to enable the best possible care of breastfeeding families,” says Kathie Marinelli, MD, FABM, Co-Chair of the ABM Protocol Committee.
According to Cynthia Howard, MD, MPH, FABM, Associate Professor of Pediatrics at the University of Rochester, and member of the ABM Executive Committee, “NGC acceptance is a mark of the high quality of ABM protocols.” In particular, ABM protocols are developed by multidisciplinary teams of physicians who have expertise in the field, and are based on a rigorous review of the medical literature.
The development, dissemination, and use of current clinical practice guidelines remains a priority for ABM. As the only international organization of physicians in this field, ABM also provides translations of many protocols into Spanish, Korean, Chinese, and German, as well as English.
The Academy of Breastfeeding Medicine (www.bfmed.org) is a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation through education, research, and advocacy. An independent, self-sustaining, international physician organization and the only organization of its kind, ABM’ s mission is to unite members of various medical specialties through physician education, expansion of knowledge in breastfeeding science and human lactation, facilitation of optimal breastfeeding practices, and encouragement of the exchange of information among organizations.
For more information on the National Guideline Clearinghouse, and for a complete list of the ABM Protocol Guideline Collection please visit www.guideline.gov.

ABM Holds Annual International Meeting in November 2009

14th Annual International Meeting of the
Academy of Breastfeeding Medicine planned for November 6-8, 2009
The 14th Annual International Meeting of the Academy of Breastfeeding Medicine (ABM) (www.bfmed.org) has been announced for Williamsburg, Virginia from November 6-8, 2009. The meeting hold under the theme “Breastfeeding: Lessons from History, Implications for Tomorrow.” World-class speakers will provide key research materials on current and critical issues in breastfeeding medicine. ABM speakers are among leaders of clinical medicine and research in the world of breastfeeding and human lactation. The meeting will focus on the most authoritative and up-to-date clinical information on breastfeeding, spanning both maternal and child health issues. A significant educational opportunity, the ABM Annual International Meeting is an ideal context for physicians, and other healthcare providers to continue their professional education in a highly respected stimulating environment, while earning continuing education credits. This year’s meeting will also include the updated one-day breastfeeding medicine course, “What Every Physician Needs To Know About Breastfeeding” on November 5, 2009.
“The Academy of Breastfeeding Medicine’s Annual International Meeting allows physicians from all over the world to network and hear the latest basic research, public health, and clinical information about breastfeeding and human lactation,” says Conference Chair, Michelle Brenner, MD. Visit the Academy’s website regularly for the most up-to-date information on the meeting ( www.bfmed.org).
The official journal of ABM, Breastfeeding Medicine (www.liebertpub.com/bfm ), now in its fourth year, will publish the selected Conference Abstracts. With growing demands for the best evidence-based research, this interdisciplinary journal provides the international medical and scientific community with the latest peer-reviewed reports of laboratory, field, and clinical investigations, with special emphasis on the risks of not breastfeeding. A free sample issue is available at www.liebertpub.com/bfm
The Academy of Breastfeeding Medicine (www.bfmed.org) is a worldwide organization of physicians dedicated to the promotion, protection, and support of breastfeeding and human lactation through education, research, and advocacy. An independent, self-sustaining, international physician organization and the only organization of its kind, ABM’ s mission is to unite members of various medical specialties through physician education, expansion of knowledge in breastfeeding science and human lactation, facilitation of optimal breastfeeding practices, and encouragement of the exchange of information among organizations.
Issued in New Rochelle, NY, January 26, 2009
The Academy of Breastfeeding Medicine,
140 Huguenot St., 3rd floor,
New Rochelle, NY 10801-521(800) 990.4ABM
Tel:(914) 740.2115 Fax: (914) 740.2101
Email: abm@bfmed.org Website:www.bfmed.org

Development and International Cooperation

Yvonne Bekeny Ends Development Cooperation Internship At Cameroon Link
By Alice Ndeloh
Cameroon Link
The second phase of development cooperation internship of Yvonne Bekeny was packed full of activities out of Cameroon Link office. Yvonne moved from the community into the school environment to collect data for her thesis. The capital city of Yaoundé was the venue to meet the youth target population for her study. It was a very challenging exercise because it was the first time she was collecting data for analysis later. It was less strenuous because securing research permit was not as difficult as her research assistant had anticipated. On the other hand the schools were so big, with large numbers on roll that distributing the questionnaires was a bit difficult and even more so because students could not work individually as she had expected given the large numbers on roll. Despite these hindrances, she was able to administer the number of questionnaires required for her study.
After working with students for on week she returned to the office in Douala to continue administrative work and reviewing some reports and also assembling material that was to be used at an up coming workshop organized by the Cameroon Ministry of Public health on infant and young child feeding counselling in Obala, 100 kms from Yaounde on the road to Bafoussam. The preparations led to Yvonne Bekeny attending the week-long workshop as representative if the Chief Executive Office of Cameroon Link. The workshop was attended by representatives of some fourteen Non-Governmental Organizations, Faith Based Organizations and Community Based Organizations involved in the promotion and protection of breastfeeding and infant and young feeding rights in Cameroon. It was facilitated by professional medical staff from the ministry of public health, social workers and nutrition counselling consultants.
It was during the interactive exchanges at the workshop that they were taught the advantages and the benefits of breastfeeding to the baby and the mother. The discussed the health benefits, the economic benefits to the entire family and the community. It was repeated echoed that if the mothers breastfed exclusively for six months, their babies’ health was guaranteed, therefore the family saved money that would otherwise have been used for artificial feeding. Breastfeeding has no cost and helped reduce spending and was seen as a poverty alleviation ingredient that also safe guarded the family income.
● Yvonne and her colleagues at the workshop were equipped with negotiation skills on how to approach women and convince them to practice exclusive breastfeeding for the first six months after birth and how they could also encourage women to begin introducing complimentary feeding from the age of six months while continuing breastfeeding up to 24 months.. They were informed that it was easy to meet women in their community groups, in the community health facilities and also in the district hospitals to address these issues. With the creation of WABA Men’s initiative, it was decided that the men or fathers and youths be involved in the breastfeeding campaign movement because the mothers would need their support if breastfeeding practices are to be successful.
The issue of breastfeeding in the context of HIV/AIDS was also discussed lengthily. The facilitators told the participants about the advantages and disadvantages of breastfeeding when a woman is HIV positive. Statistics were quite revealing and Yvonne was equipped with the facts about breastfeeding in the context of HIV/AIDS. Every woman who is HIV positive should know the facts, be well educated and be able to make an informed choice of feeding for her baby.
Considering the advantages of breastfeeding and the fact that only about 22.5% of mothers in Cameroon breastfeed exclusively during the first six months of birth, this among other strategies are implemented by the Cameroon Ministry of Public Health to improve on infant and young child feeding, so as to mitigate malnutrition and therefore reduce infant mortality. At the end of the workshop, Yvonne and her colleagues drew up a feasible project for a period of six months, and this was used to evaluate the participating organization’s level of understanding the subject. This was yet another opportunity for Yvonne to apply her knowledge of project planning and management. She was able to come up with a short doable project from January to August 2009. Within this project, the two persons who represented Cameroon Link could also train other members of staff attached to the six Women Gender and AIDS Councils (COGESID) mentioned in her first report. As at the moment of writing this report the newly trained infant and young child feeding counsellors had started social mobilisation and sensitization activities within the communities and on the media on the importance of breastfeeding.
Upon their return from the seminar they immediately got into activities and celebration marking the 20th edition of the World AIDS Day. Yvonne and others attended the ceremony launched by the Governor of the Littoral region of Cameroon and they were involved in the organization of educative talks in secondary schools. The activities were focused on the animation of college health clubs. Other Health NGOs and women’s groups were also involved in these activities. During this celebration, the regional coordinator of the National AIDS Control Committee presented the most recent statistics on the situation of HIV/AIDS in Cameroon.
Yvonne seized the opportunity to interview the coordinators of health clubs and students in the littoral region about the activities within their respective schools. This constituted vital information for her thesis since she was researching on HIV/AIDS prevention and education in secondary schools. It was observed that all secondary schools are involved in AIDS Communication. AIDS communication embodies advocacy, behaviour change, social mobilization and social change. This strategy addresses issues that immediately impact on HIV and AIDS, the lack of knowledge on the practice of safer sex, and the driving causes of the epidemic, such as gender relations hindering safer sex practice.
A key factor in effective AIDS communication is the understanding of audiences’ needs and circumstances. It is even made easier by the training of peer educators with whom the youths and other sub populations can identify. It was very amazing that most schools pay attention to the importance of the social context of communication, including religious, economic and cultural factors. These factors determine the nature of AIDS communication in and out of schools and within communities. Consequently, practitioners are increasingly focusing on the creation of enabling AIDS communication environments through work with institutions such as the media and civil society organizations. Cameroon link was an ordinary participant during the event because Yvonne and others had just returned from a training workshop in the Capital City of Yaoundé ahead of World AIDS Day and the memory was still very fresh on Mother to Child HIV Prevention. They did not participate in demonstrations but planned some counselling and educative campaigns with women groups during the week that preceded the World AIDS Day as part of the National AIDS Week declared by the Minister of Public Health. She also conducted interviews with the Littoral Regional Coordinator for AIDS Control Committee. The World AIDS Day activities were very significant to her because she was able to get recent statistics on the situation in Cameroon and other issues concerning prevention, care and support for people living with HIV/AIDS (PLWHA) and the rehabilitation of HIV orphans.. This would have been a bit difficult during ordinary times because getting information in Cameroon is quite complex. Officials are usually very reluctant to give statistics and other vital information on their work.
LOCATION OF RESEARCH SITES
The first phase of the research study was carried out in Douala in the Littoral region, while the second phase in November 2008 was in Yaoundé, the capital city of Cameroon situated in the centre region. The choice was based on the resources available to Yvonne Bekeny. This means that the choice of research site was based strictly for convenience reasons, especially as other schools running the new HIV education programme are situated in the far south and distant northern regions. Yaoundé’s location makes access a lot easier as it is situated at the centre of Cameroon and it is the administrative capital of the nation. Considering the bilingual nature of Cameroon, Yaoundé has many public and private bilingual secondary schools. The choice of Government Bilingual High School Yaoundé and Government Bilingual Practicing High School Yaoundé was based on the similarities in characteristics of both schools. Similarities in terms of enrolled students. These are very thickly populated government education institution. Most of the students attending these colleges live in the out skirts of Yaounde City. Since one of the secondary schools undertook the new HIV/AIDS education programme and the other did not, this formed the basis of Yvonne Bekeny’s comparison.
RESEARCH APPROACH
To achieve the objectives of the study, a quantitative research approach was employed. This was important because it provided statistical data on the actual number of students involved in the research survey, their basic characteristics, level of education, gender differentiation, and religious inclinations among other variables. Secondary data from the National AIDS Control Committee was also consulted, to know the actual national statistics and to find answers to some of the research questions.
COLLEGE SELECTION
The choice of the colleges for the research survey was based on the following criteria:
1. Geographical location of colleges putting into consideration proximity and access to all.
2. Similarity in characteristics of both collegs. Both are bilingual educational institutions with English and French speaking students undertaking English and French systems of education respectively. They are similar also in terms of enrolment of large number of students each year.
3. Most of the students live at the heart of the city, while a few live in the out-skirts and neighbourhoods of Yaoundé..
4. One school does the new HIV/AIDS education programme and the other does not. This constituted the basis for a comparative analysis.
Due to the researcher’s English speaking background, only the English speaking students in each school where involved for the survey and research study.
SURVEY SAMPLING
The study utilized a random sampling frame. The two schools formed appropriate basis for comparison as the age group required for the study where easily identified. The main guiding criteria for choice were:
1. The age of the students. The age was considered as a major criterion for sampling and this lead to the next level of sampling.
2. The class of the students strictly followed the age. It was realized that the classes had different age ranges. But then, each level for example like form 3 classes had the same age range between 14-16 years. It is for this reason that random sampling of classes was done for each level. This gave the students equal chances to be drawn from the population.
The two colleges have different populations. GBHS Yaoundé has a total population of 6000 with 3000 English speaking students and 3000 French speaking students. The sample size for this school was 320 (10.6 percent) and it consisted of students with ages between 12-21 years. While GBPHS Yaoundé had a total population of 4800 students with 2300 English speaking students and 2500 French speaking students. The sample size in this school was 322 (12.8 percent). The sample also consisted of students with ages between 12 -21 years. The research expected to have a larger sample, but due to resource constraints on the part of the researcher, only the above sample could be considered. The sample strictly took into account the age, sex and gender of the respondents.
DATA COLLECTION METHODOLOGY
The research used two methods to collect the relevant data to measure the students’ knowledge, attitudes and reported behaviour on HIV/AIDS and to see the impact of the new HIV/AIDS education programme on the students. Secondary data was used to review the relevant literature on HIV/AIDS related issues within schools in Cameroon and within the youth population in general. Primary data was used for the most part and the instrument used was a questionnaire.
Some 642 questionnaires were administered to students in English. The questionnaire took into account the target age group for the study. From the college environment, Yvonne Bekeny returned to Cameroon, where she was initiated on information, education and communication strategies, networking and report writing.
Information, Education and Communication
A press conference was organized at the headquarters of Cameroon Link in the third week of December 2008 to highlight advocacy strategies by NGOs using the Sickle Cell Society UK approach. The conference speaker was the Director of Sickle Cell Society UK, Dr. Asaah Nkohkwo, who paired the relationship of sickle cell disorder and other diseases and how they affect African and Asian communities most.
Yvonne Bekeny was involved in the organisation of the conference logistics and report writing. The use of media for advocacy was also an aspect valorised by her participation in a live programme presentation at the Catholic Community Radio Station « Radio Véritas ». The live show was on highlights of the 5th Anniversary celebrations of the radio station. Yvonne and James were invited as guests speakers to the programme audience on what they considered to be the truth and how it is employed within the Cameroon communities and elsewhere. The live show was recorded and rebroadcast twice on the same channel at different peak listening hours.
Networking Linkages
Yvonne Bekeny had the opportunity to learn from Cameroon Link the importance of networking at national and international levels. Cameroon Link leads the Federation of Cameroon Breastfeeding Promotion Associations, FECABPA, and is also affiliated to two international health networks, while acting as focal point for the networks in Cameroon.
Cameroon Link is affiliated to the International Baby Food Action Network, (IBFAN) Africa, and the World Alliance for Breastfeeding Action, (WABA). In the latest development, the Executive Director of Cameroon Link was appointed to the position of International Coordinator of WABA’s Men Initiative, which calls for the mainstreaming of gender promotion within infant and young child feeding promotion and the encouragemen of youths to get involved in health development issues.
Yvonne Bekeny ended her field research studies at Cameroon Link with designing of a project for the initiation of fundraising in Finland to support the execution of humanitarian activities planned within the next four years. This aspect is found to be vital for the survival of any organisation, especially as all projects aim at durability of impact social change and behaviour change communication, BCC. This is how Yvonne Bekeny was given the opportunity to test all her skills. A project for Sickle Cell Awareness in Cameroon was designed as a team for fundraising lobby by her in Finland.
The strategies of Cameroon Link transferred to Yvonne will serve her at any time when she would have completed her studies in development and international cooperation..
Conclusion
Cameroon Link was very appreciative of the devotion, interest and willingness to cooperate with all staff of the organisation and to serve as a volunteer. There is no doubt that the internship of Yvonne Bekeny at Cameroon Link valorizes her as an excellent international development and cooperation agent in the making, considering the high level skills she achieved before returning to Finland..

Reproductive Health, Mother & Child Care

Reproductive Health,Mother & Child Care
OPERATIONAL RESEARCH AND HIV/AIDS
By James Achanyi-Fontem
Cameroon Link
Nearly four decades after the emergence of the HIV/AIDS pandemic, biomedical, and epidemiological research has identified and described in great detail the nature of HIV infection and its modes of transmission.
These findings have been used by scientific experts to develop effective drug treatments, targeted behaviour change strategies, and sensitive surveillance and modelling tools.
Yet far less research has been devoted to basic operational issues that affect the delivery of services in prevention, care, and support.
We have learned much about which behaviours place persons at risk and have some sense of what types of interventions work to prevent HIV transmission, but we know far less about why and how these interventions work, what they cost, and where and when they can be successfully replicated on a large scale.
These questions are especially important in Cameroon in general and the Littoral or the south west provinces in particular, which are our main target populations, where more than 90 percent of HIV infected people live, because prevention, care, and support interventions remain the primary tools for dealing with the pandemic.
To successfully design and implement effective HIV/AIDS prevention and mitigation activities, we suggest that the program managers and policy makers urgently need accurate and timely information on the operational mechanisms that make these programs work in an era of scarce resources.
It is also critically important that decision makers be guided by the best and most current research evidence to determine which elements of policy and service programs are the most cost-effective in reducing new HIV infections and mitigating the effects of AIDS.
BREAKING NEW GROUND
As we apply for the frame work agreement for collaboration with the ministry of public health and international institutions in Cameroon, we would be reinforcing our strategies in the next five years (2009/2014) with focus on operational mechanisms of implementing policies and programs.
In addition to previous objectives, the focus will include:
- Identifying cutting-edge issues affecting the design and delivery of STI/HIV/AIDS programs.
- Test new approaches to prevention, care, and support programs through practical, field-based research.
- Disseminate the findings from the research.
- Recommend best practices to improve policies and programs.
Since the inception in 1992, the Cameroon Link (Human Assistance Programme) has worked with a bread group of local, regional, and international organisations to identify the key constraints to service delivery and to test viable alternatives to programs with limited effectiveness.
Focusing on some broad topic areas, Cameroon Link HAP is one of the first STI/HIV/AIDS projects in Cameroon to use operational research to identify program problems and test new solutions to overcoming these problems.
The operational research process has been employed extensively by Cameroon Link in collaboration with the Ministry of Public Health, IBFAN Africa, WABA, FECABPA, German Technical Co-operation, GTZ, Care International and the Cameroon Association of Newspaper Journalists, CANJ, over the last ten years in reproductive health service delivery.
It has proven extremely effective in improving the quality and effectiveness of service delivery programs in large part because it has applied research that places a premium on involving key stakeholders in the entire process.
These stakeholders are many and include government ministries, local NGOs, Local community leaders, people living with STI/HIV/AIDS, research agencies, and international organisations, amongst others.
Multi-stepped Approach
Cameroon Link operations will in the next five years involve five basic steps:
- Problem identification and diagnosis.
- Strategy selection.
- Strategy experimentation and evaluation.
- Information dissemination.
- Results utilisation.
From past experiences, we have noted that this process increase the efficiency, efficacy, quality and cost-effectiveness of prevention and care services, and changes individual behaviour by making services more accessible and acceptable.
The Cameroon Link Human Assistance Project concentrates on working with local service delivery organisations and groups to design and implement three basic types of field-based studies.
EXPLORATORY STUDIES
These studies are needed whenever there is a perceived problem, but the nature and extent of the problem are not known. Such studies can identify individual behaviours, and the legal, cultural, and socio-economic factors that influence risk and vulnerability, as well as the parameters of a service delivery.
FIELD INTERVENTION STUDIES
This study is useful when the factors responsible for a problem situation is or are known (i.e., lack of finances, lack of training, inadequate involvement of local NGOs, lack of collaboration of target groups, high prevalence of risk behaviours).
The most efficient and cost-effective means of prevention have yet to be determined. Field intervention studies test new approaches to behaviour change and new modes of configuring and delivering prevention and care services.
EVALUATION STUDIES
Often the problem situation is known from earlier diagnostic studies and a range of possible solutions have been identified from earlier field intervention studies, but the effect and sustainability of implementing these solutions in the larger community, beyond the confines of a tightly controlled intervention study are not known.
Evaluative studies are a valuable approach for examining the out come or impart of interventions that are implemented through out a service delivery environment.
Regardless of the type of study, the goal is always to improve the way in which policies are designed and implemented. This goal can only be met if each activity is accompanied by a strong information dissemination and results utilisation program.
This explains the connection of the Cameroon Association of Newspaper Journalists, AJPEC, partnership in the Human Assistance Programme and the raison d’être of the revival of the Cameroon Link newspaper for the presentation of NGOs activities through the forum columns. Articles, feedback and suggestions or information will be welcome.
STI INTERVENTIONS
PUTTING NEW PREVENTION AND TREATMENT APPROACHES TO THE TEST AS PROJECT
One of the most important prevention discoveries made about HIV is that the presence of other sexually transmitted diseases (STDs) greatly increases vulnerability to and transmission of the virus.
This has been a key factor in HIV’s virulent spread in Cameroon, where untreated STDs are also endemic. Thus, strengthening STD prevention and management and, wherever possible, incorporating these efforts into HIV prevention programs have become a key global strategy for curbing the virus that causes AIDS.
But this is not a simple matter. The stigmatisation of those with STDs, a very common problem, inhibits people from seeking treatment.
Designing effective behaviour change campaigns that address sexual behaviour is often difficult, especially if literacy is low. Several constraints on national health budgets restrict the implementation of STD prevention and treatment programs, just as poverty limits the ability of individuals to pay for their own treatment.
Access to care is also limited, particularly in rural areas isolated by weak infrastructure. Even in urban towns with more resources, STD prevention and control programs are often insufficiently funded.
Despite the growing wealth of knowledge about STDs, few large-scale prevention and treatment programs have evolved in the districts where the need is greatest.
One of the biggest challenges is how to translate important research finding into effective, affordable and real programs that can be adapted to very different settings.
A key lesson learnt from past experiences is that like the HIV and STD epidemics themselves, real solutions are complex and multi-faceted.
STI PREVENTION STRATEGIES
PERIODIC PRESUMPTION TREATMENT
This is mass treatment of individuals presumed to be infected with one or more STDs, without attempting to make an individual diagnosis. This strategy can be targeted to persons with known high-risk behaviours like sex workers or free girls.
SYNDROMIC MANAGEMENT
Treating a patient for all likely causes of a symptom or sign of STD, rather than on the basis of a specific diagnosis.
PEER EDUCATION
Training individuals in health education and counselling techniques so that they can educate others in their peer groups.
POLICY OF 100% USE IN SEX ESTABLISHMENT OF CONDOMS
An intervention that seeks to reduce transmission of HIV and other STDs to and by sex workers by ensuring that condoms are used for every act of intercourse.
I.E.C PROJECT OBJECTIVES
LONG TERM
The training of staff and production of information material and publication will enhance a greater awareness of the local communities and contribute to the process of community development by mobilising the local communities towards involvement in the prevention of STD/HIV/AIDS/TB and social welfare. Media organisations must be regularly implicated in I.E.C programs.
CONCLUSION
To back up this executive summary, please click the profile of Cameron Link, its projects plan of action from 2009 to 2012 to get highlights of major health initiatives.

HIV AND INFANT FEEDING

HIV AND INFANT FEEDING
By James Achanyi-Fontem
Cameroon Link
HIV was first detected in breastmilk in the mid-1980s, creating problems as to how to advise HIV-infected mothers on the feeding of their infants. The risk of transmitting HIV through breastfeeding must be balanced against the risks that can result from not breastfeeding.
Breastfeeding is near universal in Cameroon, making it hard to conduct studies on the risks of artificial feeding. The lack of data makes it difficult to balance these risks. As at now, HIV prevalence is high and rising in pregnant women in Cameroon, so it is important that guidance should be developed to help reduce the risk of mother-to-child transmission (MCTC). It must be borne in mind that breastfeeding in Cameroon is recommended usually from birth and may continue in most cases to over 24 months, but also that complementary foods are often introduced within the first 3 months of life.
In the resource poor settings, the many benefits of breastfeeding become especially important and the risks associated with the alternatives to breastfeeding also become greater. In developing countries like Cameroon, the high cost and irregular supply of breast milk substitutes, and the lack of safe water to make up such foods, results in higher levels of morbidity and mortality for infants who are not breastfed.
Studies carried in Cameroon by Cameroon Link have found that babies who are not breastfed in the first month of life are six times more likely to die than breastfed babies. The protective effect of breastfeeding declines with age but remains significant for the first 8 months of infancy, and it is greatest among mothers with limited education.
In the district hospitals in Cameroon today, for an HIV-infected mother, the decision whether to break with tradition and not breastfeed, or to run the risk of transmitting the virus through breastfeeding, imposes a heavy burden. A woman who does not breastfeed may be stigmatised and others will suspect she has HIV, and there could be many adverse social consequences.
A woman may try to hide her HIV status by breastfeeding but also use artificial feeding in an attempt to reduce the risks to the baby. This , however, exposes her baby to both sets of risks. For now , options for replacement of infant feeds to HIV-positive mothers and children for the first six months are discussed by the UN agencies like UNICEF,WHO, and WHA.
On the other hand, there is information on home-prepared foods for children over this age. These guide are generic and should be locally adapted. Through counselling, they should also be tailored to individual circumstances . Local guidelines are being developed in Cameroon, but little is known about their implementation or effectiveness. What is known is that it is difficult to achieve safe replacement feeding in Cameroon for now.
HIV transmission through breastfeeding
The mechanisms of HIV transmission through breastfeeding are not clear but the virus probably infects the infant through breaches in the integrity of the intestinal mucosa. An improved understanding of how HIV transmission through breastfeeding occurs might make it possible to reduce the transmission risk.
Data suggest that 10 – 20 % of babies born to HIV-positive mothers will become infected through breastfeeding when it continues beyond one year. Several factors associated with increased risk of breastfeeding transmission have been identified. Those for which there is strong evidence of increased risk include:
* high maternal HIV load (found in recent infection and in advanced disease)
• clinical symptoms of advanced disease
• immune deficiency (low CD4 and high CD8 counts)
• duration of breastfeeding
•breastfeeding whilst experiencing mastitis, abscesses, or ripple fissures.
Exclusive Breastfeeding
Exclusive breastfeeding defined as breastfeeding without any supplementary food or liquid, is generally recommended for the first 6 months of life. It reduces mortality from diarrhoea and respiratory infections and protects against other diseases. Infants who are breastfed exclusively for at least 3 months have significantly lower HIV transmission at 3 and 6 months compared with infants who received breast milk plus other feeds (“mixed feeding”) within the first 3 months of life.
The rate of transmission in exclusively breastfed infants and infants who were never breastfed were similar , 19,4 % at 6 months. In contrast, 26,1 % of infants who were mixed fed are HIV-positive at this age. At 15 months, 24,7% of babies exclusively breastfed for at least 3 months are HIV-infected , compared with 35,9% of the babies who are mixed fed in the early months of life.
Mastitis
Mastitis is a condition resulting from inadequate or poor drainage of milk from the breast. It may be either infectious or non-infectious in origin. Mastitis affects up to a third of breastfeeding women, usually in the first 3 months after delivery. Some vitamin deficiencies may increase the risk of mastitis.
Mastitis can be treated with low-cost antibiotics. Counselling women about good breastfeeding techniques can help them avoid problems that would cause elevated milk sodium, poor milk drainage and inflammation leading to mastitis, as well as nipple problems which may also increase the risk of HIV transmission.
Antiretroviral drug trials for prevention of MTCT
Short-course , prophylactic Antiretroviral drugs (ARV) are the most effective way to reduce MTCT during pregnancy, labour and delivery, and through breastfeeding during the first days of infant life.
It must also be recognised that ARV protocols require the identification of HIV-positive women through voluntary counselling and testing (VCT) services, which need to be expanded in Cameroon.
Recommendations for making breastfeeding safer in the context of HIV
Mothers have a right to information and support so that they can feed their babies safely. They must know their HIV status and they must understand the consequences of each feeding option.
Most of the options for reducing MTCT discussed in this supplement so far only apply to those women who know their HIV status. In Cameroon, however, the vast majority of HIV-infected mothers are unaware of this.
The UN policy is that breastfeeding should be promotes and supported among women who are HIV-negative and those who do not know their HIV status. The following recommendations are therefore made.
• Breastfeeding should begin within 30 minutes of birth
• Breastfeeding skills (proper position and attachment, how to feed the baby ) comfortably) should be established immediately.
• Infants should be fed frequently, ‘on demand’.
• Breastfeeding should be exclusive ( no other solids or liquids) for about the first six months.
• Age-appropriate complementary foods should be introduced at 6 months;
• Women at risk of HIV should take steps to avoid infection during the breastfeeding period. (Risk of MTCT is greater immediately after infection because of elevated levels of the virus in the blood).
• Mothers should seek immediate treatment for breast inflammation, cracked nipples or infant mouth sores.
• If such problems occur in one breast only, mothers should express and discard milk from that breast.
These “safer” breastfeeding practices are important for public health programs because they may reduce transmission risks when mothers are:
• unaware of their HIV-status
• HIV-negative but at risk of infection
• HIV-positive but have decided to breastfeed.

HIV/AIDS AND NUTRITION

HIV/AIDS AND NUTRITION
By James Achanyi-Fontem,
Cameroon Link
HIV infection not only compromises the nutritional status of infected individuals, but poor nutritional status can affect the progression of the infection. Research to identify nutritional interventions has been undertaken in Africa by the Commonwealth Regional Health Community Secretariat in Africa seeking to:
• review what is known about the clinical and social dimensions of HIV and nutrition
• synthesise current understanding of the role of macro and micro nutrients in HIV
• describe the impact of HIV on nutritional status and the impact of nutritional status on HIV progression and transmission particularly mother-to-child transmission (MCTC)
• highlight important research from Africa
• identify gaps in research and make recommendations.
Epidemiology and social impact
Although the number of infected people is increasing in Cameroon, HIV/AIDS affects a disproportionate number of young women and large number of children. Declining life expectancy and changing population structure are harming economic and social development, including food security, illness and death from AIDS cab profoundly affect a family’s ability to provide adequate food and nutrition for its members, particularly for young children who are already vulnerable.
An estimated 12 million children in Africa have lost one parent or both before the age of 15. This highly vulnerable group is expected to grow dramatically.
Paediatric HIV/AIDS
Infants can acquire HIV from their mothers during pregnancy, at the time of delivery , or during breastfeeding. If no interventions are in place to prevent mother-to-child transmission, about 5 – 10% of infants will be infected during pregnancy, about 10 – 20 % will become infected during delivery; and another 10 – 20% will become infected fi breastfed to one year or longer.
In these cases, children are more likely to suffer from failure to thrive and low weight-for-age than uninfected children. Disease progression may be more rapid than among children in industrialised countries because of endemic malnutrition, frequent exposure to infectious diseases, and limited access to health care and treatments.
According to the WHO recent clinical approach to diagnosing HIV in children living where testing is not available, the following guidelines suggest that, where three out of seven conditions are present, HIV infection should be suspected. These are the seven conditions:
* two or more chest infections requiring antibiotics (pneumonia) in the past two months
• one or more episodes of persistent diarrhoea or two or more episodes of acute diarrhoea in the past two months
• a patient with tuberculosis
• oral candidacies (thrush)
• enlarged lymph nodes in tow or more sites
• growth faltering (weight curve flat or falling for two consecutive months)
• weight-for-age below the 3rd percentile, using international growth reference standards.
Malnutrition
Malnutrition in its many forms is endemic and measurements of body size indicate protein-energy malnutrition, but micro nutrient malnutrition in its milder forms is not easily recognised. The most commonly reported micro nutrient deficiencies are iron, vitamin A, and iodine.
Deficiencies in other vitamins and minerals are not commonly reported , but occur frequently where diets are lacking in variety and contain few animal products. Malnutrition in children is increasing due to HIV/AIDS and other factors that affect food security , access to health care, and family caring practices. Vitamin A deficiency is widespread, and about 60% of African children under five years , and half of all pregnant women , suffer from anaemia.
The clinical context
Nutritional status affects the progression of HIV disease . Infectious diseases, no matter how mild, influence nutritional status. Conversely nutritional deficiency, if sufficiently severe, will impair resistance to infection.
Infants and young children are frequently malnourished, so the differentiation of HIV malnutrition from other causes is difficult. HIV not only destroys the CD4 cells of the immune system, but also affects the cells of the intestine, brain and other organs.
Infections lead to reduced dietary intake and nutrient absorption, whilst increasing utilisation and excretion of proteins and micro nutrients. The immune system responds to infection by releasing pro-oxidant cytokines, which demand increase demand for and utilisation of anti-oxidant vitamins and minerals.
Oxidative stress occurs when there are not enough antioxidants to form enzymes needed to respond to the pro-oxidant immune response. Oxidative stress may hasten HIV replication and increase production of hormones involved in the metabolism of carbohydrates, proteins and fats, contributing to further weight loss.
Social Context
Quality of life is seriously affected by HIV infection. Weight loss leads to fatigue and decreasing physical activity. Entire families are affected when infected adults cannot work steadily and provide for their dependants, but face increased expense when infected members require medication and continued care.
A common result is food security, which is especially severe in female-headed households and in areas where farming is a primary occupation. Parental death is a frequent precipitating cause of childhood malnutrition.
Weight loss and wasting in HIV/AIDS
The syndrome once known as ‘slim disease’ typically found in AIDS patients is a severe nutritional manifestation of the disease. In earlier stages of HIV infection, weight loss typically follows one of two patterns: slow and progressive weight loss from anorexia and gastrointestinal disturbances, and rapid episodic weight loss from acute infection.
Three, sometimes overlapping processes cause weight loss and wasting.
1. Reduction in food intake due to physical or psychological factors affecting food availability and nutritional quality, and the side-effects of drugs.
2. Nutrient malabsorption due to frequent diarrhoea and possible damage to intestinal cells by the virus. Fat malabsorption also affects the absorption and utilisation of fat-soluble vitamins (A,E), further compromising nutritional and immune status).
3. Metabolic alterations is also a serious problem. Infection results in increased energy and protein requirements. Furthermore , severe reduction of food intake can cause changes in metabolism, as the body uses up carbohydrate reserves and begins to break down protein to produce glucose, causing muscle – wasting cachexia. This process occurs when skeletal muscle is broken down for proteins required to bind and clear infectious agents.
Malnutrition due to the first two processes may be reduced by treating the immediate source of the problem (other infections) and providing well-tolerated foods to the infected individual, whilst increasing food intake during convalescence.
Weight loss and wasting due to metabolic changes cannot be reversed by feeding alone. Industrialised countries have used expensive appetite stimulants and hormones to treat wasting in AIDS patients. However, a less expensive supplement on weight again appeals to depend upon the stage of the disease. Nutrition supplementation combined with glutamate and antioxidants appears to be effective over a 3-month period .
Other nutritional supplements tested, such as fish oil supplements and high energy-protein drinks, have resulted in improved weight again among some HIV-infected adults. The impact of these supplements on weight again appears to depend upon the stage of the disease. Nutrition supplementation combined with counselling about appropriate diet has had the greatest impact before the onset of chronic secondary infections. Unfortunately, relatively few people in Cameroon learn of their status early in the disease, in time to take preventive actions.
Vitamins and Minerals in HIV/AIDS
The table below summarises the role of vitamins and minerals in supporting body functions and the immune system. HIV – infected individuals have decreased absorption, excessive urinary loss, and low blood concentrations of several nutrients.
It is not known if these deficiencies are independent markers of disease progression or whether they are causally related to the worsening symptoms of HIV/AIDS. But low intakes and pre-existing malnutrition are likely to worsen the impact of HIV on immune function.
Metabolic alterations that accompany acute infections
Protein
Increased urinary nitrogen loss
Increased protein turnover
Decreased skeletal muscle protein synthesis
Increased skeletal muscle breakdown
Increased hepatic protein synthesis
Lipid (Fat)
Hypertriglyceridemia
Increased hepatic de novo fatty acid synthesis
Increased hepatic triglyceride esterification
Increased very low-density lipoprotein production
Decreased peripheral lipoprotein lipase activity
Increased adiposity triglyceride lipase
Carbohydrate
Hyperglycaemia
Insulin resistance
Increased peripheral glucose utilisation
Increased gluconeogenesis
These are causally related to the worsening symptoms of HIV/AIDS; But low intakes and pre-existing malnutrition are likely to worsen the impact of HIV on immune function.
Micro nutrient deficiencies:
• vary across populations and according to disease stage
• are associated with accelerated progression of the disease
• are predictive of HIV-associated mortality.
Micro nutrient supplementation has thus the potential to be an affordable public health measure.
Selenium deficiency is unusual in most populations of Cameroon. Deficiency impairs the immune system and has been associated with faster HIV progression. Selenium is believed to play an important role in reducing oxidative stress and animal studies suggested that lack of it increases viral pathogenicity.
Micronutrients and Mother-to-Child- transmission (MCTC) of HIV
High viral load due to recent or advanced infection increases the likelihood that HIV will pass on to the baby during pregnancy, delivery, or breastfeeding. If malnutrition –facilitated immune suppression contributes to high viral load, then the risk of MCTC is greater. Some micronutrient deficiencies during pregnancy (vitamin A and zinc) result in reduced foetal nutrient stores, which may affect their immune status and subsequently increase their vulnerability to HIV.
In addition, malnutrition during pregnancy may further erode the woman’s immune status and possibly accelerate disease progression. According to studies carried out, breastfeeding mothers with HIV lost more weight and died earlier than those also HIV infected who did not breastfeed.
Interpreting the results
What is known to favour the continuous increase in the HIV figures in Africa than in the industrialised countries could be related to the following views:
• The general level of nutrition is higher in industrialised countries than in Africa. Nutritional interventions may therefore have a greater impact in Africa.
• Most studies of adults in industrialised countries have been among homosexual men and /or drug users. Their diet and health status are likely to be quite different from HIV – infected adults in Africa.
• Most Americans and Europeans are taking anti-retroviral drugs and treatment for secondary infections, including nutritionally fortified foods and supplements. These are not generally available or consumed by Africans. Nutritional interventions have had a positive impact in populations also receiving antiretroviral drugs.
HIV+ and Nutrition Support
Nutrition programmes serving people with HIV/AIDS have significantly increased their quality of life. Programmes addressing the needs of people living with HIV and AIDS can have varied objectives. These objectives will depend on the needs of the population and the stage of HIV disease in individual participants.
For people with HIV but no opportunistic or secondary infections, programmes should focus on building nutrition stores to prevent nutrition deterioration. People with AIDS, at the other end of the spectrum, will require palliative nutrition care.
Specific objectives for nutritional care and support programmes may include:
• improving nutrition, diet and eating habits
• building or replenishing body stores of Micronutrients
• preventing weight loss
• preserving muscle mass
• preventing food borne illness
• preparing for and managing AIDS related symptoms that affect food consumption
• ensuring that nutritious food is available to AIDS-affected families
Nutritional support should be provided within the context of holistic care and people with HIV/AIDS should be allowed to participate in providing programme services .
Components of a holistic care programme include counselling for emotional and psychological stress, physical exercise , health care and treatment of opportunistic infections. Nutritional programmes may include one or more of the following :
• education regarding diet
• safe water , personal hygiene , and food safety
• support for healthy members of family affected by HIV/AIDS
• nutrition supplements , group meals, or food baskets
• home-delivered ready-to-eat foods for AIDS patients
Recommendations for nutrition care
Recommendations vary according to the nutritional status, stage of infection, and level of disease. In the asymptomatic stage, advice will focus on maintaining health and building nutrition stores in the body.
In later stages, advice may shift to address the problems of anorexia, infections causing protein catabolism, and to mitigate the adverse nutritional effects of chronic diarrhoea and other secondary infections.
Nutritional support is more likely to be effective during the early stages of the disease, but this requires early diagnosis and early detection of the disease is rare in Cameroon.
For HIV-positive asymptomatic individuals, a healthy diet that is adequate i terms of energy, protein, fat, and other essential nutrients should be promoted as a key component for positive living, and to prolong the period between HIV infection and the onset of secondary infections attributed to AIDS. Local available foods should be recommended and these should be familiar to all health care providers, and made accessible , along with sources of social support , to families affected by HIV/AIDS.
Nutritional counselling should include information on appropriate diets, taking into account the individual’s particular preferences and needs in terms of age, sex, and physiological state- for example, pregnancy, lactation, engaged in strenuous physical labour and so on.
Even those who are asymptomatic have increased metabolism due to the HIV infection. The potential for increasing nutritional reserves and improving dietary intake are greater when an individual is still relatively healthy. Therefore , programmes should emphasise building nutritional reserves at an early stage.
People with HIV/AIDS should be encouraged to maintain physical activity. Weight –bearing exercise may help build lean body mass. Exercise also stimulates appetite. Counselling should also include discussion on personal hygiene, safety in food preparation and cooking, and emphasise the importance of seeking immediate attention for digestive or other health related problems. Preventing food and water borne infections is especially important in people with compromised immune systems.
HIV-positive individuals experiencing weight loss
Most early weight loss is the result of depressed appetite during secondary infections, particularly diarrhoea. Nutrition advice for managing common conditions and maintaining intake by having more frequent meals, and well liked foods, suggests that intake should be increased during periods of recovery from infection.
All people with HIV/AIDS at whatever stage should be advised against unhealthy lifestyles that include alcohol consumption, tobacco and drug use, and unsafe sexual practices, which increase the risk of infections. They should be advised to have all infections treated immediately and completely, to maintain personal hygiene, and to prevent food contamination at all times.
Recommendations for nutritional support for people with AIDS
The advice is similar except that the emphasis shifts from preventing to mitigating th nutritional consequences of the disease and preserving functional independence wherever possible. Preservation of lean body mass is important.
Protein-energy consumption should be maintained and medical recommendation should be followed for specific symptoms. Foods low in insoluble fibre and fat should be avoided to minimise gastro-intestinal discomfort and, during periods of nausea and vomiting, people should be encouraged to eat small snacks.
Fluid intake should be maintained at all times , especially during periods of diarrhoea. Specific eating times should be set and made pleasant and supportive. It should be noted that several medications against opportunistic infections have nutritional consequences or side effects such as nausea and vomiting.
In situation of food insecurity, programmes providing food supplements should insure that rations are of sufficient size to meet the needs of the HIV/AIDS patient and his /her dependants. All family members are extremely vulnerable in this situation.
Nutrition Care for children with HIV/AIDS
Children with mothers who are HIV-positive are especially vulnerable, as a result of their own infection with HIV or because of the deteriorating health of one or both parents. In this case, recommendations should follow those for all young children but take into account the increased nutritional requirements that accompany the infection.
Children less than 2 years need to be fed patiently and persistently with supervision and love, especially as they are likely to be frequently ill. Solid foods can be introduced gradually in small portions at least three times a day, and by the time they are one year old most children can eat adult diet as long as food is cut or mashed and not too spicy.
Variety and foods containing essential vitamins are a priority – locally available fruits and vegetables, and animal products and fortified food if available. Nutritious snacks between meals can be provided to increase consumption.
The following guidelines are suggested for nutritional management of HIV infected children :
• regular monitoring of weight, growth, and development
• review of child’s diet at every health visit
• immunisation and prophylactic vitamin A supplements
• prompt treatment of any secondary infection and maintenance of food and fluid intake
• for those who are severely malnourished , local guidelines should be followed and entered or parenteral nutrition should be considered if available.