HIV This Week

Mamlin J, Kimaiyo S, Lewis S, Tadayo H, Jerop FK, Gichunge C, Petersen T, Yih Y, Braitstein P, Einterz R. Integrating Nutrition Support for Food-Insecure Patients and Their Dependents Into an HIV Care and Treatment Program in Western Kenya. Am J Public Health. 2009;99(2):215-21.

The Academic Model Providing Access to Healthcare (AMPATH) is a partnership between Moi Teaching and Referral Hospital, Moi University School of Medicine, and a consortium of universities led by Indiana University. AMPATH has over 50000 patients in active care in 17 main clinics around western Kenya. Despite antiretroviral therapy, many patients were not recovering their health because of food insecurity. AMPATH therefore established partnerships with the World Food Program and United States Agency for International Development and began high production farms to complement food support. Today, nutritionists assess all AMPATH patients and dependents for food security and refer those in need to the food program. Mamlin and colleagues describe the implementation, challenges, and successes of this program.

Editors’ note: This comprehensive programme combines HIV treatment initiation with extensive nutritional support for food-insecure patients (one-third) and their dependents for the 6 months needed to get them back to a productive life. Sustained through a combination of food production, food donation, and an effective food distribution infrastructure, including a computerized nutrition information system, this trailblazing programme aims to enhance income security for those patients who still need nutritional support after 6 months, rather than fostering dependency. They are referred to a family preservation initiative where they may benefit from, for example, microenterprise training, with or without microfinance, or participation in cooperatives with other patients to grow high value produce. It is time for domestic governments and international donors to step forward to replicate similar food security programmes for selected patients on antiretroviral treatment.

Swaans K, Broerse J, Meincke M, Mudhara M, Bunders J. Promoting food security and well-being among poor and HIV/AIDS affected households: Lessons from an interactive and integrated approach. Eval Program Plann. 2009;32(1):31-42

Participatory and interdisciplinary approaches have been suggested to develop appropriate agricultural innovations as an alternative strategy to improve food security and well-being among HIV affected households. However, sustainable implementation of such interactive approaches is far from easy and straight forward. This study reports of the Interactive Learning and Action approach, a methodology for agricultural innovation which has been adapted to the context of HIV. Role players in agriculture and health were brought together to stimulate and sustain innovation among three support groups for poor and affected households in a rural high HIV prevalence area in South Africa. The effectiveness of the approach was evaluated using both outcome and process criteria. The results indicate that an interactive approach in which service providers/researchers engage themselves as actors to explore the livelihood system and develop appropriate solutions in joint collaboration with resource users has potential. However, it also revealed that cooperation among participants and stakeholders at the interface of agriculture and HIV is complicated and sensitive to erosion. Of particular concern was the difficulty of mobilizing members from poor and affected households to participate and to overcome stigma and discrimination. Lessons and potential applications for the further development of interactive approaches are discussed.

Editors’ note: Interactive approaches build a close collaboration between relevant stakeholders to share knowledge, insights, experiences, needs, and creativity and to generate required involvement and ownership. The Interactive Learning Approach is characterised by enhancement of trust relationships, mutual learning, and knowledge integration between relevant stakeholders in a carefully guided process that is both interactive and iterative, around a shared vision. Adapting it to HIV clearly has some pitfalls, not the least of which are HIV illness and death, on the one hand, and stigma and discrimination on the other.