1. WFP’s Urban HIV/AIDS Nutritional Support Program in Ethiopia A joint program of USAID/Ethiopia – FFP, PEPFAR, and WFP Michelle Jennings USAID/Ethiopia

2. Overview Problem Background WFP/USAID Urban HIV/AIDS Nutritional Support Program Opportunities Challenges Broader Issues Future vision

3. The Context Staggering malnutrition country-wide 47% of children under five are stunted 8-10 million (avg.) food insecure in rural areas

4. The Numbers National HIV/AIDS prevalence is 2.03 which means over 1.5 million people in Ethiopia are living with HIV/AIDS Equally troubling is the high prevalence in URBAN areas, esp. among girls and women (1 and 8 in Addis are infected) We think that almost half of PLWHAs come from the RURAL setting although are infected in Urban areas

5. The Problem “ART without food is meaningless” ARV Clinic M.D., Nazareth, Ethiopia HIV and malnutrition exacerbate one another and have profound consequences for clinical outcomes for PLWHA Effectiveness of drug response in patients under treatment for HIV/AIDS is strongly dependant upon their nutritional status

6. History WFP had supported an urban food security program in Addis Ababa in 2000 Refocused program to address nutritional support for Urban HIV/AIDS affected households in Addis Ababa in 2003 WFP scaled-up further to the current 14 large towns in Ethiopia

7. $350,000 USD from PEPFAR 13,800 MT of Title II food ($8.2 million) Total program cost: $19.2 2006/2007 (2 yr.) –Outstanding needs for 2007 are $5 million in food resources

8. Objectives By providing nutritional support WFP contributes to the national response to HIV/AIDS by Increasing nutrition, health and overall well being of PLWHAs (including complementary support to Home Based Care Services) Supporting enrollment and adherence to anti retroviral treatment (ART) and prevention of mother to child transition (PMTCT) programs Supporting school attendance of orphans and vulnerable children (OVCs)

9. Urban HIV/AIDS Project The project targets urban food insecure/poverty stricken, HIV/AIDS infected or affected households The Food Basket provided consists of Wheat, Corn Soya Blend (CSB), Oil and Pulses There are currently more than 111,000 beneficiaries

10. Food and Nutritional Support EntryExit Orphans and Vulnerable Children Individual Ration VCT/PMTCT (HIV +) Nutritional Counseling and Support HH ration Pre-ART or ART Provision of Basic Care Package & HH ration Severely Malnourished Pre-ART or ART RUTF (if eligible BMI/MUAC) HH ration

11. Linkages Nutritional Support for affected HHs is linked to a collection of other referral services Care Treatment Prevention

12. Capacity Building PEPFAR funding provides training in HIV/AIDS & Nutrition for Partners and Home Based Care Volunteers Training in preparation of Corn Soya Blend (CSB) provided to beneficiaries through HBC volunteers Training in Logistics and M&E for partners Capacity Building for implementing partners through provision of IT equipment

13. Promising Results 98% of patients receiving ART and nutritional support were able to adhere to their treatment Over 90% of PLWHAs receiving nutritional support reported that their health condition was improving or stable 90% of OVCs receiving nutritional support were able to attend school regularly

14. Opportunities Nutritional support provides entry points to increase nutrition awareness and linkages to other HIV/AIDS services for beneficiaries Strong and committed partnerships between Government, donors and WFP to collaborate on nutritional support Presence of strong implementing partners, including government and NGOs Complementary activities, including Home Based Care and OVCs programmes

15. Challenges  Increased demand as VCT and ARV services expand  Lack of longer term food security programs with which to link in the Urban areas  Exit strategy and linking to income generating activities (IGA)  Unpredictable food resource

16. Broader Issues  Inadequate food and food security resources link to PEPFAR programs  Imbalance in USAID resources (Title II and PEPFAR)  Are there alternative mechanisms to provide food to PLWHAs?  Can PEPFAR cover transportation and operational costs to allow for more food to be purchased?  Capitalize on geographic overlap (mainstreaming)

17. Future Vision  Establish a long term solution to HIV/A nutritional support that is predictable and reliable  Ensure nutritional support to acutely malnourished PLWHAs is linked to complementary household ration  Title II and community therapeutic center (CTC) experience is applied and informs HIV/AIDS programming for nutrition  Harmonize policy and implementation guidelines

18. THANK YOU ! Questions?mjennings@usaid.gov