1. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS: Practical Tools for Health Workers

2. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 2 Objectives Define nutrition List foods from each food group, and at least one nutrient that each food contains Identify locally available foods from each food group Identify important vitamins and minerals and their function Explain the connections between HIV and AIDS, the immune system, and nutrition

3. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 3 Definition of Nutrition Nutrition is the science of foods Involves the action, interaction, and balance of nutrients in relationship to health and disease Involves the processes by which food is digested, absorbed, transported, utilised, and excreted in the body Nutrition is concerned with social, economic, cultural, and psychological implications of food and eating

4. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 4 Gastro-Intestinal Tract Tube that runs from mouth to anus where food is ingested, digested, and absorbed into the body Foods enter through mouth, travel down through stomach and intestines, are absorbed into blood at various stages, then the unused food waste is excreted in faeces

5. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 5 Nutrition Basics Foods contain nutrients in various quantities Macronutrients Carbohydrates Protein Fats Micronutrients Vitamins Minerals

6. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 6 Nutrition Basics (2) Include water every day Calories or Energy Come from macronutrients – carbohydrates, proteins, and fats Provide energy to move and stay healthy People with HIV and AIDS need more calories than others

7. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 7 Food Groups 4 Food Groups Cereals and Staple Grains Animal Foods, Milk Products, and Beans Fruits and Vegetables Fats and Sugar

8. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 8 Cereals and Staple Grains Provide energy, fibre, vitamins and minerals Starches or cereals: white or brown bread, mahangu, mealie-pap, macaroni, rice, or Weet-bix

9. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 9 Typical Grain in Natural Form Courtesy of Nordin S. Permaculture, Nutrition and HIV Files CD Rom. 2006 Starch Husk Germ: Many Nutrients Bran: Protein, Vitamins & Minerals

10. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 10 Grains: Maize Courtesy of Linda Larsdotter, 2005

11. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 11 Animal Foods, Milk Products, and Beans Protein to build immune system and muscles Iron to prevent anaemia (iron deficiency) Animal Sources: meat (beef, game, etc), chicken, fish, eggs, insects, milk, cheese, yoghurt, sour milk Non-animal Sources: beans, lentils, peas, nuts and soy products (soy mince) Most sources contain some fat

12. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 12 Dried Fish © I-TECH, 2005

13. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 13 Dried Mopani Worms © I-TECH, 2005

14. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 14 Fats and Sugars Fats: butter, margarine, and oils Fat is a concentrated form of energy, some oils contain vitamins A and E Helps with weight gain Fat also naturally found in meats, fish and milk products

15. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 15 Fats and Sugars Sugars: add calories (energy), but no protein, vitamins or minerals Sugars include cool drinks (Coke, Fanta), sweets, cakes, cookies, etc. Too much sugar can lead to cavities and promotes yeast and bacteria growth Cool drinks like Coke also have caffeine, which can dehydrate the body

16. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 16 Fruits and Vegetables Provide mostly vitamins and minerals Essential for body functions, building the immune system and helping heal wounds and infections Provide carbohydrate-fibre for good digestive health

17. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 17 Spinach © I-TECH, 2005

18. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 18 Dried Eenyandi Fruit © I-TECH, 2005

19. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 19 Important Vitamins and Minerals Vitamin A Function: improves vision, immune system by strengthening cells Foods: yellow, orange, and dark green fruits and vegetables, milk, liver, eggs and fish oil Deficiencies: blindness, poor skin, teeth and nails Give vitamin A supplement as part of treatment of severe malnutrition and diarrhoea in children

20. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 20 Important Vitamins and Minerals Vitamin C Function: promotes healthy cells and tissues, strong immune system, wound healing Foods: oranges, lemons, grapefruit, paw-paw, guava, green leafy vegetables, baobab fruit, eembe, and potatoes Deficiencies: decreased immune function, scurvy, poor wound healing, bleeding gums, bruising

21. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 21 Important Vitamins and Minerals Vitamin E Function: forms and protects cells Foods: vegetable oils, nuts, seeds, grains, eggs, legumes, dark green vegetables Deficiencies: decreased immune function

22. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 22 Important Vitamins and Minerals Iron Function: carries oxygen through body, builds immune system Foods: Liver, meat, chicken, fish, eggs, dried beans, green vegetables, cereals Deficiencies: anaemia, fatigue, weakness

23. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 23 Important Vitamins and Minerals Calcium Function: keeps bones and teeth strong, helps muscles and heart work better Foods: milk, cheese, yoghurt/sour milk, fish (with bones), dark green leafy vegetables Need calcium-rich foods every day Deficiencies: poor growth and bone development, frequent leg cramps HIV medications can interfere with calcium absorption, causing weakened bones

24. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 24 Important Vitamins and Minerals Zinc Function: protects and strengthens immune system, heals wounds Foods: seeds and nuts, grains, green leafy vegetables, eggs, liver, seafood Deficiencies: skin problems, low appetite, no wound healing, slow growth in children Give short-term zinc supplement as part of treatment for diarrhoea, especially for children 20mg/day for no more than 10-14 days

25. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 25 Antioxidants Oxidation is when cells breakdown and release “free radicals” or substances that are harmful to cells Antioxidants are substances that prevent cell breakdown by slowing oxidation Vitamins and minerals found in fruits and vegetables act as antioxidants (vitamins A, C, E and Selenium) Oxidation occurs over time as we age, but faster with a disease or unhealthy lifestyle

26. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 26 The Nutrition and HIV Link The Immune System: Cells to fight infections HIV attacks these cells Causes weakening of immune system and infections Nutrition helps keep the cells healthy and fight infections

27. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 27 The Immune System and HIV © ITECH, 2006

28. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 28 CD4 and Viral Load Counts Poor nutrition status contributes to decrease in CD4 count and/or increase in viral load As CD4 counts decrease and viral load counts increase, greater need for nutrition to protect cells

29. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 29 HIV Impact on Nutrition What’s the problem? Extra burden on body Decreased food intake and decreased absorption due to disease and/or side effects from medications What can we do? Early nutrition assessment, education and treatment of nutrition-related problems

30. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 30 Nutrition Requirements for HIV Calories/Energy: increase to fight infections and prevent weight loss 10 percent increase for all HIV patients 20-30 percent increase with other infections and co-infections such as TB, malaria, and pneumonia Protein: 12-15% of total calories from protein Increase with infections only

31. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 31 Nutrition Advice for Persons with HIV Eat at least 3 times a day to: Maintain weight Prevent side-effects and nutrient deficiencies If 3 large meals are not possible, try 5-6 smaller meals/snacks per day (every four to five hours)

32. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 32 Healthy Eating Try to eat foods from each food group What is a “balanced” diet? Most meals contain all nutrients (food groups) How do we “balance” our meals? Use locally available foods

33. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 33 Balanced Meal equals Healthy Meal Grains: mahangu, sorghum, cassava, maize, wheat, rice, potato Protein Foods: beans, peas, nuts etc. or animal food like milk, Mopani worms, egg, meat, fish, etc. Fats: oilseeds, oil, butter, avocado Fruit: paw-paw, banana, eenyandi, eembe, guava, etc spices, herbs Vegetables: pumpkin, spinach, carrots, etc Use Namibian Food Groups

34. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 34 Stay Hydrated Drink at least 2 litres of liquids per day: boiled water, juice, non-caffeinated or non- alcoholic drinks Important for the cells in body to function Caffeine and alcohol are dehydrating

35. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 35 Exercise Why exercise? Keep muscles strong Keep bones strong and prevent osteoporosis Maintain weight Keep immune system strong Improve appetite

36. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 36 Types of Exercise Walking or light jogging can improve appetite Gardening or Farming Uses different muscles Also provides food and source of income Stretching Improves blood circulation and appetite Only need 15-20 minutes a day See Handout 1.3: Exercises and Moving Bedridden Patients

37. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 37 Maintain weight and prevent side effects Stronger immune system to fight infections Slower progression of HIV and better health Optimal food intake, balanced diet Cycle of Good Nutrition

38. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 38 Key Points 1.Balanced meals with variety of locally available foods are essential and include: Cereals and staple grains Animal foods, milk products, and beans Fruits and vegetables Fats and sugars

39. Session 1: The Nutrition and HIV Link Nutrition Management with HIV and AIDS Training Slide 39 Key Points (2) 2.Provide nutrition counselling for clients with HIV on how to improve nutrition, including information regarding: Use of Mixed Meal model for planning meals Hydration Exercise