HIV and nutrition

What is the link between nutrition and HIV/AIDS?

Globally, 1.8 million children under age 15 are living with HIV (2015).

Infants born to mothers living with HIV have poorer growth and higher morbidity and mortality than children who are born to mother who are not infected with HIV. Furthermore, abnormalities in growth are common in children infected with HIV. Children living with HIV/AIDS are at increased risk of malnutrition. Chronic infection including HIV/AIDS can lead to poor growth and may reduce appetite, food intake, and nutrient absorption at a time when the body needs good nutrition the most to fight the infection. The result is a further weakened immune system that is ill equipped to fight the virus and infections like tuberculosis.

Many children living with HIV suffer from severe acute malnutrition, a life-threatening condition. To increase their chances of survival, these children need therapeutic foods to urgently treat malnutrition, combined with antiretroviral treatment to stop the disease from progressing.

How can we prevent children from getting HIV in the first place?

HIV can be transmitted to babies from a mother during breastfeeding, or pregnancy, and birth – but the good news is that in most cases, it can be prevented.

Evidence suggests that antiretroviral (ARV) drugs greatly reduces the risk of transmitting HIV to their babies. In the form of just one pill a day, antiretroviral treatment can protect the health of a mother living with HIV and prevent transmission to her child – in the womb, during delivery, and throughout the breastfeeding period. Treatment adherence and continued medical care are critical to suppress the virus in the mother and ensure safe breastfeeding.

But why breastfeed at all when there is still a small risk of transmission?

Breastfeeding ensures the greatest chance of child survival. This is particularly true in low and middle income countries where HIV prevalence is the highest and resources are limited.

Breastfeeding reduces the chances that a child will fall ill and die from common illnesses such as diarrhoea and pneumonia. In settings where families live in poverty and are exposed to disease, poor sanitation and contaminated drinking water, the benefits of breastfeeding greatly outweigh the risk of HIV infection. With its unique combination of nutrients and antibodies, breast milk is the healthiest food for babies, provides unmatched protection from disease and death; and combined with ARVs, will greatly reduce the risk of HIV transmission.

The World Health Organization and UNICEF recommend that mothers with HIV take antiretroviral treatment, exclusively breastfeed for the first six months of life, introduce complementary foods thereafter, and breastfeed for at least 12 month and may continue for up to 24 months or longer.

What are the challenges?

There are challenges in reaching vulnerable populations of children, adolescents, pregnant women and nursing mothers with HIV. Many of them lack access to antiretroviral treatment due to barriers such as stigma and discrimination, as well as weak and inefficient health care systems.

The knowledge that most mothers living with HIV can breastfeed safely while on ARVs is relatively new – but cultures, attitudes and public health practices can take time to change. Education and training at all levels – within families, communities, and the health care system – are critical, as well as access to antiretroviral treatment for all those who need it.

How is UNICEF responding?

Training and support – UNICEF helps train health and community workers to prevent mother-to-child transmission of HIV, and to support safe breastfeeding.

Integrated testing and treatment – UNICEF supports provider initiated voluntary, confidential HIV testing to women throughout pregnancy, at delivery, and during the breastfeeding period. UNICEF also works to integrate HIV testing and treatment with the management of severe acute malnutrition so that acutely malnourished children undergoing treatment are screened for HIV and provided with antiretroviral treatment as appropriate.

Nutritional care and therapeutic feeding – UNICEF provides support for nutritional assessments and counselling to manage HIV disease and the side effects of antiretroviral drugs. UNICEF also supports therapeutic feeding, together with antiretroviral therapy, for children living with HIV and suffering from severe acute malnutrition.

Norms and standards setting – UNICEF provides leadership in developing global guidance. The latest guideline on HIV and infant feeding were released in July 2016.

Policy development – UNICEF supports governments to establish national policies on infant and young child feeding, including those that consider mothers and children living with HIV.

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