HIV and nutrition

What is the link between nutrition and HIV/AIDS?

Globally, 2.6 million children under age 15 are living with HIV.

Children living with HIV/AIDS are at great risk of malnutrition. HIV/AIDS stunts child growth and can 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 HIV-positive children 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 an infected mother during breastfeeding or pregnancy and birth – but the good news is that in most cases, it can be prevented.

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.

Experience has shown that when mothers living with HIV take antiretroviral treatment and practise exclusive breastfeeding during the first six months of life, the risk of transmitting HIV to their babies is significantly reduced. In fact, exclusive breastfeeding is associated with a three or four-fold lower risk of HIV transmission than mixed feeding. The key is that breast milk be given exclusively – i.e. without any other foods or fluids, including water – for the first six months.

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

The answer is: breastfeeding ensures the greatest chance of child survival. This is particularly true in low and middle income countries where HIV prevalence is the highest.

Breastfeeding reduces the chances that a child will fall ill and die from common illnesses such as diarrhoea and pneumonia. In settings where children 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, and provides unmatched protection from disease and death.

The World Health Organization and UNICEF recommend that mothers with HIV practise exclusive breastfeeding in combination with antiretroviral treatment. Infant formula should only be used when safe water and sanitation are assured, when access to formula is affordable and sustainable, and when it can be safely prepared. It is rare for all of these conditions to be met in much of the developing world.

What are the challenges?

Antiretroviral drugs are most effective when children are well-nourished and have safe and sufficient access to food. Unfortunately, this is not the case for many mothers and children living with HIV. To complicate matters, diarrhoea and nausea can be side effects of antiretroviral drugs, making eating a challenge even in settings where there is easy access to nutritious foods.

There are also 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 poverty, social and gender norms, stigma and discrimination, as well as weak and inefficient health care systems.

The knowledge that most HIV-infected mothers can breastfeed safely 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 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 guidelines on infant and young child feeding in the context of HIV/AIDS.

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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