In sub-Saharan Africa, the region hardest hit by the HIV/AIDS pandemic, the thrust to bring antiretroviral (ARV) drugs to the 3.8 million people who need them has tended to overshadow all other treatment efforts.
|Better nutrition can buy time. Credit: IRIN
The reality on the ground is that only five percent of those who qualify for the life-prolonging medicines are so far receiving them.
The World Health Organisation is pushing to increase access with its "3 by 5" initiative, which aims to have three million people in developing countries on ARVs by the end of 2005. But putting millions of people on lifelong drug regimens in countries with under-resourced health systems presents enormous logistical hurdles that will take time to overcome.
The question, in the meantime, is how to slow down the alarming loss of life that is robbing children of their parents, communities of their spirit and economies of their skilled workforce. In other words, how can governments buy their HIV-positive citizens time until they can make the drugs more widely available? The answer may be as simple as good nutrition.
But in sub-Saharan Africa nutrition is no simple matter. Here people who contract the HI virus spiral towards death much more quickly than their western counterparts, not primarily because they lack access to ARV drugs, but because they often lack even basic foods in sufficient quantity. The HI virus reduces the body's ability to absorb nutrients, making good nutrition especially important to people living with the disease, and particularly devastating to those who cannot afford it.
"The problem of food, in so many southern African countries, is desperately acute," Stephen Lewis, the UN's special envoy on HIV/AIDS in Africa, pointed out recently. "I'm not merely talking nutrition; I'm talking survival. Enough food not to be starving and perpetually hungry, so hungry it robs your immune system of its ability to fight the virus."
The World Food Programme has expanded its focus on disaster and famine relief to include providing nutritional support to HIV/AIDS programmes in eight African countries. In general, though, the issue of food security is still not attracting anything like the international attention and resources that ARVs has.
In South Africa, in particular, the issue of nutrition has been marginalised by a damaging debate that has tended to frame it as an alternative to ARV drugs. Statements by the health minister, suggesting that eating immune-boosting foods, like garlic and olive oil, can delay the need for ARV drugs, have been perceived as a tactic to divert attention from the slow place of the government's ARV rollout.
In fact, say many nutritionists, she was on the right track, although she could be accused of bad marketing.
In the early days of the epidemic, when South African David Patient was diagnosed as HIV positive, doctors told him there was nothing they could do. Patient began watching his diet - avoiding sugar and fast foods, eating more fresh fruits and vegetables and taking multivitamin tablets - because, he says: "It was the only thing I could do to empower myself".
Twenty-two years later, Patient recently started taking ARVs because he wanted to lower his viral load enough to safely father a child. In his view, the successful promotion of good nutrition will mean changing the perception of AIDS as an automatic death sentence.
"For 20 years we've been telling people AIDS kills, and now we're saying, 'you can live with this disease', so we need to remarket it," he told PlusNews. "We need to educate the population about wellness, so people realise that their health is in their hands."
In the last five years, Patient said, nutrition has become increasingly "mainstream". Positive living campaigns have helped spread awareness and the "either or" debate has evolved into widespread recognition that nutrition is essential, both as a means of postponing the time when ARV treatment becomes necessary, and in terms of the body's ability to handle the powerful drugs.
The key issue now is one of affordability. With poverty deepening across much of Africa, most people living with HIV do not have the resources to support a healthy diet. In Southern Africa they fill up on starchy maize-based staples that have been largely stripped of their nutrient content as a result of food processing.
A more sustainable solution to food insecurity may come in the form of nutritional supplements that can be cheaply produced and easily distributed.
Industrial chemist Basil Kransdorff developed one such product three years ago at the request of Community AIDS Response, a Johannesburg-based NGO that provides home-based care to severely ill AIDS patients. The product, called ePap, is a powdery mixture of pre-cooked maize meal, soya and a host of vitamins and minerals that can be mixed with cold or lukewarm water or milk to create a filling porridge or shake.
According to Kransdorff, one portion of ePap has 29 times the nutritional value of refined maize meal and is nutritionally equivalent to eating a five-course meal. Without fanfare, largely through word of mouth, ePap has developed into something of an international phenomenon. Distributed mainly by NGOs and community projects, 2 million portions of ePap a month are now consumed in 17 countries across the continent.
Kransdorff believes he may have hit upon "an African solution to an African problem" - an affordable intervention that can empower people with HIV to continue living productive lives, while governments develop the capacity needed to manage large-scale ARV rollouts.
"My belief is that with good nutrition we can turn the HIV pandemic into one very similar to diabetes, where you can live with the problem and manage it with good nutrition and medicines," Kransdorff said. "Parents can carry on living, working and caring for their children."
[Resources: "Living well with HIV/AIDS - A manual on nutritional care and support for people living with HIV/AIDS", - www.fao.org
ProNut-HIV - an electronic forum on Nutrition and HIV/AIDS - www.pronutrition.org]