Nutrition is the foundation of a robust immunity needed to fight infections
HIV weakens the immunity of a person making them prone to other infections
People living with HIV have increased nutrition needs
New Delhi: HIV (Human immunodeficiency virus) transmits during the exchange of infected body fluid. The main routes of transmission are unprotected sexual interaction; blood transfusion that is not tested for HIV; sharing of needles, syringes, other injecting equipment; from mother to infant during pregnancy, child birth or breastfeeding. HIV infection directly affects the immune system – the fighter of the body that protects one from contracting infections and diseases – and makes an individual prone to other infections. Nutritional deficiencies further weaken the immune system which in turn can affect HIV disease progression and mortality. Adequate nutrition, which is best achieved through the consumption of a balanced healthy diet, is vital for health and survival for all individuals but more so for HIV infected people as they need extra immunity to safeguard themselves from viral infections and diseases. NDTV spoke to Bishow Parajuli, United Nations World Food Programme Representative and Country Director in India to understand the role of nutrition and food security for people living with HIV especially during the COVID-19 pandemic.
NDTV: HIV impacts different age groups from children, adolescents, pregnant women to men in their productive age. How does the food and nutrition needs vary for patients in each of these categories?
Bishow Parajuli: The impact of the disease varies from person to person and the energy requirements vary according to the stage of the disease and severity of the infection. For people living with HIV during the asymptomatic stage, energy needs are increased by 10 per cent over the accepted levels for otherwise healthy people. Increased energy intake of about 20 to 30 per cent is recommended for adults during periods of symptomatic disease or opportunistic infections (illnesses that occur more frequently and are more severe in people with HIV) to maintain body weight. At present, there is no specific data on the impact of HIV/AIDS and related conditions on energy needs during pregnancy and lactation, over and above those requirements already identified for non-infected HIV women. Pregnancy and lactation increase the energy requirements by 350 kcal and 520-600 kcal respectively in non-infected HIV women.
NDTV: In terms of policies to control HIV, how much importance is given to food and nutrition needs? Is there a case for stronger policies in this sphere for HIV/AIDS control programme?
Bishow Parajuli: The nutritional intake depends on the economic aspects of a person. If I have enough income and I can afford to provide immediate food for myself then I guess they are not impacted. But if we are talking about the communities and the population which are not able to afford food and meet various nutrition requirement then obviously for that group of population provision of antiviral drug as well as various counselling and food support will be a fundamental need and that will have a good impact in terms of progress for them to have a normal life.
National Food Security Act (NFSA) 2013 is largely silent on people living with HIV and key populations. NFSA asks states to devise inclusion and exclusion criteria for priority households under targeted Public Distribution System. Few states have included people living HIV as a priority household for support, except for limited criteria like household income. But many states cover such households through the Antyodaya Anna Yojana (AYY). There is a need for clear policy guidance, which will go a long way in improved treatment adherence as well as reduced mortality among PLHIV.
Recently, the Supreme Court had issued an order to allocate food to sex workers which I think is a good move. Since India has one of the largest public distribution programme it doesn’t take much effort to ensure all these people are certainly part of this programme.
NDTV: Is the world going through a double epidemic of HIV and food insecurity amid the COVID-19 pandemic? How has COVID-19 affected the lives of people living with HIV especially in the areas of food and nutrition?
Bishow Parajuli: In countries where there is a high burden of HIV like in Zimbabwe, where 14 per cent of the population is affected, there is also a food crisis. Also, other factors like natural calamities including drought, and economic crisis have seriously affected people. Due to the COVID-19 pandemic, people have lost jobs and in turn access to remittance is decreased. Our projections tell that the number of people facing acute food insecurity stands to rise to 265 million in 2020. Sadly, that will also certainly impact a part of the people living with HIV when food and nutrition are concerned. But, I will not generalise this as HIV has not affected every country in the same way. People living with HIV who during the COVID-19 have lost income would also have reduced access to food and if they are not to benefit from the public distribution system (PDS) they would certainly be affected.
NDTV: What will be the long-term impact of COVID-19 on people living with HIV?
Bishow Parajuli: People living with HIV are already at increased risk of contracting COVID-19. If we talk about the impact of COVID-19 on the food security and nutrition of people living with HIV then it’s multifold. Production capacities are affected; access to food is compromised due to loss of livelihoods and decreased purchasing power; limited dietary diversity due to a shift in diets to more shelf-stable and pre-packaged foods; the lack of consumption of micro and macro nutrients can result in malnutrition; stability is compromised as the markets themselves are highly unstable leading to a great degree of uncertainty. In the longer run, people who have lost jobs and are unable to get back at it or at the same level then the risk will increase.
NDTV: In India, how can food safety nets aid people living with HIV overcome the dual crisis of HIV and COVID-19?
Bishow Parajuli: Important thing is to leave no one behind. The government’s food safety nets are instrumental in this respect, given their wide reach, reliability and affordability. Access to Government’s food safety nets is the most sustainable way of ensuring the food security of people living with HIV. If there are certain groups of people who have faced job loss and are not included in safety net programs then they should be included in one way or the other in current programmes.
NDTV: How is WFP India helping people living with HIV fight the COVID-19 pandemic?
Bishow Parajuli: WFP India is increasingly advocating having no one left behind. We have been focusing on enhancing the inclusion of vulnerable and marginalised groups in food assistance programmes, whether of the government or the voluntary sector. These include people living with HIV/AIDS. In the recent past, we helped an NGO in Lucknow, Uttar Pradesh, to identify and provide food assistance to around 20,000 vulnerable households. We will share that experience with our partners to see how vulnerable groups can be supported and ensure are included in safety net programs.
NDTV: Going forward, how can we protect the basic human right of food security for people living with HIV?
Bishow Parajul: Anyone who needs food should receive food and nobody should go hungry. Along with providing antiretroviral therapy (ART) to HIV patients, we have to provide food security. The key solution is to enable their access to public food safety nets. There are multiple challenges that need to be addressed in this process like many sections of people living with HIV who belong to at-risk groups such as transgender or sex workers do not have the requisite papers to register themselves as beneficiaries of food programmes. We have to devise a means of including them in food safety nets. We also have to counter the stigma surrounding HIV. Also, HIV infected people need to be educated about the importance of nutrition in their fight against the virus.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.