Where’s the “N” in PreveNtion?

by Janine Schooley, PCI's VP for Technical Services & Program Development

August 7, 2008
Mexico City IAC

Well, actually there are 2 “Ns” in prevention so you would think that nutrition and food security would be considered in more discussions about HIV prevention at the World AIDS Conference this week. It is certainly gratifying to hear so many people now talking about food and food security in connection with treatment, care and support, but I did not hear one person mention the role that food and nutrition security (FNS) plays in prevention! When I was in Bangkok last year at a regional meeting on HIV and Food, several participants flat out told me that there was no link between food and prevention. I was astonished!

Starting with prevention of mother to child transmission, when done right in countries with infant mortality rates above 25 per 1,000 live births, PMTCT must involve the promotion, protection and support of exclusive breastfeeding to 6 months followed by clean, safe, affordable and nutritious complementary foods. Exclusive breastfeeding is the first defense against food insecurity (among other things) and is critical for child survival and the fight against malnutrition, as well as HIV.

Then there is the link between ART adherence and food. Yes, this relates to therapeutic feeding and treatment, but it also relates to prevention in the sense that people who do not have food, or do not have access to services/medication because of the high cost of food and household food insecurity, will be more likely to abandon treatment, have poorer immune status, adopt a fatalistic attitude about their health, and may adopt more risky behaviors as a result.

Livelihood security is an important part of FNS and, as such, must be linked to prevention in that households need to have sufficient funding to buy food, medications, condoms if not available for free, etc. Women, girls and boys may resort to risky sexual behaviors in order to put food on the table for themselves or their families. This does not have to result in full out commercial sex work, but sexual favors in return for help with household expenses, including “sugar daddyism” and other similar relationships could lead to infection. I once asked a sex worker in Addis Ababa why she didn’t practice safe sex and she said that she would “rather die a slow death from AIDS than die of hunger”. Hunger can make people do things that they would never otherwise do, particularly if you are a mother with hungry children.

FNS and OVC of course must go together and it is critical that children are well nourished so that they can study in school, have a full and healthy life, free from as many of the risks that lead to HIV as possible. Luckily there is more understanding of the links between children and maternal and child health/primary health care, including nutrition, but it is seldom placed in the prevention context.

Positive living and empowerment are not concepts that only apply to PLWHA. They apply to everyone and are essential for keeping people virus free. Empowerment comes with health and good nutrition, as well as with livelihood security and the ability to grow and/or buy sufficient food. There are likely even more linkages between FNS and HIV prevention, and clearly this needs to be the topic of more discussions and analysis, particularly as the cost of food rises and the world food crisis deepens. I hope that at the next meeting I go to on HIV/AIDS I will hear about a few of them.