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.

A million deaths is a statistic; one death is a tragedy

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

“Imagination is more important than knowledge”
--Albert Einstein

There are many statistics being presented here at the Mexico City IAC 2008. They are presented via power points, through poster presentations, in graphs, in pie charts and in handouts galore. But somehow all these facts and figures keep going in one ear and out the other, not really sticking and not really bringing the HIV/AIDS epidemic to life.

Fortunately there are a few other ways that information is being presented. For example, in the entrance to the grand exhibit hall, there is an old shack made up of roofing materials, cardboard and other miscellaneous junk. Hanging on the outside of the shack are large photos of people living with the co-infection of TB and HIV. A brief story is written in their own handwriting below their photo. If the handwriting is in a language other than English, then there is a translation into English written in magic marker below the photo and story. People can enter the shack and walk through the small living area, the smaller bedroom and out the other end.

For those of you who have been to Tune Town in Disneyland, it is kind of like walking through Mickey or Minnie’s houses, but not really. This house is filled with additional photos and stories, and none of them are cartoon character happy and peppy, although there is hope and dignity in this house. Even in the shabby furniture (the sofa is an old car or truck bench seat, the tables and chairs are mismatched and look like they were taken from a land fill) there is hope and dignity. There is an old wheel chair in the corner and various personal items here and there. It feels real, almost too real to bear. It looks like so many of the homes we have been invited into around the world, only this one echoes with the stories and voices of many families, many people living with these mutually reinforcing diseases, making it even more powerful.

There are many positive people here, like the 16 year old young woman who moderated a session I attended, introducing the scientific/medical presenters from around the world. She has been HIV positive since birth and she thanked all of us for the chance to express her pride in being HIV positive because, in her native country of Australia, she cannot be so open because of stigma and discrimination. She also brings the issues of HIV/AIDS to life in a way that all the power points in the world could never do.

And finally, every once in a while during a presentation filled with statistics, filled with the problems we are all here trying to address, someone will make a statement that makes us all sit up pay attention just a little bit more. Last night that statement was about the new phrase that the presenter has been hearing recently in Haiti to describe the terrible food crisis there. I don’t speak French so I won’t get that right, but basically it was that people have coined the term “Clorox hungry”, meaning the level of hunger that feels like they have been bleached dry, bleached of everything. I had heard about the riots in Port Au Prince and I had seen the statistics about the cost of food and the rising levels of malnutrition in Haiti, but somehow just the fact that this new term is being used made my blood run cold.

Statistics are important of course, but when this conference is over, it will be these and other such memories that will stick with me, will go in both ears and stay in my mind, probably for a very long time.

How Big is Too Big?

Reflections on the Mexico City IAC 2008
by Janine Schooley, PCI's VP for Technical Services & Program Development

This conference is huge! I’ve never been to such an event. They say there are 25,000 people here, but it feels like more when you are trying to make your way anywhere in the conference center, buy a sandwich, use the rest room, or get on a shuttle bus back to one of the hundreds of hotels participants are using all over this huge city. It is rainy and grey here in Mexico City, but the conference participants don’t seem to mind. There is an energy and a critical mass-ness about such a large group of people all coming together for a common purpose, to Stop AIDS Now!

But is the meeting too large? It’s so gargantuan that they can only hold it every other year. In 2 years it will be held in Vienna. Two years ago it was Toronto. The logistics are mind boggling and so I choose not to boggle my mind with them, simply thanking my lucky stars that it isn’t MY job to organize this monstrosity. The program book (and that’s without the supplemental program which is quite large itself) is the size of a good sized city’s phone book.

But it is the World AIDS Conference and the world’s eyes are upon us. The size and scope is a good thing when you have President Clinton speaking and the paparazzi’s cameras buzzing, sending images and messages around the globe. This conference may be too big for me, but it isn’t too big for the topic of HIV and AIDS. HIV and AIDS needs a meeting of this size to attract the attention of the media and the politicians. The energy and the scale of the conference is helping to ensure that this unprecedented humanitarian crisis does not go unnoticed, does not fall off the headlines, and does not fade from the consciousness of the planet.

So is this monstrosity too monstrous? NO! It is just the right size for the job, the job of helping us all tackle HIV and AIDS, raise awareness, keep the funding flowing, keep the folks in the trenches motivated and uplifted, and keep us all reminded that size does matter, particularly when the dragon we are trying to slay is as huge and monstrous as it is…

Let’s just hope Vienna is big enough for IAC 2010!