Building partnerships to address nutrition and food insecurity of people living with HIV (PLHIV) in latin america and the Caribbean

Poor nutrition and food insecurity negatively affect antiretroviral adherence and HIV outcomes, but few relevant interventions have been documented in Latin America and the Caribbean (LAC). RAND and the World Food Program formed a partnership to develop and evaluate pilot projects that address the nutritional needs and food insecurity among PLHIV in LAC. With local partners, we conducted formative research in Bolivia, Honduras, and the Dominican Republic among patients at HIV clinics (total n=390). Free listing and pile sorts identified frequently consumed, culturally salient foods; home and market visits supplied contextual information about food consumption, availability, and prices; anthropometric measurements assessed nutritional status; 24-hour food recalls measured micro and macro-nutrient intake; structured interviews collected socio-demographic, food frequency, and food security data; chart abstraction provided health status and adherence information. Common findings included: 1) most PLHIV had household food insecurity, frequently severe; 2) food insecurity often co-existed with overweight and obesity, particularly among women; 3) people's diets tended to be high in fats but low in protein and various micronutrients. Applying these findings in collaboration with local WFP country offices, governmental agencies, associations of PLHIV, and HIV clinics, we designed country-specific pilot projects incorporating locally-tailored nutrition counseling with one or more of the following: a monthly household food ration, linkage to income-generating projects, and/or urban gardens (evaluation is on-going). Formative research and inter-sectoral collaboration supported the design of locally appropriate nutritional interventions for PLHIV, enhanced local nutritional and research capacities, and helped incorporate nutritional guidelines into national policies and clinical practice.