Community Care

Infection caused by HIV and malnutrition have a complex interaction and often coexist geographically. Malnutrition has synergistic immune effects and HIV affects nutritional status. HIV care and treatment programs are compelled to confront this dual burden to optimize HIV outcomes. In this article, we review the published literature concerning intervention studies in adults and children and the effect of food prices on HIV treatment programs. While the evidence base is relatively incomplete for specific macronutrient interventions in the context of HIV treatment, it is clear that a new standard of care is needed, guided by experience, rationale, and existing data, in which malnourished patients may easily access nutritional therapies within HIV treatment. From this clinical foundation, we may both treat patients and evaluate novel therapies. Some HIV care and treatment programs provide food-based supplements; however, rising food costs and economic instability may jeopardize the success of these programs. HIV treatment programs may struggle to meet the needs of patients with potential increased rates of malnutrition and food insecurity in the setting of high food prices.

This newsletter was intended as a quarterly publication to provide an update on the activities of the Centre for International Mental Health, as a means of communication with students, and to provide a means of communication to facilitate further collaboration in mental health service development.

The HIV/AIDS pandemic places tremendous strains on households and communities to care for those who are chronically ill as well as the orphans and the elderly. This paper examines some of the coping mechanisms seen within Malawian families and communities as they respond to the HIV/AIDS pandemic. The extended family system is still the first choice of coping though it is under great strain due to HIV/AIDS. This applies to both caring for the chronically ill as well as taking care of orphans. In the absence of relatives (or unwilling relatives), children assume the role of caregivers to their parents or indeed in the case of the death of both parents children care for themselves. Early marriages, dropping out of school in order to head a family, casual labor and piece work, small scale sales, are some of the strategies being used in Malawi to cope with the impacts of HIV/AIDS. In addition to these informal social safety nets, community based organizations have also been established in different parts of Malawi with the aim of assisting those families affected by HIV/AIDS.

This grass-roots level mental health awareness programme considerably increased use of community-based mental health services in a part of Nigeria where knowledge about treatability of mental illness was limited. The benefits of the programme were sustained for a significant period after the initial awareness programme. In order for attitude changes to be reinforced, similar awareness programmes must be repeated at regular intervals.

Many important studies have identified what puts vulnerable women at risk for HIV/AIDS and gender-based violence. However, solving these problems on a larger economic scale will require institutional participation and political support for women’s equity, HIV-prevention literacy, and a broader HIV-prevention agenda. This can be accomplished with a multilevel, collaborative response among government, communities, and international partners using multiple prevention strategies and fostering sustainability.

The cross sectional study examined the association between mental illness and HIV risk behaviors among 645 randomly selected individuals living in households in a South African township. A self-administered translated questionnaire investigated sexual risk behaviors [including sexual partners, condom use, casual sexual contacts, and sex in exchange for money, drugs or a place to stay (transactional sex)]. The findings emphasize the substantial burden of mental illness in this setting, and its association with forced and transactional sex. Public health interventions are needed to address the dual burden of HIV/AIDS and mental illness in this and similar settings. This study found that having evidence of mental illness was associated with experiencing forced sex, transactional sex and increased condom use.

This self-teach manual is designed to help new and recently promoted managers of programs serving vulnerable children and youth who are affected by disease, extreme poverty, and trauma. The Way We Care promotes a child-focused and family-centered approach and emphasizes the newest literature, as it highlights the integration of prevention, care, and treatment and addresses both HIV and risk factors for other diseases.

Factsheet that discusses PROFILES, a computer-based software and advocacy process developed to assist policy-makers in quantifying the consequences of nutritional deficiencies and making projections about the benefits of nutrition programs and policies.

BACKGROUND: The clinical implications of lower body weight in drug using populations are uncertain given that lower mean weights may still fall within the healthy range. OBJECTIVES: To determine the effect of type, mode and frequency of drug use on underlying body composition after accounting for differences in body shape and size. METHODS: We conducted a cross-sectional analysis of 511 participants from the Tufts Nutrition Collaborative (TNC) Study. Data included measures of body composition, a 24-hour dietary recall, and a detailed health history and lifestyle questionnaire. Multivariate regression analysis was used to determine the independent effect of drug use on percent body fat (BF) after adjusting for BMI and waist circumference. RESULTS: Heavy injection drug users (IDUs) had a 2.6% lower percent BF than non-users after adjusting for BMI, waist circumference, and other confounders. (p = 0.0006). Differences in percent BF were predominantly due to higher lean mass, rather than lower fat mass. Cocaine and heroin had similar effects on body composition. CONCLUSIONS: In the U.S., where the general population is prone to over-nutrition, the average percent BF for heavy injectors does not fall into a range low enough to suggest harmful effects. However, in populations with substantial levels of under-nutrition, small differences in percent BF among drug users will have a greater impact on health status. SCIENTIFIC SIGNIFICANCE: Differences in BMI, weight and body composition are not always straightforward. Accounting for underlying nutritional status and relative differences in fat and FFM is critical when interpreting results. diagnosed patients and prevent them from returning to prison.

The guidelines define nutrition actions for service providers to take in providing quality care and support to PLWH. This updated version of the national guidelines, first developed in 2006, provides guidance to service providers in Ethiopia about how to effectively incorporate nutrition into a range of community and facility-based HIV services. The guidelines define nutrition actions for service providers to take in providing quality care and support to PLWH as part of counseling and testing, PMTCT and maternal child and health services, ART, orphans and vulnerable children services, and home-based care.