HIV/AIDS
PUBLICATIONS
Food
and Water Safety for Persons Infected with HIV
CDC,
June 9, 2003
RCSA
Food Security Strategic Option
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Multisectoral
Responses to HIV/AIDS
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Acrobat Reader)
HIV/AIDS-RELATED
COMPLICATIONS
COPING
WITH DISCOMFORTS
Malnutrition, severe weight loss, and gastrointestinal problems are common
complaints of HIV/AIDS. Continuous nutritional care can help to promote intake
of food and improve weight gain during periods of wellness. Nutritional care
can also help address malnutrition and gastrointestinal complications during
periods of illness.
WHEN YOUR MOUTH
IS SORE
Enjoy foods with a smooth creamy texture like yogurt, whipped potato, melted
ice-cream. Avoid lumpy foods. Instead blend all foods.
Choose soft foods such as macaroni and cheese, stews, custard, well-cooked
vegetables, soft fruit such as banana, mango, papaya, pineapple, etc.
Eat less acidic foods such as orange juice; spicy foods made with a lot of
pepper; salty foods such as salt fish; rough or "grainy" foods such
a popcorn, chips or raw vegetables.
Foods at room temperature or even cold foods are generally less irritating.
Avoid hot foods.
Rinse your mouth after every meal with a mild mouthwash. (Suggestion: 1 teaspoon
baking soda to 2 cups warm water).
WHEN YOU HAVE
DIARRHEA
Diarrhea is common among patients with HIV infection and may be resistant
to treatment. Regardless, a causative intestinal pathogen should always be
sought, since many do respond to treatment. Although diarrhea in HIV/AIDS
often cannot be alleviated by dietary changes, the following suggestions may
be helpful. The primary goal here is to prevent dehydration.
Eat less foods with a laxative effect such as prunes, prune juice, raw fruits
and vegetables. They may make diarrhea worse.
Because they can make diarrhea worse, cut back on fatty foods and milk or
milk-based beverages such as ice-cream, milk shake, cheese, milk powder etc.
Drink liquids between meals, rather than with meals.
Fill ice-cube trays with favorite juices instead of water and suck them throughout
the day.
Watch for signs of dehydration. Take small, frequent sips of fluid to replace
fluid and mineral losses; broth, juices and nectars are good choices.
Eat foods that are good sources of pectins and gums such as oatmeal, dried
beans, apples, beans, pears and other fruits and vegetables. Bran-type fibers,
seeds, and husks of grain should be limited at this time.
Avoid caffeine containing foods such as coffee, tea, chocolate and some carbonated
beverages.
Since they may cause gas and cramps, avoid carbonated drinks, cabbage, and
some green leafy vegetables, beans, cauliflower, highly spiced foods, and
too many sweets if cramping is a problem.
Eat small, frequent meals served at room temperature.
REMEMBER: Taking charge of what you eat should
give you a sense of control over a very important part of your life. Make
what you eat a priority and part of your daily routine.
WHEN YOU ARE NAUSEOUS
Nausea and vomiting can affect food intake and nutritional status. Not eating
only contributes to more nausea and wasting. So eat anyway! The following
recommendations are made to help combat this discomfort:
Munch on dry crackers or plain toast to help absorb stomach acid.
Avoid raw, fried or spicy foods. Instead, enjoy well-cooked foods that are
easy for you to digest.
Do not eat and drink at the same time. Eat first, then wait at least half
hour before drinking any beverage.
Enjoy ginger tea, ginger ale or just grate fresh ginger and sprinkle in drinks
and food.
Sniff a slice of fresh lemon or lime for 2-3 minutes to help settle your stomach.
Sip peppermint tea throughout the day. It will help settle your stomach. It
relieves gas and bloating as well
Eat slowly and chew your food well.
Eat frequent small meals and snacks instead of large meals.
Sit upright for at least 1 hour after eating to ease digestion.
Eat larger meals at times when feeling better.
Monitor and reschedule meals if nausea occurs at the same time of day.
Avoid an empty stomach by eating small frequent meals slowly throughout the
day since they are often easier to handle.
In the absence of lesions, eat dry foods such as crackers or toast especially
if nausea occurs in the morning.
Eat soft, bland foods that are easy to tolerate, such as custards, mashed
potato, yams or other vegetables, yogurt, etc.
Eat meals before taking medications that may cause nausea.
Maintain good room ventilation.
Since they are usually less aromatic and better tolerated, try cold entrees
instead of hot ones.
Stay away from meal preparation areas if food odor provokes nausea.
Avoid fatty or greasy foods.
Avoid very sweet foods.
Chew foods thoroughly and slowly.
Replace fluids when vomiting occurs. Broth, ginger ale and juices are good
choices.
Avoid reclining or lying down immediately after eating.
WHEN YOUR MOUTH
IS DRY
Sip juices and other fluids throughout the day.
Dip dry foods into liquids before eating. For example bread into tea, crackers
into milk, etc.
Suck on hard candies, ice or sour fruit such as lemon, lime, sour orange or
tamarind throughout the day.
Use extra gravy, margarine, mayonnaise, sauce, etc. to moisten foods.
WHEN SWALLOWING
IS DIFFICULT (Mouth Ulcers)
When oral and esophageal lesions from candidiasis, herpes simplex, etc., make
chewing and or swallowing food painful or difficult, nutritional status may
be compromised. In such cases, foods that will not irritate the throat are
highly recommended. The following suggestions are recommended:
Foods eaten at room temperature are more soothing. Avoid very hot or very
cold foods.
Enjoy foods with soft-texture such as whipped potatoes, well-crushed banana,
yam, dasheen, etc. Use a blender or grinder when possible.
Avoid sticky, dry foods like peanut butter since they may be difficult to
swallow.
Avoid commercial mouthwash because the alcohol may dry your mouth
Eat foods that will not irritate your throat.
Eat single textured foods like mashed potatoes or cooked oatmeal.
Eat soft/semi-sold foods or liquid/pureed foods.
Use a straw to help when drinking to avoid irritating lesions.
Soak some dry foods in liquids such as soups, stews, coffee, milk, cooked
cereal, soup, or tea.
Use hard candy or chewing gum to help stimulate saliva production if mouth
is dry.
Avoid coarse foods such as nuts, corn and rice, since they can get stuck in
the throat.
Avoid dry, crisp, rough-textured foods.
Avoid irritating lesions by eliminating spicy, as well as acidic foods including
citrus fruits and juices.
Avoid sticky, dry foods like peanut butter since it may be difficult to swallow.
Also avoid slippery foods like Noodles, etc., they may slide down too fast
and possibly result in aspiration pneumonia or aspiration-related illnesses.
KEEPING YOUR FOOD
SAFE
With HIV/AIDS, your body becomes less effective at fighting bacteria that
can grow in unsafely handled food. The following suggestions can be useful
when buying, preparing and storing food. A basic knowledge of the most common
harmful bacteria can go a long way in assisting you to eat defensively.
Wash all food preparation utensils in hot soapy water.
Use separate cutting boards for cooked and raw foods.
When eating out, persons with HIV/AIDS need to avoid the same foods in restaurants
that they would avoid at home.
All food should
be well-cooked.
If the food looks undercooked send it back. Don't be afraid to ask questions!
If you are unfamiliar with a particular dish or are unsure about the ingredients,
ask before ordering.
If the food looks undercooked send it back. Don't be afraid to ask questions!
If you are unfamiliar with a particular dish or are unsure about the ingredients,
ask before ordering.
REMEMBER: Taking charge of what you eat should
give you a sense of control over a very important part of your life. Make
what you eat a priority and part of your daily routine.
BUYING FOOD
Do not buy or use cans with bulges or those with leaks or dents.
Never buy excessive amounts of food since it may spoil before you eat it.
In the supermarket, select canned and dry foods first then, select perishables
such as meat, poultry, fish, eggs and milk before going to the cashier.
Place packaged meat, poultry or fish in a plastic bag before putting it in
the shopping cart. This prevents drippings from coming into contact with other
foods which can cause contamination.
The chilled and frozen foods you purchase, should be placed in the refrigerator
or freezer as soon as possible.
STORING YOUR
FOOD
Refrigerate or freeze perishable items as soon as possible.
Use airtight containers, plastic wrap or foil to protect opened foods
Date foods before storing to help you use previously bought foods first.
COOKING YOUR FOOD
Heat kills bacteria! Prevent food poisoning by properly cooking all foods
Don't eat food that has been left at room temperature for more than 2 hours.
Do not thaw food at room temperature. Instead, thaw food in the refrigerator,
under cold running water, or defrost in a microwave oven.
Eat cooked foods while they are still hot.
Thoroughly cook meat, poultry, fish, and eggs. Do not eat foods made with
raw animal flesh.
Heat leftovers thoroughly before eating.
Wash and scrub vegetables and fruits before eating or cooking them.
Avoid runny eggs; make sure that the yolk and white are firm.
Boil all drinking water for at least 3 minutes before drinking. Don't forget
to boil water used for making ice.
Never eat food you think may be spoiled. Wash your hands thoroughly with warm,
soapy water before handling or eating food.
GUIDELINES FOR
BALANCED MEAL PLANS
Good nutrition is important for everyone. It is a key part of the treatment
for HIV and AIDS. One fact is clear, malnutrition is common in HIV and AIDS.
When faced with the risk of malnutrition, it is important to act quickly to
maintain nutritional health. Nutrition intervention can enhance your quality
of life.
The following nutrition
principles can provide a blueprint for this health plan:
Eat a variety of foods from each of the food groups everyday.
Select foods that are rich in micronutrient.
Eat small, frequent meals or snacks (at least four-six times per day).
Drink sufficient fluids (at least 8 cups) every day.
Increase caloric intake from carbohydrates and/or protein-rich foods to gain
or maintain desirable weight.
Take a multivitamin/mineral supplement.
Avoid using chemical stimulants such as caffeinated drinks brewed coffee,
some dark teas, and regular sodas), alcoholic drinks, or recreational drugs.
Guidelines for Poor Appetite:
Anorexia, a lack of appetite, is a common symptom for individuals diagnosed
with HIV. Anorexia may result from depression, fever, side effects of medication,
and other causes. The most useful technique to enhance intake is the consumption
of small, frequent meals and snacks consisting of nutritionally dense foods.
Nausea and vomiting occur with many opportunistic infections. Cool, clear
beverages, dry bread and crackers may help to calm the stomach. When they
do feel like eating, individuals diagnosed with HIV tend to prefer and can
tolerate frequent small meals and snacks rather than large meals. When diarrhea
is present, meals should also be low in caffeine, fat and lactose-containing
foods such as milk and milk-based beverages, due to malabsorption.
The following suggestions
may be helpful:
Pass up low-calorie foods and beverages for example, tea, and coffee.
Try to eat at regularly scheduled times each day.
Encourage high calorie/protein snacks.
Eat favorite foods.
Drink liquids between rather than with meal or snack.
Arrange to eat with family or friends.
Try new foods to tempt the appetite.
Guidelines
for Altered Taste:
Nutrition plays a big part in enabling patients to properly take medication,
manage side effects and maintain adequate nourishment. Oral candidiasis is
common in persons with HIV/AIDS. Symptoms include soreness of the mouth and
tongue, often described as a "burnt" feeling and pain or difficulty
with swallowing. Alternate feeding routes should be considered when painful
mouth affect food intake. Oral complications and drug treatments can cause
changes in taste. This may adversely affect food intake and in turn nutritional
status.
To help overcome unpleasant
or reduced taste sensations, the following are recommended:
Alter the sweetness or saltiness or tartness of foods.
Try new foods.
Eat foods cold or at room temperature.
Enhance flavors by experimenting with herbs and spices.
Marinate meat, poultry, fish and beans to further enhance flavor.
HIV
- NUTRITION RESOURCES
U.S. Government Resources- Centers for Disease Control and
Prevention (CDC): An agency of the Department of Health and Human Services,
the CDC health surveillance system monitors and attempts to prevent the outbreak
of disease.
HHS - AIDSInfo: On December 2, 2002, the HIV/AIDS Clinical Trials Information
Service (ACTIS) and its sister service, the HIV/AIDS Treatment Information
Service (ATIS), were merged into AIDSinfo.
The AIDSinfo project provides all of the services that are currently available
from ACTIS and ATIS, as well as quick and easy access to wide-ranging Federal
resources on HIV/AIDS clinical research, HIV treatment and prevention, and
medical practice guidelines for health care providers and consumers.
Center for Disease Control (CDC) National Prevention Information Network:
The HIV/AIDS section of the NPIN Web site is designed to facilitate the sharing
of information and resources on HIV and AIDS for all individuals searching
for prevention information.
Centers for Medicare & Medicaid Services (CMS): Formerly known as HCFA,
this federal agency administers Medicare, Medicaid and the State Children's
Health Insurance Program (SCHIP).
HHS Office on Women's Health: The Office on Women's Health coordinates women's
health efforts in HHS to eliminate disparities in health status and supports
culturally sensitive educational programs that encourage women to take personal
responsibility for their own health and wellness.
Department of Health and Human Services HIV/AIDS Bureau (HAB/HRSA/DHHS): Provides
federal funding for HIV/AIDS care for low-income, uninsured, and underinsured
individuals.
HHS - Office of Minority Health Advises the Secretary and the Office of Public
Health and Science (OPHS) on public health issues affecting minority populations.
National Institutes of Health Office of AIDS Research: The NIH Office of AIDS
Research (OAR) is "responsible for the scientific, budgetary, legislative,
and policy elements of the NIH AIDS research program."
Substance Abuse and Mental Health Services Administration (SAMHSA): Federal
agency responsible for improving the quality and availability of prevention,
treatment, and rehabilitation services in order to reduce illness, death,
disability, and societal costs resulting from substance abuse and mental illnesses.
Center for Disease Control (CDC) National Health Statistics HIV/AIDS
Fast Stats Page: Quick government statistics on the incidence of HIV and AIDS
in the U.S.
LOCAL,
NATIONAL AND INTERNATIONAL CONSULTING
National/International Consulting. TvT Associates, Inc., in collaboration
with USAID Ethiopia. Health/Nutrition Consultant. Work as part of a technical
evaluation team throughout Ethiopia to evaluate the impact of USAID’s
Title II program of food security and health outcome measures; develop strategic
plan for further improvements.
Land O’Lakes, Inc., in collaboration with USAID South Africa. HIV/AIDS
Nutrition Consultant. Work as part of a team in South Africa to develop nutrition
and food related strategies to prevent Mother-To-Child Transmission of HIV.
Develop nutrition response to HIV/AIDS.
Comprehensive AIDS Training Initiative (CATI) at Howard University, Washington,
DC, Expert Nutrition Faculty. Educate professionals and paraprofessionals
about nutrition andHIV/AIDS; help in the development of community-based HIV/AIDS
nutrition-related programs.
National Minority AIDS Education Training Center (NMAETC) at Howard University,
Washington, D.C. —Expert Nutrition Faculty. Provide current scientific
information, clinical nutrition guidelines and training and act as preceptor
to medical/clinical professionals in the field of HIV/AIDS.
CONCLUSION
HIV/AIDS have taken a foothold worldwide. While prevention remains the most
effective tool in managing HIV/AIDS, poor nutrition is one of the most pervasive
factors that exacerbates this virus. Malnutrition weakens the immune system
and makes illness worse. The challenge is to not only prevent the spread of
HIV/AIDS but, to help those already infected to continue to live a productive
life in spite of the disease. For this reason nutrition intervention is paramount
in helping to mitigate the impact of HIV/AIDS.
REFERENCES
CITED
Babamento G and Kotler DP (1997) Malnutrition in HIV infection
Gastrointestinal Clin North Am 26:393-415.
Chandra RK. (1997) Nutrition and the immune system: An introduction. Am J
Clin Nutr 66:460S-463S
Fields-Gardner, C. et. al (1997). A Clinician’s guide to Nutrition in
HIV and AIDS. American Dietetic Association, Chicago IL.
Nerad JL et. al (1994). Nutritional aspects of HIV infection. In Management
of Infection in HIV Disease. Infect Dis ClinNorth Am. 1994;8:499-515.
HIV/AIDS
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