[Guyana] Poor nutrition, poverty may be affecting HIV patients - govt welfare subsidy in the works

from Stabroek News

By Iana Seales

In the last decade nothing has grabbed more attention as far as health issues go in Guyana than HIV/AIDS and given its far-reaching implications and devastating impact, international funding continues to come in as the fight against this epidemic endures. But there is a side of HIV/AIDS we hardly hear about.

Perhaps it pales in relevance to the successes we have had locally in making adequate treatment and drugs available free of cost, in manufacturing our own antiretroviral drugs, in commencing viral load testing and in getting more infected persons to join the treatment programme at the Genito-Urinary Medical (GUM) Clinic at the Georgetown Public Hospital.

But the story we are still to know is just how many infected persons are getting the proper nutrition they need and how many are wasting away because of inadequate meals. It is of concern because poverty is part of the lives of many infected persons, particularly those living on the streets and in run-down sections of the city, who eat perhaps one meal a day or none at all.

This is troubling since in order for the antiretroviral (ARV) therapy to be of effect, those using it must have regular meals. In fact, infected persons who are homeless and without family support and who have no access to regular meals are not offered ARV treatment.

Deficiencies of important nutrients, vitamins and minerals severely affect the body's immune function and studies have shown that this coupled with the destructive effects of HIV on the immune system, increases the risk of infected persons contracting opportunistic infections and dying.

Not on ARV treatment

There are a number of reasons why some infected persons do not qualify for ARV treatment. Firstly, their CD4 count is above 350 in which case they are considered to be doing okay but they could be placed on treatment if they have an opportunistic infection. Then there are tuberculosis patients who are at a high risk of dying faster.

Some infected persons who default on the treatment programme, by missing doses and not taking their drugs on time also do not qualify for ARV treatment.

Dr Jadunauth Raghunauth who now heads the GUM Clinic at the Georgetown Public Hospital recently explained that it is absolutely necessary that certain requirements are met before infected persons are placed on ARV treatment because some persons run the risk of developing resistance to the treatment.

"We have to be assured that persons on treatment are taking the drugs and doing so on time when they are required to. This is important and though 95 percent adherence is somewhat acceptable, we expect patients to have 100 percent," he related.

In the years that he has worked with HIV infected persons, Dr Raghunauth said he has not known any specific case whereby persons could not be placed on ARV treatment mainly because of their nutritional status. But he admits that there may be many infected people out there who are poor and are not getting help in terms of regular meals.

Dr Emanuel Cummings, Assistant Dean within the Medical Faculty of the University of Guyana was part of a team that recently studied the nutritional status of infected persons who attend the GUM clinic.

Of the 150 patients studied, the majority, 55.17% were unemployed and 44.83% were employed. Some 59.31% said they do not earn a salary (some did not wish to disclose their income). While 10.34% earned between $10,000 and $20,000 (US$50-US$100); 8.97% earned more than $80,000 (>$US400) and 2.07% earned less than $10,000 (

On average, more than half of the participants ate beef, ham, luncheon meat, salmon, pork, shellfish, soy protein, hot dogs and sausages, pepperoni and bacon less than once per month. Of the protein group, the most common foods eaten on a fairly regular basis were fried chicken 32.39%, 1-2 times per week; eggs - 30.99%, 3-4 times per week; legumes - 37.32%, 1-2 times per week; white fish - and chicken - 32.39% - more than 5 times per week.

The study also found that 66.52% of patients thought that their nutritional intake was satisfactory; 33.10% thought that it was unsatisfactory and 69% did not know whether it was satisfactory or not and 65.52% were unable to respond to the question.

It said that 15.17% attribute their lack of proper nutrition to the lack of money; 6.90% attributed this to a lack of appetite; 4.83% attributed this to their lack of knowledge; and 3.45% attributed it to a lack of access to food.

Government subsidy

programme

A street dweller who walked into Stabroek News a few months back begging for something to eat aroused much curiosity because of his deteriorating physical condition. Sickly is a mild way of describing how he looked and though he did not initially say that he was HIV positive, people who saw him concluded that almost immediately.

"I ain't gat nobody to give me food and de condition I in right now people ain't even wan give me a dollar when I beg. Is na me family alone turn from me is everybody I know in me life," the street dweller said.

He looked about ten years older than his stated age of 27 years and his physical condition was bad. When he spoke with Stabroek News he was covered in ulcers from head to toe and frothing at the mouth.

The man said he was not on ARVs because of his economic situation and though he had been treated for opportunistic infections many times he always slipped back into a deteriorating state.

Several years ago he recalled living a reckless life in Cayenne, French Guiana. He summed up his life then in three words: drinking, money and sex. In his late teens he came back to Guyana with nothing and had no place to go but on the street. He later learned that he was infected with HIV.

He said dying was not something he feared. For him, it would be "a way out of the endless days of hunger". But he said while he was waiting to "close his eyes and go wherever," it would be nice to get a plate of food each day.

What then could be done for infected persons like the street dweller who is thankful if he gets one meal a day?

Perhaps soup kitchens in the city and a few other areas that are open to anyone who is in need of a meal would be the answer. That way, there would be no stigma attached and those really in need could benefit. But even this appears too demanding an effort in the long term, which is why the idea of government offering a subsidy to infected persons is a more welcome initiative.

Minister of Health, Dr Leslie Ramsammy when contacted on this said it is something that government is planning. He said they are trying to put together funds at the moment to introduce such a programme.

"We are trying to make the resources available and if I am to project when such a programme would come on stream I would say some time in 2007 providing everything is in place," the minister added. But in the meantime a few non-governmental organisations (NGOs) have begun providing meals to persons in need regardless of their status. These include the Network of Guyanese Living With and Affected by HIV/AIDS (G+) and Comforting Hearts, which is based in New Amsterdam, Berbice.

Free Hot Meals

Early this month, Comforting Hearts started its UNICEF-sponsored Hot Meals Programme, which has become very popular. Free meals are offered to children and adults in the area who are in need and among them are HIV/AIDS infected and affected children and adults.

Beaming boys and girls flocked the Comforting Hearts building at Coopers Lane, New Amsterdam when Stabroek News visited around midday last week, awaiting lunch. And when wafts of delicious frying fish floated on the air, one boy happily announced, "Fish today".

Shawndelle Charles-Gouveia, Project Coordinator at the NGO related that the programme was initiated for orphans and vulnerable children in the area but they are also providing meals for their shut-in clients (those who are really ill) and other adults. When it started earlier this month, she said, they were catering for around 60 persons but as word spread that number quickly climbed to 100.

She said Comforting Hearts handed out hampers in the past to persons infected and affected by HIV but it was not long before they realised that the children were not benefiting.

"We embarked on this new project after we found that the children were still in need and that many of them were not going to school because of [a lack of] meals. A lot of them could not attend school because they had nothing to eat," Charles-Gouveia said.

According to her, the programme is going well and though UNICEF funding is only for one year she is optimistic it will continue to receive support because of the impact it has already had in the Berbice area.

Comforting Hearts has already received a request from the New Amsterdam Hospital to provide meals for a few shut-in patients. They also have plans to take meals home to persons who are in need and do not want to go to the NGO.

A nutritionist has joined forces with the NGO so balanced meals are being prepared, Charles-Gouveia related. She said they had sessions with their clients before the Hot Meals Programme started and persons were educated on how to prepare healthy low-cost dishes.

Comforting Hearts also offers home-based care, counselling and voluntary counselling and testing. There are 12 full-time persons on staff, 20 mentors who work with the children and other volunteers.

Charles-Gouveia who has been a volunteer since her early teenage years has been at Comforting Hearts since 2002, four years after the organisation started operating in the Berbice area. She said bringing a smile to a child's face does a lot in terms of job satisfaction and she also loves working in a field where she is able to help people on a daily basis.

She added that the people she works with have an unwavering dedication, which makes it easier to get things done. "Sometimes we are here until eight at nights and no one ever complains because this is what we do," she said.

Dusilley Cannings, President of G+ said their nutritional programme will commence some time next month since they recently got the okay that was required. She said that they have long recognised the need for such a programme and hence its provision in their recent proposal to the Ministry of Health.

According to her, this support effort will complement what the Ministry of Health will soon implement - a welfare subsidy programme for persons living with and affected by the disease.

Cannings said G+ hopes to distribute food hampers to persons in serious need on a regular basis. She said orphans and vulnerable children will also benefit from hampers. Since their work is also about empowering those affected with the disease, Cannings said, they will continue to provide basic needs, school materials for orphans and vulnerable children, support and home-based care as well as counselling.

Extending lives

According to the study, the nutritional status of the HIV+ patient is of utmost importance to their quality of life and relates to the ability of that person to live an extended and productive life. This is of utmost importance in Guyana as most of the persons affected by HIV/AIDS fall into the 15-44 age bracket.

"Extending the lives and the economic productiveness of these persons is crucial. Guyana has recently suffered from massive emigration, which has depleted the number of skilled and educated persons. Extending the life span of those affected by HIV/AIDS is of utmost importance in helping to maintain a steady and productive workforce and economy," it said. Further it stated that nutrition and AIDS operate in tandem, both at the individual and at the societal level. Nutritional deficits make people with HIV more susceptible to disease and infections of all sorts. Malnutrition is one of the major clinical manifestations of HIV infection.

At the household level, HIV/AIDS and food security are closely linked: an HIV-infected household increasingly risks food security and malnutrition via declines in work, income and time available for care of younger children, together with increased expenses for health care. Food insecurity may, in turn, further increase both the risk of being exposed to HIV and a household's vulnerability to its increasing impact as the disease progresses.

Nutrition is also linked to treatment, the study added, and as access to antiretroviral drugs improves, clean water supplies and adequate food must be made available as part of an overall treatment, care and support package.