Meeting the nutritional needs of men, women, boys, and girls in families affected by HIV

Megan Ivankovich

Senior Program Officer, WI-HER, LLC

Right now, millions of families around the globe are affected by HIV. This means they may be dealing with concurrent struggles related to health, nutrition, and food security, among others. We know that sticking to a healthy diet can strengthen the immune system, improve the effectiveness of ARV drugs, and sustain productivity. Yet many people living with HIV (PLHIV) often face challenges related to food access, availability, and utilization, which can further threaten their health.

The USAID ASSIST Project is working with health workers to support these families to thrive. One way is through improving nutrition assessment, counseling, and support (NACS) services, an approach to integrate evidence-based nutrition interventions into health services including the prevention, categorization, and treatment of malnutrition and sustained improved nutritional status. The NACS approach aims to improve the nutritional status of patients by integrating nutrition into policies, programs, and health service delivery infrastructure, by incorporating a self-management approach to counseling, and strengthening the linkages between communities and points of care for nutrition services.

Gender inequality is a major driver of vulnerability to malnutrition and food security, especially for PLHIV. Harmful social, cultural, and economic norms and practices related to nutrition and food security exist in many countries, leading to differences in food access, availability, and utilization for men, women, boys, and girls.

Such norms can limit the amount of nutritious food women and girls receive, as well as unequal access to inputs (e.g., knowledge and skills) and decision making to participate in food security or income-generating activities. HIV can decrease a person’s ability to produce or purchase food, and women and girls are often responsible for taking care of sick family members, both of which can dramatically affect household food security.

Many gender issues can affect NACS services. Cultural norms that influence health-seeking behavior and decision-making power or limit mobility or interaction due to gender can result in unequal access to and utilization of NACS services. Work and household responsibilities also limit males’ and females’ to access and adherence to nutrition support services.

Sometimes services are impacted by inappropriate or discriminatory nutrition counseling that don’t reflect realities at home (e.g., failure to sensitize male partners and mothers-in-law who hold decision-making power) or stigmatizing care from counselors. All of these factors, and more, can limit the impact of NACS services as well as threaten the wellbeing of PLHIV and their families.

Yet with proper planning and action, these gender-related issues can be avoided or addressed. A range of simple yet impactful actions can be taken during the design and implementation of NACS services to assess the unique needs of men, women, boys, and girls in nutrition programs. These include ensuring that sex- and age-disaggregated NACS data are collected and analyzed and encouraging both female and male patients to invite their spouse/partner to the facility to have their nutrition level assessed and be tested for HIV. These actions—and many more—can improve the quality of services and patient outcomes and to ensure existing inequalities are not exacerbated.

A new technical brief to help health workers and program managers respond to gender issues in NACS services was recently published by the USAID ASSIST Project. An Excel database to facilitate the collection and analysis of sex-disaggregated data is also available. The Excel database makes it easy to analyze sex-disaggregated data across a district or a region, and automatically creates charts to view data over time—making it easy to check if the data show a gap between males and females for any given indicator.

NACS has the potential to improve the lives of families across the globe but to ensure the needs of men, women, boys, and girls are met, gender must be considered and properly addressed.

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