A large proportion of HIV/AIDS patients are malnourished and, as a result, their bodies are unable to process the medication. Patients that are suﬀering from malnutrition are more susceptible to opportunistic infections, even if they are receiving antiretroviral therapy. Good nutrition is crucial for HIV positive people, especially children, because a diet rich in energy, protein and micronutrients helps to strengthen the body's immune system, increase energy levels and maintain a healthy body weight.
Thousands of children in Mumbai are receiving daily ART and most of these children are also chronically malnourished. Even before their HIV status worsens, many children with HIV are nutritionally deprived because of their poverty. Children with HIV are more likely to be malnourished because of reductions in appetite, increased use of calories to ﬁght infections, an increased metabolic rate and decreased intestinal absorption of micro-nutrients, (Reynolds, 2009). In ways not totally understood, ART is rendered less effective for patients who are simultaneously suffering from malnutrition. In part this is due to changes in absorption of drugs (Ivers, 2009). In order to maximize beneﬁt from the drug protocol, their chronic malnutrition needs to be reduced.
HIV-infected children receive daily ART that costs ﬁfteen dollars per day. To supply this same child with sufficient nutrition, it would cost less than ten cents per day. (MDACS) Without these ten cents, the fifteen-dollar ART is less ineffective and compliance may be poor. Although poverty is certainly a barrier, some families would be able to provide basic nutrition with proper nutritional and ﬁnancial guidance (MDACS).
In Mumbai, India, there are plenty of funds to purchase drugs for every HIV positive person that requires them, but there are no funds to deliver the drugs to the patients. Most patients are unable to spend several hours needed to travel to one of the main government hospitals to pick up the medication. As a result, many people forgo medication that is crucial to their health and available to them for free.
Funding agencies for AIDS prevention and control impose severe operational limits to prevent fraud. However this prevents hospitals from providing crucial services to patients. We plan on building an agile collaborative organization that will be able to address these structural deﬁciencies while maintaining tight oversight.
HIV-infected children who are also suffering from malnutrition mostly fall into two groups of children that have been orphaned by AIDS and are living with relatives that don't have the resources to care for an additional child or children of single mothers that are unable to ﬁnd employment because of their gender and HIV status. The ﬁrst type of family typically earns enough income to own luxuries such as furniture and television sets. However, most of these people would have to reallocate their budgets to support another child. With proper counseling, these families would be able to afford proper nutrition for their children.
We hope, through proper nutritional counseling and education, to help families allocate their income and choose foods that will help their bodies absorb their treatment to the maximum extent possible.
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