Malawi + 3 more

C-SAFE: HIV/AIDS and Nutrition Newsletter - Issue 3, Jan 2004

Prizes go out to C-SAFE Crossword Puzzle winners
Congratulations to Natalie Kruse, American Red Cross (Malawi) and Michelle Parke, WV Zambia - well done!

Communities Show Solid Understanding of C-SAFE-Suggest Inclusion of Agric Inputs

In November/December 2003, C-SAFE Malawi conducted a series of focus group discussions to verify the effectiveness of C-SAFE's current targeting procedures in an effort to see if the food rations were reaching the most vulnerable households. Findings included: Communities were well aware of the targeting criteria and affirmed that the rations were going to households within these vulnerable groups (households with chronically ill, elderly or disabled members, and households with orphans)Both beneficiaries and non-beneficiaries had a solid understanding of the purpose of C-SAFE, recognizing the positive impact on both food security and agricultural productionWhile there was no mention of stigma attached to the targeting, non-beneficiaries expressed some resentment towards beneficiaries since they are often quite needy/ vulnerable themselves, especially since C-SAFE is unable to meet the current need of all households which fall within the targeting criteria.When asked how they would select beneficiaries from numerous qualifying households, participants said they would prioritize the households with the greatest number of dependants or those with the least household assets. Communities suggested including agricultural inputs in the rations to beneficiary households to address longer-term household needs.C-SAFE Malawi is presently discussing ways of utilizing these findings. For further information contact Clara Hagens at

World AIDS Day Activities

In spite of hectic project schedules, C-SAFE partners in all three countries put on a huge effort for WAD 2003. Starting November 23rd and running through December 5th, C-SAFE partners pulled out all the stops to organize and participate in a huge range of activities, including: hosting both Tommy Thompson and Oprah Winfrey in Zambia (see reports below); facilitating video shows and discussions with staff and partners; distributing red ribbon badges;hosting a photo exhibition at a shopping mall, with information about VCT and peer counselors on hand;distributing brochures and flyers with information about HIV and stigma at food distribution points; posting red ribbons and banners with stigma-reduction messages in prominent locations participating with partners in candlelight services and marches, wearing t-shirts with messages like 'My friend with AIDS is still my friend'; and organizing poetry readings, prayers and staff memorial services to help colleagues and families remember those who have passed away.

TB patients in Zimbabwe Recover Faster with Food Aid

CRS is distributing Corn Soya Blend (CSB) to more than 150,000 beneficiaries in 75 hospitals around the country. The target beneficiaries are malnourished children under 5years; pregnant mothers above 7 months gestation; lactating mothers with children under 6 months; and the chronically ill (TB, HIV/AIDS or cancer). A recent visit to Driefontein Sanatorium that caters for tuberculosis patients revealed that daily intake of CSB porridge by the patients has resulted in significant weight gains, faster recovery and earlier discharges. Sister Christiana Ebel, the acting matron of the sanatorium articulated that most of the TB patients have gained between 6 and 10 kg on average, and the number of deaths has dropped from eight/nine deaths per month, to only two/three. All these improvements have been attributed to the important role of nutritious food (CSB) in the patients' treatment.

Tommy Thompson Visit to Zambia

US Health and Human Services Secretary Tommy Thompson toured four African countries, including Zambia, with a U.S. delegation of more than 100 lawmakers, business leaders and religious groups, including Randall Tobias, head of the new State Department Office of the Global AIDS Coordinator, and Richard Holbrooke, president of the Global Business Coalition on HIV/AIDS and former U.S. ambassador to the United Nations.The delegation also included UNAIDS Executive Director Peter Piot, Global Fund To Fight AIDS, Tuberculosis and Malaria Executive Director Richard Feachem and CDC Director Julie Gerberding. After visits to World Vision and CARE project sites in Livingstone, Thompson said, "It was a very revealing trip in which we learned a great deal. But we found for the first time ... there's a degree of hope and optimism that wasn't there previously. People that I talked to were very appreciative of what President Bush is doing with his initiative. They need the dollars. They need the programs" ("Inside Politics," CNN, 12/10).

Oprah Winfrey Visit to Zambia

A two-day visit to Zambia in early December, with UN Special Envoy Stephen Lewis, was Oprah Winfrey's first experience with the impact of AIDS outside of South Africa. She visited a CARE project in Livingstone and discussed programming challenges with representatives of CRS. As organizers had hoped, it made a deep impression and Oprah has pledged to go home and make it real for Oprah viewers. She was especially touched by the plight of orphans and children made vulnerable by AIDS. Challenged by journalists to explain how her trip would be effective in gathering public support, Oprah responded "The worldwide media has dehumanized the images of Africa, of poverty, sickness, children dying with flies on their eyes. It's so overwhelming for people. They think, 'That's not my child. My child couldn't be that way.' My goal telling these stories is for people to see these children as their children," she said. "When our special airs, people will see African children as they have neverseen them before. Their bellies are not swollen, there are no flies, these are beautiful, bright little stars. That's what they are. We get people to see the person first, not the disease. That is the difference between our show and others." Since returning to the US, Oprah has appeared on Larry King Live and has hosted the ABC primetime special "Oprah and Africa: Personal Journey, Global Challenge."

Save the Children and Johns Hopkins University to Implement HIV/AIDS Prevention Program in Malawi

A new HIV/AIDS Behavior Change Initiative Program in Malawi known as "BRIDGE" will engage local organizations and stakeholders to move Malawians from simply knowing about HIV/AIDS to taking action to reduce high-risk behaviors and prevent HIV transmission. Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (JHCCP) and Save the Children US will provide technical assistance and strengthen the capacity of local organizations in this $5.3-million program supported by USAID. To learn more, visit:

Zambia Launches Free HIV Telephone Advice Hotline - dial 990

Faced with an HIV prevalence of 16%, Zambia desperately needed an HIV/AIDS telephone hotline. High levels of stigmatization still perpetuate HIV as a "silent" epidemic in an environment where most Zambians have limited access to up-to-date, accurate and confidential HIV/AIDS information and referral services. With support from the National AIDS Council of Zambia and USAID, the Comprehensive HIV/AIDS Management Programme (CHAMP) in partnership with the Zambia Integrated Health Programme (ZIHP) launched the hotline on December 1st to promote existing services, especially voluntary counselling and testing services, which although widely established are not used as much as they could be. People living with HIV can also benefit from the support, counselling, and legal advice that the AIDS Hotline offers. The service is free from a Zamtel land line, and is available 24 hours a day, 7 days a week. For more information, visit or contact Kim Martin at 410 659-6140.


The world health report 2003 - shaping the future (18 December 2003)

highlights the urgent need for investment and international support to strengthen the failing health care systems of most developing countries. Chapter Three reviews major trends in the HIV epidemic and examines successes and failures in the struggle against the world's most devastating infectious disease, before discussing goals for the coming years. These include narrowing the AIDS outcome gap by providing three million people in developing countries with combination antiretroviral (ARV) therapy by the end of 2005 (known as the "3 by 5" target). Although robust HIV prevention and care constitute a complex health intervention, such interventions are not only feasible in resource-poor settings, but are precisely what is needed. Full report available on

FANTA recommendation for the nutrient requirements for PLHA (December 4, 2003)

The nutrient requirements of HIV-infected persons differ from non-infected individuals. Current evidence suggests that as the infection progresses, the nutrient requirements change. The requirements are different for the two distinct phases of HIV infection. The phases of infection are characterized by the absence or presence of illness symptoms: asymptomatic and symptomatic. During the asymptomatic phase: energy requirement for HIV-infected persons increases by 10 percent, protein and micronutrient requirements for HIV-infected persons remain the same (compared to the level recommended for healthy non - HIV - infected persons for the same age, sex, and physical activity). During the symptomatic phase: energy requirement for HIV-infected persons increases by 20-30 percent protein and micronutrient requirements for HIV - infected persons remain the same (compared to the level recommended for healthy non - HIV - infected persons for the same age, sex, and physical activity).These recommendations are for all HIV- infected persons, regardless of whether they are taking anti-retroviral drugs or not. There remain a number of issues related to the nutrient requirements of children and the role of micronutrients in HIV that are still emerging so these recommendations will likely change. Get the most up-to-date recommendations from the FANTA website

South African drug deal brings $140-a-year treatment within reach of African nations(10 December 2003)GlaxoSmithKline and Boehringer Ingelheim have conceded defeat in a long-running battle to preserve their antiretroviral drug patents in South Africa. Following a Competition Commission judgment against the companies in October, the manufacturers announced this morning that they will allow generic versions of their products AZT, 3TC and Nevirapine to be produced by South African-based companies at low cost. The deal will also allow South African companies to export the products to other countries in sub-Saharan Africa.

International AIDS Vaccine Initiative Begin Human Clinical Trial for ADVAX (Dec 9, 2003)

The Aaron Diamond AIDS Research Center and the International AIDS Vaccine Initiative announced on Monday that the groups have begun a human clinical trial to test the safety of the experimental DNA-based HIV vaccine ADVAX, according to an ADARC release. The trial is seeking to enroll a total of 45 healthy, HIV-negative men and women in New York City and Rochester, N.Y., over the next few months. Trial participants will be randomly assigned either the experimental vaccine or a placebo and will visit outpatient clinics 12 times over 19 months. The ADVAX vaccine is tailored to the C strain of HIV that accounts for most HIV infections worldwide and is designed to stimulate an immune response to prevent uninfected individuals from contracting HIV. The vaccine contains only portions of genetic material similar to HIV rather than a weakened version of the virus and cannot cause HIV infection.


11th Conference on Retroviruses and Opportunistic Infections (CROI 2004), San Francisco from Feb. 8-11, 2004

the largest US-based AIDS conference, drawing America's top medical and often providing some of the most cutting-edge research revelations. Stay on top of the latest at

Positive Living Training of Trainers Workshop, Nelspruit, South Africa, February 4-14, 2004

David Patient and Neil Orr have developed a shorter, leaner version of this popular (previously 20-day) workshop. The program explores all key aspects of living with HIV: basic and immune-focused nutrition, food and water security in health and in illness, interactions between illness, immune function and specific nutrients, and coping mechanisms of long-term survival. Please address all communications regarding course contents and registration to: (David Patient) or telephone: +27-83-226-9466 (Cherylynn O'Brien).

World TB Day, March 24, 2004

As the world begins to focus on "3 by 5", there is broad-based commitment to ensuring comprehensive, inclusive programming. TB patients in high-prevalence areas need access to information, clinical care, appropriate nutritional support and VCT. Joint action on TB, HIV and food aid/nutrition saves lives and livelihoods.

Assuring Food and Nutrition Security in Africa by 2020, Kampala, Uganda, April 1-3, 2004

The International Food Policy Research Institute (IFPRI), under the auspices of its 2020 Vision Initiative, will facilitate an international Conference in Kampala, Uganda on April 1-3, 2004 in partnership with the Government of Uganda and with the strong support of H.E. President Museveni, Chairman of the IFPRI 2020 International Advisory Council. This conference will bring together the traditional and new actors and stakeholders from across the spectrum to deliberate on how to bring about change and action that will yield food and nutrition security. This Conference will be unique in that it will be all-Africa, multi-disciplinary, multi-sectoral, and multi-actor.

One World Beat Festival, April 19-21, 2004

Already there are 35 confirmed events from locations such as Nigeria, Kenya, DRC, Burundi, South Africa, Australia, Germany, New Zealand, Canada, the USA, and the UK. The goal of the Festival is to have performances and other musically-related events and activities happening in local communities worldwide. The theme for 2004 will revolve around HIV/AIDS awareness, education, prevention, amelioration, and activism. OWB will encourage local musicians and anyone wanting to develop, implement, and/or volunteer for such events to partner with grassroots NGOs, CBOs, and other helping organizations, thereby creating support for these local efforts and a feeling of global connectedness and unity.

Managing HIV/AIDS in the Workplace, 3 - 14 May 2004, Nairobi

This course empowers managers from both the private and public sector to establish and maintain HIV/AIDS workplace interventions including policies, prevention activities and care and support services at both managerial and operational levels. Contact: Centre for African Family Studies (CAFS), Tel: 254 2 4448618/19/20, Fax: 254 2 4448621, Website:

XV International AIDS Conference, Bangkok Thailand, July 7-16, 2004 Conference Submission Deadlines are listed below:

  • January 14: Abstract submission by paper forms and disk or CD must be received (note online deadline a week later).
  • January 21: Online abstract submission deadline. (Online is preferred; in case of last-minute submission, note time zones.)
  • February 2: Skills-building workshop submissions due.
  • February 2: Registration fee goes up
  • February 2: Scholarship applications must be received
  • February 2: NGO exhibition request deadline
  • April 1: Deadline for guaranteed hotel reservation
  • May 26: Late-breaker abstract submission (online only)

For complete information see the conference Website:

Traditional Healing and HIV/AIDS, Dakar, Senegal, 19 - 21 July 2004

Organized by Africa First, Government of Senegal and ENDA Tiers Monde, this conference aims to determine the role of traditional healers in the fight against HIV/AIDS, based on successes achieved; foster constructive dialogue and education between practitioners of conventional medicine and traditional medicine; and promote better understanding of traditional healing practices. Registration deadline is 30 August 2003. Registration cost is US$650. Contact: J. William Danquah, email

What is an STI?

STI stands for Sexually Transmitted Infections. As the name suggests, it is an infection which is passed between people through sexual contact. It is important that people with any symptoms of an STI seek treatment as soon as possible from a clinic/health centre. Although it is common for people to choose to go to a traditional healer, it is very important to visit a clinic as well, since not only do STIs require an appropriate clinical treatment but also counseling, education and partner/contact tracing.

What are the symptoms of STIs for men and what are the symptoms for women?

Burning-urine sensation
Sores or blisters on the penis
Discharge from the penis
Painful or swollen glands in the groin
Warts on the genital area
Painful swelling of testes and scrotum
Burning-urine sensation
Sores or blisters on the genital area
Smelly vaginal discharge
Painful or swollen glands in the groin
Warts on the genital area
Abdominal pain
Some women experience no symptoms at all!

What is the connection between HIV and STIs?

Open sores due to STIs are like and 'open door', which make it very easy for HIV to enter the body. The high prevalence of STIs in sub-Saharan Africa is a contributing factor to the HIV/AIDS pandemic compared to the rest of the world. If you are HIV positive and have an active, untreated STI, the level of HIV in genital fluids increases, making it easier to pass HIV to someone else. An HIV negative person who has an STI is much more likely to contract HIV when they have unprotected sex with someone with HIV (NAM Fact sheets 20 and 21).

Besides contributing to the spread of HIV, what are the complications of STIs?

STIs in women can lead to a variety of complications, including pelvic inflammatory disease (PID). Women who have had PID may not be able get pregnant or have children.

PID may also lead to an abscess (localized septic infection) further causing septicemia (bacterial infection of blood), a serious condition that can result in death if not urgently and adequately managed.

Women with STIs can pass these infections onto their babies. Infections can be given to the baby as it passes through the birth canal of an infected mother. The best known is syphilis which can also be passed to the baby while the baby is still in the womb with serious results.

Babies infected with STIs are at risk of a variety of health problems. Babies infected with syphilis while still in the womb may die, have deformed bones, brain damage and other problems. Babies infected with herpes at birth may develop encephalitis, an infection in the brain that may cause permanent brain damage or death. Babies infected with Hepatitis B will be likely to have Hepatitis for the rest of their lives and may develop liver failure and die. Babies infected with Chlamydia or gonorrhea often have eye infections. Babies can also develop pneumonia from Chlamydia.

Complications also occur in men although they are often less severe than those experienced by women. Chlamydia and gonorrhea can cause epididymitis, which is an infection of a structure attached to the testicles. This infection can lead to infertility

In all people, untreated syphilis can cause brain damage, skin and bone damage and heart problems. Gonorrhea can cause arthritis, blood infections and heart problems. Hepatitis B can cause liver failure and is associated with liver cancer.

Early treatment if STIs at a reliable clinic or health post is vitally important. For people in relationships, both partners should seek medical advice, even if one partner doesn't have symptoms.


In the last newsletters we began translating terms and acronyms that HIV and Nutrition people tend to use that aren't always well-understood by people new to the field. Here are a few more:

Viral Load: When people talk about viral load, they are talking about how much virus is in your blood stream and how quickly or slowly the virus is multiplying. When a person is first infected with HIV, the virus reproduces very fast and the viral load can be very high. This relates to one of the reasons HIV is so dangerous: a person who is newly infected with the virus usually looks healthy but can be very infections, easily passing the virus on to another person. After this initial rise in viral load, a health person's strong immune system responds to the virus and virus replication slows down (thus the viral load usually goes down). With time, however, the virus regains its strength, begins destroying the immune system and the viral load goes up as the person's health begins to deteriorate.

STI: Just when you thought you knew what it was ....!! This acronym has been hijacked in HIV circles to define another concept: Structured Treatment Interruption. Patients often describe these as 'Drug Holidays' but doctors prefer to call them STIs, and prescribe them only in carefully studied and monitored circumstances. This is still a very experimental part of a long-term treatment program, aimed at improving compliance and possibly stimulating an immune response. It must only be undertaken under close and expert clinical supervision.

BMS: The acronym for Breast Milk Substitute - what we used to call 'infant formula'. Likuni Phala: The local name (in Malawi) for a HEPS or CSB -like commodity.


Need a quick answer to a technical question? Need a reference or a contact, and don't know where to find it? The HIV/AIDS and Nutrition Advisor might be able to help you - call, fax or email Kate on 27-11-679 3601 (office), 27-11-679 3597 (fax), 27-82 466 7651 (cell) or
We will do our best to find the answers you need and get them back to you quickly.
Don't be shy - it's what we're here for!


This is where we try to keep you informed about products and services relevant to your work: red ribbon badges, keychains, stickers, etc. Sometimes, funds come your way and you need to spend them quickly - we want to help you be prepared! Earlier newsletters had a number of sources for red ribbon badges - only two new sources this month:

Malawi: Beaded badges, available from Malawi's PLHA group NAPHAM, sell for 100 Malawi Kwacha each. They have branches in Lilongwe, Blantyre and Mzuzu -- the person to contact is Mrs. Kesbe Hara on 01-791-943.

Zimbabwe: Beaded badges if various colors, from FACT (Family Aids Counseling Trust), Box 1626 or 52 Robertson Street, Masvingo, Zimbabwe; E-mail:, or Tendai Bernadette Chimusoro email:


Food and Nutrition Implications of Antiretroviral Therapy in Resource Limited Settings As access to antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA) increases in developing countries, addressing the interactions between ART and food/nutrition becomes a critical component of care and support programs and services. This technical note developed by the FANTA Project ( provides information and guidance about the food and nutrition implications of ART and how to manage the effects of these implications in resource limited settings. The purpose of the document is to assist program planners, groups developing guidance on care and support, service providers, and networks of PLWHA to understand and address ART interactions with food and nutrition.

Country Analyses Help Inform National HIV/AIDS Policies The Country AIDS Policy Analysis Project develops and disseminates comprehensive analyses of HIV/AIDS in Malawi, Zambia, Zimbabwe and several other countries. Managed by the AIDS Policy Research Center at the University of California (San Francisco) and funded by USAID, the project links each analysis with national strategic plans for HIV/AIDS prevention, care, and support. Analyses also include a detailed map and comparative table of 70 key HIV/AIDS and socioeconomic indicators. Analyses are available at:

Population Services International Launches Faith-Based Initiative Population Services International (PSI) launched a program to help faith-based organizations around the world increase their capacity to implement HIV/AIDS prevention activities. This program was kicked off at the All Africa Conference of Churches 8th General Assembly, November 26, in Yaounde, Cameroon. See

Report Analyzes Costs of Antiretroviral Therapy in Zambia "The Costs of Antiretroviral Treatment in Zambia," a new cost and resource analysis by Partners for Health Reformplus, USAID's project for strengthening health policy and health system in developing and transitional countries, is available electronically at:

Horizons Highlights Prevention of Mother-to-Child HIV Transmission The December 2003 "Horizons Report" describes recent operations research in Kenya, Zambia, and elsewhere on implementation of programs to prevent mother-to-child HIV transmission (PMTCT). Issues discussed include infant feeding counseling, integrating PMTCT into existing reproductive health services, and increasing male involvement. "Horizons Report" is accessible at: