hidden hunger &_hiv

Health Empowerment Health Empowerment Through NutritionThrough Nutrition

Hidden Hunger & HIVHidden Hunger & HIV

HIV/AIDS – The ProblemHIV/AIDS – The Problem This pandemic has resulted in 60 million This pandemic has resulted in 60 million

people infected by the end of 2005people infected by the end of 2005 More than 25 million have diedMore than 25 million have died People living with HIV/AIDS in 2007 People living with HIV/AIDS in 2007

numbered over 33 millionnumbered over 33 million Young people account for half of all new Young people account for half of all new

infections - around 6,000 per dayinfections - around 6,000 per day Africa is facing a desperate plight and has Africa is facing a desperate plight and has

12 million AIDS orphans12 million AIDS orphans

HIV/AIDS - The FactsHIV/AIDS - The Facts More than 50 peer reviewed journal articles show thatMore than 50 peer reviewed journal articles show that

Micronutrients, including the vitamins A, B6, B12 and E, and Micronutrients, including the vitamins A, B6, B12 and E, and the minerals selenium and zinc, play a critical role in the the minerals selenium and zinc, play a critical role in the maintenance of immune function and overall metabolismmaintenance of immune function and overall metabolism

The HIV virus encodes the seleno-enzyme glutathione The HIV virus encodes the seleno-enzyme glutathione peroxidase, thereby robbing the host of selenium and the peroxidase, thereby robbing the host of selenium and the amino acids, cysteine, glutamine, and tryptophanamino acids, cysteine, glutamine, and tryptophan

Persons living with AIDS suffer from extreme deficiencies of Persons living with AIDS suffer from extreme deficiencies of all of these nutrients, which can also be responsible for all of these nutrients, which can also be responsible for depressed CD4 counts, vulnerability to infections and depressed CD4 counts, vulnerability to infections and cancers, dementia, depression, diarrhoea, muscle wasting, cancers, dementia, depression, diarrhoea, muscle wasting, neuropathy and skin diseasesneuropathy and skin diseases

SeleniumSelenium HETN does not support single issue HETN does not support single issue

environmentalism nor single fixes, but by way of environmentalism nor single fixes, but by way of illustrationillustration In Kupka’s study of 949 HIV infected, pregnant In Kupka’s study of 949 HIV infected, pregnant

Tanzanian women, lower plasma selenium levels were Tanzanian women, lower plasma selenium levels were significantly associated with an increased mortality. significantly associated with an increased mortality. Each Each 0.1µmol/l 0.1µmol/l increase in plasma selenium levels increase in plasma selenium levels were related to a 5% decreased mortality over 5.7 were related to a 5% decreased mortality over 5.7 years of follow upyears of follow up

It has been demonstrated that, in patients living with It has been demonstrated that, in patients living with HIV/AIDS, plasma selenium levels are a better HIV/AIDS, plasma selenium levels are a better indicator of morbidity and longevity than CD4 countsindicator of morbidity and longevity than CD4 counts

Selenium, Cont.Selenium, Cont. Odunukwe’s recent study examined the impact of Odunukwe’s recent study examined the impact of

selenium supplementation in Nigerians with advanced selenium supplementation in Nigerians with advanced disease (CD4 cell counts < 50) who are on ARTdisease (CD4 cell counts < 50) who are on ART 170 participants received 200170 participants received 200µµg of selenium daily and g of selenium daily and

170 received antiretroviral therapy alone. Patients were 170 received antiretroviral therapy alone. Patients were followed for 72 weeksfollowed for 72 weeks

The rate of CD4 cell recovery was significantly higher The rate of CD4 cell recovery was significantly higher and the median CD4 count increment was over twofold and the median CD4 count increment was over twofold higher in patients on selenium supplementation (+120 higher in patients on selenium supplementation (+120 cells/mm3 v. +50 cells/mm3)cells/mm3 v. +50 cells/mm3)

The incidence of opportunistic infections was lower The incidence of opportunistic infections was lower resulting in fewer hospital visitsresulting in fewer hospital visits

Weight gain was significantly higher (p = 0.004).Weight gain was significantly higher (p = 0.004). Haemoglobin increment from baseline to 64 weeks was Haemoglobin increment from baseline to 64 weeks was

3-fold higher (+30 g/l v. +10g/l)3-fold higher (+30 g/l v. +10g/l)

Selenium, Cont.Selenium, Cont. Onother recent study by Hurwitz followed 174 HIV+ Onother recent study by Hurwitz followed 174 HIV+

patients over 9 months. 91 of them received patients over 9 months. 91 of them received 200200µµg/day of selenium yeastg/day of selenium yeast Serum selenium concentration increased significantly in Serum selenium concentration increased significantly in

the selenium-treated group but not in the placebo-the selenium-treated group but not in the placebo-treated group (+32.2μg/l v. +0.5μg/l) (treated group (+32.2μg/l v. +0.5μg/l) (PP<0.001) <0.001)

Greater levels of selenium (in the ‘responders’) were Greater levels of selenium (in the ‘responders’) were significantly associated with decreased HIV viral load significantly associated with decreased HIV viral load ((PP<0.02) compared with controls <0.02) compared with controls

This correlated with a significantly increased CD4 count This correlated with a significantly increased CD4 count ((PP<0.04)<0.04)

Selenium ‘non-responders’ did not differ from the Selenium ‘non-responders’ did not differ from the placebo group in HIV levels and CD4 counts placebo group in HIV levels and CD4 counts

Parallel EvidenceParallel Evidence

The HIV/AIDS pandemic is only one of several, The HIV/AIDS pandemic is only one of several, involving viruses that encode theinvolving viruses that encode the seleno-enzyme seleno-enzyme glutathioneglutathione peroxidase peroxidase

Hepatitis B and C viruses, the Coxsackie B virus and Hepatitis B and C viruses, the Coxsackie B virus and HIV do likewiseHIV do likewise

The Chinese are winning a battle against the The Chinese are winning a battle against the Coxsackie B virus which causes Keshan disease, a Coxsackie B virus which causes Keshan disease, a fatal heart ailment that has been common for many fatal heart ailment that has been common for many years in inhabitants of the great selenium-deficiency years in inhabitants of the great selenium-deficiency belt that crosses Chinabelt that crosses China

Parallel Evidence, Cont.Parallel Evidence, Cont. Finland has shown that selenium supplementation can Finland has shown that selenium supplementation can

have a major beneficial impact on the incidence of have a major beneficial impact on the incidence of HIV/AIDSHIV/AIDS

Despite widespread, unprotected, promiscuous sexual Despite widespread, unprotected, promiscuous sexual activity in Senegal, where soil selenium levels are activity in Senegal, where soil selenium levels are naturally high, HIV is diffusing very slowly, if at all, naturally high, HIV is diffusing very slowly, if at all, amongst the populationamongst the population

In the UK there is an epidemic of TB among badgers, In the UK there is an epidemic of TB among badgers, which is infecting cattle. It has been shown that organic which is infecting cattle. It has been shown that organic herds fed on clover, which is rich in selenium, are not herds fed on clover, which is rich in selenium, are not susceptible. When badgers and traditional herds are susceptible. When badgers and traditional herds are given maize supplemented with selenium, they are no given maize supplemented with selenium, they are no longer susceptiblelonger susceptible

HIV/AIDS - Current Strategies - HIV/AIDS - Current Strategies - EducationEducation

Dedicated largely to creating awareness and Dedicated largely to creating awareness and promoting behaviour change.promoting behaviour change.

The ABC approach - Abstinence, Be Faithful, Use The ABC approach - Abstinence, Be Faithful, Use Condoms - is based on a western, Judaio-Christian Condoms - is based on a western, Judaio-Christian view of the world. It assumes that recipients of the view of the world. It assumes that recipients of the imparted knowledge believe in cause and effect, self-imparted knowledge believe in cause and effect, self-actualisation and individual responsibility. The African actualisation and individual responsibility. The African tradition is often at odds with this.tradition is often at odds with this.

Where children are your social security, condoms offer Where children are your social security, condoms offer no hope.no hope.

Many people, particularly women, do not feel Many people, particularly women, do not feel empowered.empowered.

HIV/AIDS - Current Strategies - HIV/AIDS - Current Strategies - EducationEducation

It is interesting that, in the UK, HIV is It is interesting that, in the UK, HIV is diffusing very slowly, despite the highest diffusing very slowly, despite the highest teenage pregnancy rate in Europe and a teenage pregnancy rate in Europe and a serious epidemic of chlamydia among serious epidemic of chlamydia among young people.young people.

The major problem in Africa is not greater The major problem in Africa is not greater promiscuity, but the high incidence of promiscuity, but the high incidence of multiple, concurrent sexual partners. multiple, concurrent sexual partners.

HIV/AIDS - Current Strategies – HIV/AIDS - Current Strategies – MedicationMedication Anti-retroviral therapy (ART). This has been a Anti-retroviral therapy (ART). This has been a

lifesaver, and has great appeal to Western minds, lifesaver, and has great appeal to Western minds, still wedded to pharmaceutical solutions, butstill wedded to pharmaceutical solutions, but It is not curativeIt is not curative Huge cost - all donor-dependent, so sustainability is Huge cost - all donor-dependent, so sustainability is

questionablequestionable No access for the vast majority of people living with No access for the vast majority of people living with

HIV/AIDS in Africa, and this will not changeHIV/AIDS in Africa, and this will not change Frequent shortages, which encourage drug resistanceFrequent shortages, which encourage drug resistance Compliance is a major problemCompliance is a major problem Numerous side effects, which are more frequent in Numerous side effects, which are more frequent in

people who are malnourishedpeople who are malnourished Many do not cross the blood-brain barrier, so brain Many do not cross the blood-brain barrier, so brain

damage can continue damage can continue

We Are Not Winning We Are Not Winning 20 years ago the prevalence of HIV infection in Swaziland was 20 years ago the prevalence of HIV infection in Swaziland was

less than one in a thousand. By 2004, despite huge education less than one in a thousand. By 2004, despite huge education programmes, it had reached 48% among antenatal clinic programmes, it had reached 48% among antenatal clinic attendees. Today, over one third of the adult population is attendees. Today, over one third of the adult population is infected - the world's highest prevalence rateinfected - the world's highest prevalence rate

The management of HIV and AIDS is an ongoing challenge for The management of HIV and AIDS is an ongoing challenge for Southern African companies. HIV prevalence among employees Southern African companies. HIV prevalence among employees of Anglo American companies is estimated to be 23%. At of Anglo American companies is estimated to be 23%. At AngloGold Ashanti it is 30%.AngloGold Ashanti it is 30%.

The soils of Southern Africa are seriously depleted. Selenium The soils of Southern Africa are seriously depleted. Selenium levels are very low. The staple food, maize, contains very little.levels are very low. The staple food, maize, contains very little.

We need a new paradigmWe need a new paradigm..

The Scale of the ProblemThe Scale of the Problem In Sub-Saharan Africa there will be 20 million orphans by 2010, In Sub-Saharan Africa there will be 20 million orphans by 2010,

the year of the Football World Cup. Everybody is preparing for the year of the Football World Cup. Everybody is preparing for the latter. Nobody is preparing for the orphan pandemic. the latter. Nobody is preparing for the orphan pandemic.

In South Africa 5.5 million people are infected. There are In South Africa 5.5 million people are infected. There are 500,000 new infections every year. By 2010 over 10 million 500,000 new infections every year. By 2010 over 10 million people could be infected. people could be infected.

The SA Department of Health have launched the largest ART The SA Department of Health have launched the largest ART rollout program in the world at a cost of R12 billion. This will rollout program in the world at a cost of R12 billion. This will treat 1.2 million people by 2010. treat 1.2 million people by 2010.

By then there will be 8–9 million people in the queue that By then there will be 8–9 million people in the queue that nobody is planning to support. These people will flood the nobody is planning to support. These people will flood the clinics and swamp the infrastructure.clinics and swamp the infrastructure.

South Africa, a relatively prosperous country, faces this 2 years South Africa, a relatively prosperous country, faces this 2 years from now. What hope for the rest of Africa?from now. What hope for the rest of Africa?

MeanwhileMeanwhile Multi-resistant TB is spreading unabatedMulti-resistant TB is spreading unabated Africa's nutritional crisis is not seen, heard or Africa's nutritional crisis is not seen, heard or

understoodunderstood Africans have moved away from their Africans have moved away from their

traditional foods without any understanding of traditional foods without any understanding of the role the present food chain plays in the role the present food chain plays in compounding the health issues facing the compounding the health issues facing the continentcontinent

Imported food aid, commercially grown and Imported food aid, commercially grown and processed, is dumped with little processed, is dumped with little understanding of the nutritional implicationsunderstanding of the nutritional implications

Hidden Hunger & HIVHidden Hunger & HIV HETN does not support single issue environmentalism HETN does not support single issue environmentalism

nor single fixes.nor single fixes. We support the work being done to encourage We support the work being done to encourage

behaviour change and to make ART more available.behaviour change and to make ART more available. We deplore the fact that the crucial role of We deplore the fact that the crucial role of

micronutrition in HIV/AIDS has not yet gained micronutrition in HIV/AIDS has not yet gained mainstream acceptance.mainstream acceptance.

It is our belief that the management of people living It is our belief that the management of people living with HIV/AIDS should include supplementation with with HIV/AIDS should include supplementation with micronutrients, at least to levels at which deficiency micronutrients, at least to levels at which deficiency symptoms associated with a lack of these nutrients symptoms associated with a lack of these nutrients disappear.disappear.


Good health is enabled and maintained by Good health is enabled and maintained by good nutritiongood nutrition Hidden hungerHidden hunger affects more than two billion affects more than two billion

people. Even when a person consumes people. Even when a person consumes adequate calories and protein, if they lack one adequate calories and protein, if they lack one single micronutrient - or a combination of single micronutrient - or a combination of vitamins and minerals – their immune system vitamins and minerals – their immune system is compromised, and infections take holdis compromised, and infections take hold

World Hunger Series 2007 - Hunger and HealthWorld Hunger Series 2007 - Hunger and HealthWorld Food ProgrammeWorld Food Programme


With the knowledge thatWith the knowledge that Chronic malnutrition is the biggest cause of Chronic malnutrition is the biggest cause of

immune suppression in humansimmune suppression in humans Primary micronutrient deficiencies are widespread Primary micronutrient deficiencies are widespread

and severe in Africaand severe in Africa People living with HIV/AIDS suffer from extreme People living with HIV/AIDS suffer from extreme

deficiencies of many micronutrientsdeficiencies of many micronutrients

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And evidence thatAnd evidence that There is a clear relationship between HIV infection There is a clear relationship between HIV infection

and nutritional statusand nutritional status Malnourished individuals are more susceptible to Malnourished individuals are more susceptible to

HIV infection and have a worse prognosisHIV infection and have a worse prognosis Food nutrients, particularly the antioxidant Food nutrients, particularly the antioxidant

micronutrients, have therapeutic benefitmicronutrients, have therapeutic benefit

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One might assume that the management of One might assume that the management of people living with HIV/AIDS would include people living with HIV/AIDS would include supplementation with micronutrients, but this supplementation with micronutrients, but this is not the caseis not the case Micronutrient supplementation has not become part of Micronutrient supplementation has not become part of

mainstream thinking in the fight against HIV/AIDSmainstream thinking in the fight against HIV/AIDS Global interventions consist of education to promote behaviour Global interventions consist of education to promote behaviour

change and the roll out of anti-retroviral therapy (ART)change and the roll out of anti-retroviral therapy (ART) In Southern Africa, the issue has been marginalised by a In Southern Africa, the issue has been marginalised by a

damaging public media debate on nutrition versus drugs that damaging public media debate on nutrition versus drugs that has polarised proponents of nutrition on the one hand and has polarised proponents of nutrition on the one hand and proponents of ART on the otherproponents of ART on the other

This either/or debate is specious and does not serve anyoneThis either/or debate is specious and does not serve anyone

Hidden Hunger & HIVHidden Hunger & HIV Systematic reviews of micronutrient supplementation Systematic reviews of micronutrient supplementation

conclude that there is no convincing evidence that conclude that there is no convincing evidence that micronutrient supplementation effectively reduces micronutrient supplementation effectively reduces morbidity and mortality in people living with HIV/AIDSmorbidity and mortality in people living with HIV/AIDS

But the trials that have been done concentrate on But the trials that have been done concentrate on single supplement intervention, or supplementation single supplement intervention, or supplementation with a small group of micronutrients. Neither can with a small group of micronutrients. Neither can be expected to correct the type of nutrient be expected to correct the type of nutrient deficiency seen in HIV/AIDSdeficiency seen in HIV/AIDS

The problem is compounded by the fact that the The problem is compounded by the fact that the dose of supplement is often not physiological and dose of supplement is often not physiological and the form of supplement is often not consideredthe form of supplement is often not considered

Much of the research is done in the West where Much of the research is done in the West where baseline nutrition is higherbaseline nutrition is higher


Nevertheless, the WHO is urging all concerned Nevertheless, the WHO is urging all concerned parties to make nutrition an integral part of their parties to make nutrition an integral part of their response to HIV/AIDS, and specifically to develop response to HIV/AIDS, and specifically to develop and implement operational and clinical research and implement operational and clinical research to identify effective interventions and strategies to identify effective interventions and strategies for improving the nutrition of HIV-infected for improving the nutrition of HIV-infected persons.persons.

It is feasible to provide the necessary It is feasible to provide the necessary supplements in a ‘food’ form, which significantly supplements in a ‘food’ form, which significantly improves bioavailability and therefore improves bioavailability and therefore effectiveness in supporting immune function.effectiveness in supporting immune function.


In conjunction with London University and In conjunction with London University and the University of the Witwatersrand, HETN the University of the Witwatersrand, HETN is conducting a controlled trial in a rural is conducting a controlled trial in a rural clinical settingclinical setting 150km of urban shanty sprawl. Few jobs, little 150km of urban shanty sprawl. Few jobs, little

water, serious poverty, 1 million peoplewater, serious poverty, 1 million people The soils are so depleted, the people struggle The soils are so depleted, the people struggle

to grow anything.to grow anything.

This programme, involving 3 hospitals and 45 clinics in This programme, involving 3 hospitals and 45 clinics in the Limpopo Province, is doing an impressive job, but the Limpopo Province, is doing an impressive job, but their research to date has not include micronutrition.their research to date has not include micronutrition.

The aim of this trial is to show that the addition of a The aim of this trial is to show that the addition of a broad-spectrum micronutrient supplement, in a food broad-spectrum micronutrient supplement, in a food form, to the ART regime of people living with HIV/AIDS form, to the ART regime of people living with HIV/AIDS improves clinical outcomes.improves clinical outcomes.

Hidden HungerHidden Hunger

It seems strange to some that medical It seems strange to some that medical scientists require controlled trials to prove scientists require controlled trials to prove that correcting micronutrient deficiencies that correcting micronutrient deficiencies is good for you. is good for you.

The ‘man in the street’ knows it intuitively.The ‘man in the street’ knows it intuitively.

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Before & AfterBefore & After

Before & After

Before & AfterBefore & After

In ConclusionIn Conclusion HETN is not selling anything other than a desire HETN is not selling anything other than a desire

to discover the truth.to discover the truth. We believe that in the HIV/AIDS arena there is We believe that in the HIV/AIDS arena there is

sufficient anecdotal and research data to sufficient anecdotal and research data to construct a plausible micronutrient hypothesis construct a plausible micronutrient hypothesis that is worthy of scrutiny.that is worthy of scrutiny.

Where the plight is serious and the hypothesis Where the plight is serious and the hypothesis is strong, science has a duty to research.is strong, science has a duty to research.

Given the parlous nature of the HIV pandemic, Given the parlous nature of the HIV pandemic, there is a moral imperative to be inclusive in there is a moral imperative to be inclusive in our thinking.our thinking.

The time is now.The time is now.

hidden hunger &_hiv

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