Seeds of Survival Partnership Program

AIDS Alleviation through Education, Food Production and

Income Generation

Workshop Overview1. Introduction and History of Global Service Corps

HIV/AIDS and sustainable agriculture programs in East Africa

2. GSC-Heifer Tanzania Training Project

3. SOS Partnership/Fellowship Program

4. Review of Living with AIDS Manuals, specifically highlighting nutrition

Introduction and History of Global Service Corps Programs

in East Africa

• Kenya Program 1994

• Tanzania Program 2001

• Sustainable Agriculture

• HIV/AIDS Prevention

Kenya Program

• From 1994 to 2001, our work has involved both sustainable agricultural (BIA) projects and HIV/AIDS education in Kenya

• Initial partnership with the Anglican Church of Kenya in Mumias; also worked in Kibwezi and Machakos with a variety of CBOs and NGOs

• Registered as Kenya NGO in 1998

Tanzania Program

• Moved E. Africa program to Arusha in 2001 to expand HIV/AIDS and sustainable agriculture work

• Initial partnerships with the Arusha Catholic Diocese Uhai Centre for AIDS Prevention and the Tengeru Agriculture College (MATI)

• Registered as an NGO in 2002

GSCHIV/AIDS Program

• GSC participants are assisting in the fight of HIV/AIDS by using one of the most powerful weapon available in Africa: prevention and behavior change education.

• GSC participants assist with the training of farmers and women groups, teachers and students in local high schools, as well as other community members.

Rural HIV/AIDS Training

Arusha HIV/AIDS Workshop

Secondary School AIDS Prevention and Behavior

Change Day Camps• Since Summer 2002 GSC has run Day Camps

in five different schools of Arusha.• These day camps provide a range of fun and

creative experiential learning opportunities utilizing music, drama, sports, art, poetry, dance and other special events.

• These activities are all generated with a theme of promoting HIV/AIDS awareness and behavior change.

Day Camp

HIV/AIDS Community Training Example: UMAWO

• UWAMO is a union of local farmers from the village of Moivaro.

• UWAMO approached GSC to inquire about a collaboration to educate their farmers in HIV prevention.

• GSC educated the UWAMO group to become HIV educators, counselors, and a general resource for local farming groups.

HIV/AIDS Community Training Example: UMAWO

• The training consisted of five sessions over three consecutive weeks.

• An HIV training manual for the group was created in both English and Kiswahili.

• Since the training, the community has begun to approach the UWAMO members for HIV instruction.

GSC Sustainable Agriculture Program

• What is Bio-Intensive Agriculture (BIA)

• BIA Benefits

• BIA Techniques

• GSC BIA program

• GSC BIA present activities

What is Bio-Intensive Agriculture

• A specialized form of Organic Agriculture, emphasizing “double-digging,” composting, specific spacing of plants

• Uses natural locally available resources and minimum of water in crop production

• Doesn’t use industrial chemical, herbicides, or fertilizers, thereby minimizing input costs and maximizing income

BIA Benefits

• Eliminates expensive and potentially toxic inputs

• Nurtures both human health and the health of the environment

• Serves as a financially viable alternative for farmers

BIA Techniques

• Double-dug beds • Locally available crops • Organic compost materials • Crop diversification• Intensive planting• Water harvesting

GSC Bio-Intensive Agriculture Program

• Started in Kenya, this program assisted in the initiation of over 2000 community garden plots in three years as well as a community BIA demonstration plot and training center.

• In 2001, GSC established a partnership with Tengeru Agricultural College and BIA demonstration plots and training center outside of Arusha, Tanzania.

GSC Bio-Intensive Agriculture: Present Activities

• GSC volunteers first learn and then educate Tanzanian community members about sustainable small-scale farming.

• Volunteers and community members then work together to create organic farming plots in the Arusha region.

GSC-Heifer Tanzania Workshops

• The development of the workshops

• Results of the workshops

• Learning from the evaluation: more training in the field needed

The GSC-Heifer TZ Project

• Heifer Tanzania: A well established and agriculturally based NGO in Tanzania.

• Heifer targets the rural disadvantages, and the impact of HIV/AIDS on rural population.

• In 2002 GSC and Heifer TZ partnered to launch a cross-sectoral education and Training of Trainers (TOT) campaign.

The Development of the GSC-Heifer Workshops

• After training Heifer-TZ headquarters staff, GSC was asked to train all field staff and selected partners.

• This campaign prepared Heifer staff, farmers, and local leaders to be trained as community trainers and resource people.

• These trainings developed from a 3 day HIV/AIDS workshop to a 6 day workshop covering HIV/AIDS, nutrition and BIA.

Results of the GSC-Heifer Workshops

• 244 local staff and partners on HIV/AIDS and BIA were trained.

• These trained trainers then provided follow-on training to 15,000 local community members in less than one year.

Results of the GSC-Heifer Workshops

• An evaluation showed a change in attitude about HIV/AIDS by over 83% of the participants.

• One participant founded the Huruma Orphans Trust Fund to provide resources to AIDS orphans.

Learning from the Evaluation: More Training in the Field Needed

The initial program participants expressed their needs in an evaluation of the workshop:

• Desires of more extensive training

• Requests of seminars expanded to local zones where a larger audience can be reached at a lower cost

Seeds of Survival: A Rural Africa

Fellowship/Partnership Program

• Seeds of Survival: Introduction

• The Fellows

• The Partners

Seeds of Survival: Introduction

• To continue and expand the much-needed work started with the GSC-Heifer workshops;

• Global Service Corps is launching the Seeds of Survival Fellowship Program.

• This fellowship program provide qualified trainers in rural zones where partners organization local staff is established.

Seeds of Survival:A Rural Africa Partnership Program

The Fellows

• GSC is recruiting candidates for six-month in-country fellowships. Fellows will have at least a Masters Degree and some experience in a developing country.

• First month of fellowship consists of HIV/AIDS prevention, nutrition and sustainable agriculture TOT training.

• Five-month placement with local NGO/PVO.

The Fellows• Trained fellows work with local counterparts to

develop and provide HIV/AIDS prevention, nutrition and sustainable agriculture workshops in rural areas.

• Fellows assist local NGO staff with development of ongoing, sustainable community training and education programs.

• Fellows provided with homestay accommodations and project support by the local NGO/PVO.

The Partnership

• GSC is developing partnerships with other NGOs/PVOs operating in rural Africa.

• Partners collaborate to provide rural populations with HIV/AIDS prevention, nutrition and sustainable agriculture training, resources and support.

• NGOs/PVOs provide counterpart to attend four-week training and work with Fellows.

The Partnership

• Partnerships draw on and further develop local capacity of NGO/PVO partners.

• Partner NGOs/PVOs provide homestays, project and logistical support for fellows.

• GSC and partner NGO/PVOs collaborate on program funding.

SOS Training Program

• Four-week training for Fellows and counterparts in Arusha, Tanzania

• Classroom and field training in BIA, HIV/AIDS and nutrition

Nutrition Training

• HIV/AIDS: a Guide for Nutrition, Care and Support. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington DC, 2001.

• Living well with HIV/AIDS. FAO, 2002.

HIV/AIDS: A Guide for Nutrition, Care and Support

Food and Nutrition Technical Assistance Project, Academy for

Educational Development.

Academy for Educational Development, Washington DC, 2001.

Manual Introduction

Covers the following subjects:

• Purpose of the manual

• Audience

• How to use this guide

Module 1: Nutrition and HIV/AIDS Basic Facts

• This module provides basic information on HIV/AIDS, the relationship between HIV/AIDS and nutrition and basic elements of good nutrition.

Module 1: Nutrition and HIV/AIDS Basic Facts

• What is HIV? What is AIDS?• How HIV is transmitted• How HIV is not transmitted• HIV Cases in Africa• Nutrition and HIV/AIDS• Other nutritional impacts of HIV• How to maintain good nutrition form

macronutriments and micronutriments

HIV Infected babies

• An HIV-infected pregnant woman without antiretroviral access: 15-40% chance of infecting her baby.

• In a high HIV prevalence community, 20% of the mothers are HIV-infected, the number of babies infected by breast milk will be less than 4%.

• Conclusion: the vast majority of babies and mothers are not HIV-infected. Breastfeeding is a safe option for this majority.

Relation between HIV/AIDS and Nutrition

Immune Impairments“Weak body”

“Body can’t fight Illness”

Malnutrition“ Swollen body and feet”

“Pale skin, eyes, hair”“Lack of blood”“Underweight”

“Thinness”“Muscle wasting”

Infectious DiseaseDiarrhea

Tuberculosis (TB)Malaria

Pneumonia

Summary of Nutritional Impacts of HIV

• Poor food intake

• Poor nutrient absorption

• Disruption of metabolism

• Chronic infection

• Muscle wasting or loss in lean body tissue

Illnesses Associated with Nutritional Impacts

• Anorexia

• Fever

• Thrush

• Diarrhea

• Nausea

• Anemia

Energy Needs

• An active non HIV-infected adult requires approximately 2070 kcal/day

• An HIV-infected adult requires 10 to 15 percent more energy per day

• Approximately 400 additional Kcal for men, 300 Kcal for women

Protein Needs

• A non-HIV-infected man requires about 57 grams/ day of protein and a woman requires 48 grams/day

• An HIV-infected adults needs approximately 50 to 100 percent more protein per day

• For a total of 85 grams/day for men, and 72 grams/day for women.

Multiple Positive Impacts of Adequate Nutrition for PLWA

• Prevents malnutrition and wasting• Achieves and maintains optimal body

weight and strength• Enhances the body’s ability to fight

opportunistic infections• May help delay the progression of HIV• Improves the effectiveness of drug

treatments• Improves the quality of life

Module 2: Coping with HIV: Nutrition and Other Strategies for

Living Positively

• This module provides guidelines for helping HIV-infected adults who are not showing signs of illness maintain good nutrition and health status.

Module 2: Coping with HIV: Nutrition and Other Strategies for

Living Positively

• Good nutritional practices

• Growth promotion and preventive health care for children

• Safe hygienic practices: proper storage and handling of food and water

• Safer sexual and reproductive health practices

Module 2: Coping with HIV: Nutrition and Other Strategies for

Living Positively

• Physical activities

• Immediate attention for illnesses

• Eating during and after illnesses

• Psychological support

• Involvement in Community activities

Eat a Variety of Foods

• PLWHAs should eat a “balanced” diet consisting of:

- Beans,

- Nuts,

- Animal foods,

- Starchy staples (rice, potato, maize),

- Fruits and Vegetables

Eat a Variety of Foods

• The main food groups people need to live a healthy life include:

- Body-building foods

- Protective foods

- Energy

Body-building Food: Proteins and Minerals

• Are obtain from :- Legumes: beans, lentils, cowpeas, pigeon peas, groundnuts and nuts- Milk Products: yogurt, cheese, and for infants breast milk- Animal foods : fish, eggs, chicken, pork, and beef- Cereals: wheat, maize, rice

Body-building Food: Proteins and Minerals

• Animal products are important sources of nutriments, but because they are usually more expensive than vegetable protein source, it may not be feasible to consume them everyday

• Daily consumption of legumes and cereals is recommended

Protective Food: Micronutriments and Minerals

• Can be found in:- Dark green, leafy vegetables: collard greens, cassava and potato leaves, spinach, pumpkin leaves and cabbage

- Yellow and orange fruits and vegetables: mango, papaya or paw paw, sweet potato, pumpkin, carrots, tomato, avocado, oranges, lemons and bananas

Energy: Carbohydrates and Fats

• Can be found in various starchy staple foods such as:

- Maize: prepared as nsima, sadza, posha, ugali, uge- Rice- Matooke or green banana- Sorghum- Millet and roots- Tubers: cassava, taro, potato, sweet potato

Module 3: Food Management for Adults Living with AIDS-Related

Symptoms and Illnesses

• This module provides dietary recommendations for adults who are coping with AIDS-related symptoms and illness.

Module 3: Food Management for Adults Living with AIDS-Related

Symptoms and Illnesses

• Planning meals for PLWHAs

• Nutritional counseling and support

Advice to help maintain weight and avoid loss of muscle mass

• Eat small amounts of low-fat food regularly• Eat a variety of food• Avoid alcohol• Avoid smoking• Eat more when recovering from an illness• Try to maintain body weight, and avoid weight

loss• Be as physically active as possible

Planning a meal for an HIV-affected household

• Always select body-building (such as proteins) to form the core of the meal

• Choose available vegetables. Dark green leafy vegetables and yellow fruits and vegetables like pumpkin are very important

• Use energy food to fill up the body

Planning a meal for an HIV-affected household

• Increase the energy value during food preparation. By, for example:- Adding sugar to porridge or juice- Adding a teaspoon per person of oil to

porridge

• Add fruits such as mangos and papaya to enhance nutriment intake

Sample Menu for PLWHAs

• Breakfast: Maize porridge, fruit (banana or paw paw), tea with milk and sugar, bread

• Tea meal: Tea with biscuit, eggs• Lunch: Groundnuts, potatoes or maize

nsima, fruit juice• Supper: Chicken or fish stew, maize

nsima, cooked vegetable• Bedtime: Milk

Module 4: Nutritional issues Associated with Modern and

Traditional Therapies

• This module describes the nutritional issues associated with therapies to treat HIV/related illnesses and symptoms. Many people may take modern medications, such as antibiotics, or use traditional therapies such as food and herbs to manage AIDS-related symptoms.

Module 4: Nutritional issues Associated with Modern and

Traditional Therapies

• Modern Medications

• Traditional therapies

The Two Major Side effects of ARVs

ARVs: Antiretrovira Drugs used to treat HIV/AIDS by reducing viral loads in the blood. Two side effects:

• Change in taste: Food and spices can lose their appeal. Salt, sugar, vinegar, lemon or onions will boost flavor and improve intake.

• Nausea: Avoid lying done during digestion time; Reduce intake of spicy food; Eat biscuit, cracker or dry bread to reduce nausea.

Role of the Traditional Medicine

• People use them widely

• Traditional therapies may be beneficial or detrimental to a person’s health

• There is a cost associated with the therapies and often people are willing to pay

• It is worthwhile to find out the common traditional therapies used in the program area

• Dietary recommendations often still apply during the use of traditional medications

Traditional Therapies• Garlic

--Used to build a healthy heart--Helps soothe symptoms of thrush--Mild diarrhea and headaches

• Tea made from lemon leaves guava leaves, or gum or Neem tree leaves--Sore throats and coughs

• Gum tree leaves with vegetable oil --Minor skin problems

• Lavender or geranium, crushed and boiled with water --Skin rashes associated with shingles

Module 5: Nutrition and Care Recommendations for

Infants/Children

• This module provides feeding and care recommendations for infants and children regardless of HIV status.

Module 5: Nutrition and Care Recommendations for

Infants/Children

• Messages for Health Workers and Promoters Working with mothers Whose status is unknown or HIV-Negative

• Recommendations for Health Workers and Promoters Working with HIV-Infected Mothers

Nutrition and HIV-Infected Children

• Following problems should receive special medical attention:

- Inadequate food intake- Stomach pain- Feeding difficulties- Nausea, vomiting, diarrhea

Breastfeeding

• All infants from birth to six months of age should be exclusively breastfed

• 6 to 24 months: Continue to breastfeed with complementary feeding

Feeding recommendations for Infants of HIV-infected Mothers

• Mixed/partial breastfeeding: Additional risk of HIV transmission to the child.

• If breast milk substitutes available and affordable, replacement feeding is recommended.

• But replacement feeding is not a safe alternative to exclusive breastfeeding for the first six months.

Feeding recommendations for Infants of HIV-infected Mothers

• Exclusive breastfeeding is recommended until 6 months of age, regardless of the infant HIV status.

Module 6: A Food-Approach to Support HIV/AIDS Affected

households and Communities

• This module provides information on the selection, composition and size of food commodities, to program managers who address HIV-affected populations at the community and institutional level.

Module 6: A Food-Approach to Support HIV/AIDS Affected

households and Communities

• Introduction

• Community-based care and support

• Institution-based Feeding Programs

• Institutional care for severely malnourished individuals

Food as mean to Provide Care and Support:

• Facilitating a Community-led Assessment of local food

• Designing and Implementing a Food Program

• Selecting Ration Size and Composition

• Linking Communities with Other Services

Facilitating a Community-led Assessment of local food

• Gathering information: quantitative information available form the host government Ministries, national survey data, existing studies and reports.

• Ensure that the community conducts its own assessment of the situation, then devises an appropriate plan based on the findings.

Facilitating a Community-led Assessment of local food

• Useful questions to gather the information:

- Where do households get their food?- What factors limit the ability of households to obtain food?- How do households obtain their cash income?- What factors limit how well households use their food to meet their dietary needs?

Facilitating a Community-led Assessment of local food

- Who are the most food insecure or vulnerable population groups?

- What are the traditional community feeding and care practices?

- What are the locally available foods?

- What are the market services?

- What are the links to health services?

Designing and Implementing a Food Program

• Program Managers+ the Community Develop together :

- A set of program goals and objectives- Strategies for delivering food and other services- Preferable to work with existing organizations rather than creating entirely new structures

Designing and Implementing a Food Program

• Three basic questions should be considered:- What is the purpose of introducing a food program to the community?

- What is the appropriate way to deliver food aid in the community?

- Who are the beneficiaries and what are their energy needs?

Living Well With AIDS

A Manual on Nutrition, care and Support for People Living with

HIV/AIDS

FAO, 2002.

Table of Contents• Introduction• Adapting and using the manual• The benefits of good nutrition for people and

families living with HIV/AIDS• Healthy and Balanced nutrition is important

for everyone• Healthy and balanced nutrition• Special eating needs for people living with

HIV/AIDS

Table of Contents

• Protect the quality and safety of our food

• Coping with the complications of HIV/AIDS

• Taking care of people living with HIV/AIDS

• Herbal treatments and remedies

• Annexes

• Summaries

Introduction

• A Manual on Nutrition, Care and support for people with HIV/AIDS.

• Released in 2002 by the FAO to help individuals and program managers improve the health of people living with HIV through improved nutrition.

Adapting and using the manual

• Adapting the manual for local use

• Changes needed

• Some suggestions on how to adapt the manual

• Dissemination of the guidelines

• Monitoring and evaluation

The benefits of good nutrition for people and families living

with HIV/AIDS

• We eat for many reasons

• HIV/AIDS and nutrition

• Healthy and balanced nutrition is important for people living with HIV/AIDS

Healthy and balanced nutrition is important for everyone

• Our bodies need food

• Healthy and balanced nutrition

Healthy and balanced nutrition

• Enjoy a variety of foods • Eat staple foods with every meal • Eat legumes if possible every day • Eat animal and milk products regularly • Eat vegetables and fruit every day • Use fats and oils as well as sugar and sugary

foods • Drink plenty of clean and safe water

Special eating needs for people living with HIV/AIDS

• People living with HIV/AIDS have increased nutrient needs

• HIV/AIDS affects weight

• Gaining weight

• Increase vitamin and mineral intake

• Micronutrient supplementation- which, how much, when?

Protect the quality and safety of our food

• Disposal of faeces

• Personal hygiene

• Hygiene in the kitchen

• Cooking and storage of food

• Animal foods

Coping with the complications of HIV/AIDS

• Diarrhea• Lack of appetite• Nausea and vomiting• Sore mouth or when eating is painful• Other digestive problems• Change sin the taste of foods• Skin problems• Colds, coughs and influenza• Fever

Taking care of people living with HIV/AIDS

• Taking care of yourself-advice for the person with HIV/AIDS

• Caring for a person with HIV/AIDS

• Recommendations for carers

Herbal treatments and remedies

• Traditional treatments; locally promoted approaches

• Herbs and spices

Annexes

• Recipes and food for a healthy diet

• Form to monitor food intake over one week

• Important vitamins and minerals for people living with HIV/AIDS

• Form to monitor weight changes over time

Annexes

• Institutions and organizations providing support to people living with HIV/AIDS

• Bibliography and sources

• Glossary

Summaries

• Healthy and balanced nutrition for growth, work and play

• Maintaining weight

• Food safety and hygiene

• Diarrhea

• When you are not hungry…the best way to regain your appetite is to eat

Summaries

• Nausea and vomiting

• Sore mouth or throat or when eating is painful

• Colds, coughs, sore throat and fever

• Look after yourself

• Caring for someone with HIV/AIDS

Summary of the Workshop

1. Introduction and History of Global Service Corps programs in East Africa

2. GSC- Heifer Project Training3. SOS Partnership/Fellowship Program4. SOS Program Training5. Review of Training Manuals