Summary:

There are over 190,000 people living with HIV (PLHIV) in Haiti. As of March 2007, 10,000 HIV-positive

individuals were receiving anti-retroviral therapy (ART) and over 50,000 have received palliative care. Haiti

suffers from high rates of malnutrition (e.g. 24 percent of children under the age of five are stunted, 22

percent are underweight, and 16 percent of women are too thin (BMI<18.5)), which can worsen the impact

of HIV and pose significant challenges to care and treatment. HIV and malnutrition interact in a vicious

cycle that is exacerbated by and results in reduced food intake, increased energy needs and poor nutrient

absorption.

Strong food and nutrition intervention can help alleviate this cycle by improving food intake/utilization,

immune response, management of symptoms, response to treatment, nutritional status, and quality of life

and productivity. Recognizing the critical role food and nutrition can play in effective responses to HIV,

USAID Haiti is working with a number of partners to strengthen food and nutrition interventions.

In Haiti, deterioration of nutritional status due to HIV is aggravated by the poor socio-economic condition

and food insecurity. In addition, people living with HIV (PLHIV) placed on ART need food to tolerate their

medication and are at risk of developing metabolic complications from the medications. Some of these

complications may be ameliorated with appropriate food and nutrition interventions.

By September 2008, PEPFAR Haiti expects to enroll 100,000 PHLIV in palliative care through a continuum

of care at the clinical, community, and home levels. PEPFAR Haiti aims to increase capacity at all of these

levels to provide high quality food and nutritional care and support for PLHIV enrolled in care. In order to

do this, PEPFAR Haiti will build on activities started in COP 2007 to develop 1) a national food, nutrition,

and HIV strategy, 2) national guidelines, 3) a training plan for food and nutritional care and support capacity

building and, 4) the design and implementation of a food production intervention to strengthen therapeutic

and supplementary feeding of PLHIV, pregnant and lactating women and OVC.

The USAID/Government of Haiti/FANTA follow-on project will provide technical assistance for these efforts

by:

1)Providing ongoing technical support for the national technical working group (TWG) comprised of

stakeholders from the Haitian Government, United States Government, implementing partners, United

Nations agencies and other donors to plan and coordinate food, nutrition, and HIV activities in the country.

2)Providing ongoing technical support for food production for the HIV context and for therapeutic and

supplementary feeding of the President's Emergency Plan for AIDS Relief (PEPFAR) priority target groups.

3)Producing a training manual on food, nutrition, and HIV for training of service providers in food and

nutritional care and support. Existing training materials from other countries (e.g. Rwanda, Kenya) will be

adapted and refined for the Haiti context. Initial training of trainers and HIV service providers will also be

implemented.

4)Producing materials to support nutrition counseling and assessment (e.g. counseling cards, BMI charts,

etc.) for PLHIV at both the clinical and community levels.

5)Technical assistance to HIV care and treatment facilities and sites to support the integration of nutrition

assessment and counseling into HIV services and the integration of nutrition information into the flow of

data in the facility.

While the primary entry point for food and nutrition services will be HIV treatment facilities, the capacities of

community- and home-based care services will also be built to provide nutrition education and counseling.

Linkages between facility-based and community-based programs will be established, as well as linkages to

programs providing food assistance and livelihoods support, where possible. These activities follow

PEPFAR policy guidance on the use of PEPFAR funds to support food and nutrition interventions.

These activities will strengthen the quality of care and treatment services supported by PEPFAR and will

increase the number of PLHIV that PEPFAR is reaching with nutritional care and support. It is expected

that approximately 30 trainers of service providers will receive training in nutrition and HIV, approximately

100 service providers will receive training in nutrition and HIV, and approximately 85 service outlets will

provide nutritional care and support.