Global South-South Development Expo

Solution Exchange Forum on NUTRITION, HIV/AIDS, AGRICULTURE AND FOOD SECURITY

December 7, 2011

9:00-12:00

Venue: The Red Room

FAO Headquarters, Rome, Italy

A “Solution Forum on Nutrition, HIV/AIDS, and Food Security’ will be held during the Global South-South Development Expo (GSSD).

The objective of the Forum is to feature some of the successful southern development solutions for HIV and AIDS, nutrition and food security. Organized by the World Food Programme, it will specially focus on solutions in expanding access to HIV and AIDS prevention, treatment, care and support as well as mitigating the impact of AIDS through nutrition and other means.

The Solution Forum will be chaired by Dr. David Nabarro, Special Representative of the UN Secretary General for Food Security and Nutrition, with support from Dr. Martin Bloem, Chief for Nutrition and HIV/AIDS Policy and UNAIDS Global Coordinator at the United Nations World Food Programme. The panelists are experts with demonstrated capacity development and experience with regard to HIV and AIDS and other domains of relevance to nutrition and food security.

The forum will feature solutions from Africa, Asia, Latin America and the Caribbean.

North-South-South cooperation: Sharing of best practices of North-South-South cooperation in the area nutrition and HIV and AIDS.

The Lao-TACHIN project will showcase how Thailand succeeded in integrating nutrition interventions into HIV comprehensive care and transferring it to Laos through the technical support from the Australian government.
Integrating food and nutrition dimensions with HIV treatment and care: Strengthening capacities of national actors to integrate food and nutrition within HIV treatment and care in Latin America and the Caribbean.

This solution will showcase the impact of a regional south to south approach to integrate nutrition as a critical element of HIV care and treatment in three countries of the LAC region.

The regional project has involved the development and implementation of nutritional counseling and food support for vulnerable people living with HIV to support treatment adherence and treatment outcomes. This initiative involves strengthening national and institutional capacities through collaboration with National Aids programs, civil society and research organizations.
Mobile technology: Utilization of automated cash and voucher systems through the private sector for the delivery of nutrition and HIV service.

The SPLASH Programme, is an innovative example of how the integration of a Payment Service Provider (PSP) and technology transfer can decrease operational overheads and opportunity costs to clinic staff involved in food support and nutrition rehabilitation to clients both on Art and TB-DOTS. This programme has been replicated in Mozambique and Zimbabwe.

Key messages

Providing nutrition and food assistance can support treatment uptake, adherence and success.

HIV has profound consequences on nutritional status. Many people are often food-insecure and malnourished before infection, and disease becomes a cause of malnutrition through its effect on metabolism and the ability to ingest and digest food. For those on treatment, good nutrition helps tolerate drug intake and manage side effects.
Nutrition and/or food support needs, therefore, to be an integral part of treatment regimes. They enable uptake and initial adherence to treatment as well as accelerate nutritional recovery, both of which reduce mortality and enhance treatment success.

Evidence exists to support the link between nutritional support and treatment success.

When assessing the cost effectiveness of food security and nutrition programmes, it is critical to take into account their impact on increasing treatment uptake and adherence, thus improving overall treatment success and potentially reducing the need for expensive second-line and third-line treatment regimens that patients must take when first-line regimens stop working.
Improving nutritional status around the start of treatment is an important factor in reducing disproportionate early mortality. In addition, many treatment drugs and the treatment of HIV-related infections interact with food intake and/or absorption.
Safety nets prevent people from engaging in negative coping strategies.
When a productive household member is infected with HIV and falls ill, the household faces rising health care costs and significant income loss, sometimes compounded by stigma and discrimination. Food assistance to households can complement support provided by families, communities and institutions and will support basic education, vocational training and livelihood opportunities.
Programmes that support food security can help reduce the likelihood of negative coping strategies such as selling household assets (e.g. livestock, agricultural equipment) which lead to even worse poverty and migration, removing people from their homes and communities.

Food and nutrition support help overcome barriers to treatment.

People living with HIV and TB patients face multiple barriers to seeking a diagnosis and accessing and adhering to treatment. These barriers include poverty, food insecurity as well as stigmatization. A well designed food and nutrition intervention makes it more likely that people living with HIV and TB patients can overcome these barriers.
As treatment coverage increases, more attention needs to be paid to adherence and prevention of loss to follow-up, which is already emerging as a major, often poorly understood challenge. Integrated food and nutrition services at both health sector and community levels are critical in helping overcome barriers to treatment adherence, and should be considered as part of a comprehensive package of care. As enablers of treatment adherence, such services can ensure scarce resources are spent effectively while preventing the development of resistance to treatment.
Good adherence is also very important for reducing new infections, including vertical transmission. Nutritional support is also important for those who do not have access to treatment or, in case of HIV, are not yet eligible for treatment. Targeted nutrition support may delay disease progression as well as mitigate the consequences of the disease on households.

Each panelist will have 15 minutes to present his/her solution. After all the presentations the moderator will ask the audience for some questions to facilitate a discussion on how these projects contribute in integrating nutrition and food security in solutions that can be scalable, cost effective and innovative.

Dr. David Nabarro Assistant UN-Secretary-General Special Representative for Food Security and Nutrition 9:30 – 9:45	KEYNOTE ADDRESS Chairperson – Dr. David Nabarro Born in London on August 26th 1949, David Nabarro studied at Oxford and London Universities and qualified as a physician in 1973. He has master’s degrees in reproductive endocrinology and community health. After a short period in the UK National Health Service he worked for six years in child health and nutrition programmes for Save the Children in Iraq, South Asia and East Africa, taught for six years at the London and Liverpool Schools of Tropical Medicine, served as Chief Health and Population Adviser to the British Government’s Overseas Development Administration and in 1997 became Director for Human Development in the UK Department for International Development (DFID). In 1999 ha was selected to lead Roll Malaria at the World Health Organization (WH0). Within two years he was appointed as Executive Director at WHO (in the office of Gro Harlem Brundtland, Director General): he worked with her for two years on a variety of issues including the Commission on Macroeconomics and Health, Health Systems Assessments and the creation of the Global Fund to fight AIDS, Tuberculosis and Malaria. David was then appointed to lead the WHO cluster handling Food Safety, Emergency Health Action and Environmental Health. In 2003, after Dr Brundtland had moved on, David Nabarro was asked to head up the new WHO Department for Health Action in Crises, coordinating worldwide support for health aspects of crises preparedness, response and recovery. In September 2005 David Nabarro joined the office of the UN Secretary General as Senior UN System Coordinator for Avian and Pandemic Influenza and the United Nations Assistant Secretary-General. In January 2009 he was given the additional responsibility as Coordinator of the UN system’s High Level Force on the Food Security Crisis. In October 2009, Ban Ki Moon, UN Secretary General, appointed David Nabarro as his Special Representative for Food Security and Nutrition.
NORTH-SOUTH-SOUTH COOPERATION: Sharing of best practices of North-South-South cooperation in the area nutrition and HIV and AIDS
Martin Bloem, WFP Chief, Nutrition and HIV/AIDS Policy 9:45– 10:00	INTRODUCTION OF PANEL MODERATOR – MR. Martin Bloem Dr. Martin W. Bloem is Chief for Nutrition and HIV/AIDS Policy and UNAIDS Global Coordinator, at the United Nations World Food Programme, in Rome, Italy. He holds a medical degree from the University of Utrecht and a doctorate from the University of Maastricht and has joint faculty appointments at both Johns Hopkins University and Tufts University.  Martin has had more than two decades of experience in nutrition research and policy in developing countries. He was the Senior Vice President Chief Medical Officer of Helen Keller International prior to his appointment at the World Food Programme.  Martin has devoted his career to improving the effectiveness of public health and nutrition programs through applied research. He has participated in task forces convened by many organizations, including international non-governmental organizations, the UN Standing Committee on Nutrition, the United Nations International Children’s Emergency Fund, the United States Agency for International Development, and the World Health Organization.
Dr Praphan Phanuphak, Thai Red Cross AIDS Research Centre, Thailand 10:05– 10:15 Dr Chansy Phimphachanh, Center for Control HIV/AIDS/STI, Lao PDR 10:15-10:25	The first three year Lao-TACHIN project (2008-2011) has started implementation in one province in the south of Lao PDR, Champasak province. It aimed at building the capacity of CHAS in Lao in collaboration with the Thai Red Cross AIDS Research Centre (TRCARC) to work with Lao PDR partners to scale up and manage their HIV services, focusing on the area of nutrition. The need and interest in developing the capacity of health care workers and peer support staff in providing basic medical care and nutrition support to PLHIV were identified through collaborative assessments at the beginning of the project and again by the end of the first three years: For instance, they clearly noticed the improvement of BMI. Health personnel, as PLHIV, in that province have also learned the importance of good nutrition to improve their health as much as the role of ARV regimens and adherence. Based on the assessment, the project is currently extended to the 4th year with expansion to the second province in Lao PDR, the Savannakhet Province. From this initiative project, Lao PDR has planned to implement the model nationwide through a grant to be submitted to Global Fund for AIDS, TB and Malaria (GFATM). Prof Prapahn Phanuphak Education and Certification Medical Doctor, graduated from Chulalongkorn University, Bangkok, Thailand Ph.D. in Microbiology (Immunology) from University of Colorado, U.S.A. American Boards certified in Internal Medicine, Allergy and Immunology Current Positions / Functions Professor Emeritus, Faculty of Medicine, Chulalongkorn University Director, the Thai Red Cross AIDS Research Centre Co-Director, the HIV Netherlands Australia Thailand Research Collaboration (HIV- NAT) Co-Director, the Thai-Australian Collaboration in HIV Nutrition (TACHIN) Vice-Chair, Thailand Country Coordinating Mechanism (CCM) of Global Fund for AIDS, Tuberculosis and Malaria. Member of Governing Council of International AIDS Society (IAS), Asia-Pacific Region Prof Chansy Phimphachanh Education Nurse and Midwifery from Melbourne, Australia MD from University of Health Sciences, Lao PDR MPH from Faculty of Public Health, Mahidol University, Thailand Current position Director of the Center for HIV/AIDS/STI9CHAS) since 1999 Working Experiences Chair of ASEAN Task Force on AIDS (2005-2007) Director of National Committee for the Control of AIDS Bureau, and now becomes the Center for HIV/AIDS/STI (CHAS) National Project Director of the HIV/AIDS Trust Fund from 1999 until April 2002 A member of UN Regional Task force on Mobility from 2000 until 2004 National coordinator for the Control of HIV/AIDS/STD Partnership Project in the Asian Region (CHASPPAR) up to the end of the project April 2004 Focal Point for ASEAN Task Force on AIDS (ATFOA)
Jayne Adams, WFP, Panama 10:30– 10:40	INTEGRATING FOOD AND NUTRITION DIMENSIONS WITH HIV TREATMENT AND CARE: Strengthening capacities of national actors to integrate food and nutrition within in HIV treatment and care in Latin America and the Caribbean In 2007, WFP established a technical agreement with RAND Health to develop LAC (Latin America and the Caribbean) specific evidence and best practices related to integration of food, nutrition and livelihood security strategies with ART (HIV antiretroviral therapy) and PMTCT (prevention of mother to child transmission) services. In the initial phase, formative research was conducted in Bolivia in collaboration with the National AIDS Program (NAP) and other key stakeholders. The methodology that was developed and tested in Bolivia was later replicated in Honduras with a grant from NIH (National Institutes of Health). In both countries this led to the development, implementation and evaluation of nutritional counseling and food assistance interventions linked to ART and PMTCT in clinical settings with technical expertise and lessons learned being shared between the two countries at each stage. At this time the initiative is being replicated in Dominican Republic with technical support provided by WFP, RAND and the project staff from Honduras. Proposed next steps include expansion in Honduras, replication in Guatemala, and integration of an operational research component in Dominican Republic. Ms. Jayne Adams Jayne graduated in Social Administration at the University of Nottingham in 1988 and has since dedicated her career to the development and implementation of social service and public health programs targeting vulnerable populations, with a particular focus on women and children. After working as a social worker with disenfranchised youth for several years in London, Jayne moved to the United States. There she became a Program Officer with a Los Angeles based non-profit organization providing medical relief in countries impacted by conflicts or natural disasters. Later she served as Director of Social Services for a large early childhood development agency where she managed a comprehensive range of programs targeting immigrant families living in severe poverty. In 1997, Jayne became the Executive Director of Common Ground, an organization providing a range of “harm reduction” based services targeting people with HIV facing the multiple challenges of homelessness, mental illness and substance use. Since 2006, Jayne has held posts at the World Food Programme’s Regional Bureau for Latin America and the Caribbean. The first as Regional HIV Adviser and the second, which she still holds at present, as Head of Strategic Planning and Resource Mobilization.
Lourdes Jiménez Lopez, WFP, Honduras 10:40-10:50	INTEGRATING FOOD AND NUTRITION DIMENSIONS WITH HIV TREATMENT AND CARE: Strengthening capacities of national actors to integrate food and nutrition within in HIV treatment and care in Latin America and the Caribbean Lourdes Jiménez Lopez Lourdes is a Doctor of Medicine and Surgery from the Autonomous National University of Honduras, with master's degree in the HIV / AIDS from the University King Juan Charles in Spain. She is also Graduated in nutrition from the Catholic University of Honduras. She has more than 15 years of experience in the clinical attention of the first and second level in the public and private sector. Futhermore, she worked more than 6 years with NGOS (NON-GOVERNMENTAL ORGANIZATIONS) in the individual and community attention of vulnerable groups: pregnant women, children and populations in the risk of acquiring ITS and HIV / AIDS. These last three years, Lourdes Jimenez has been a Consultant in HIV and Nutrition for the United Nations World Food Program. Project’s Name: Evaluation of Food safety and Nutrition roles in the Promotion of Adhesion to Treatment with Antiretroviral Medicines for people older than 18 years in Honduras.
Mr. Calum McGregor, WFP, Zambia 10:55 – 11:05 Dr Tsitsi Mutasa-Apollo Zimbabwe government 11:05 – 11:15	MOBILE TECHNOLOGY: Utilization of automated cash and voucher systems through the private sector for the delivery of nutrition and HIV service In November 2009, WFP Zambia launched the Mobile Delivery and Tracking (MDT) system as a delivery mechanism for its SPLASH (Sustainable Programme for Livelihoods and Solutions for Hunger) programme which targets vulnerable households including patients on ART/TB treatment. In the first month of implementation, 320 ART/TB patients received food assistance through MDT voucher scratch cards. At the close of the SPLASH, the system had delivered over 275,000 successful vouchers which were redeemed for a specified food basket in local shops. The shop keepers were paid instantly and electronically for these items. The system and technical expertise has been passed to both the WFP Zimbabwe and Mozambique COs that have continued to partner with the private sector provider in various guises to deliver nutrition programming. The WFP Zambia office has continued expanding on the research around new technologies and financial services to provide further technical support to governments and other UN agencies in the region and beyond, and to look at the capacity of such systems to provide nutritional supplements (for nutrition rehabilitation) and/or fresh foods. Mr. Calum McGregor Mr. McGregor is a project manager at the WFP Zambia Country Office. He is currently specializing in utilization and set up of mobile banking systems and payment service provider products for cost efficient delivery of development and emergency programmes that has taken him to various countries including Zimbabwe, Mozambique and Sudan. He initiated the development of a vanguard WFP e-voucher solution through a public private partnership with national Mobile Payments and Transfers Company (Mobile Transactions Zambia Ltd) to provide accurate registration of beneficiaries, tracking of financial transfers and reporting. He is now also acting as a technical advisor to the Zambian Government and Cooperating Partners (DFID & UNICEF) on the procurement of a Payment Service Provider (PSP) for the Government’s national Cash Transfer System (scheduled for full launch in 2011). Dr Tsitsi Mutasa-Apollo Dr Tsitsi Mutasa-Apollo is currently the national coordinator for HIV, AIDS care and treatment programme in Zimbabwe. As a medical doctor with specialization in Public Health she has been practicing in Zimbabwe in the public health system for over 10 years, at district, provincial, and national levels. She has experience in managing communicable and non-communicable disease programmes in both rural and urban settings. Her previous work experience: HIV/AIDS Advisor- JSI/SCMS (2006-2007) Assistant field coordinator for master’s in public health program-university of Zimbabwe College of Health Sciences (2006) Control Programme Manager (2005) Provincial epidemiology and disease control officer (2004)
11:15– 12:00	MODERATOR: GENERAL DISCUSSION & WRAP-UP