For the last fifteen years I have been working towards helping people with HIV achieve an optimal nutritional intake. In London, the majority of people living with HIV are able to afford a balanced diet, with a variety of foods providing all the protein, energy, essential fats, vitamins and minerals they need to support their immune function. However even in London some people ill with HIV are isolated or surviving at a degree of poverty where they cannot afford to buy the food they need.
The Food Chain, the UK's main HIV nutrition organisation, has been supporting housebound people with HIV for almost 20 years, providing meals, food parcels and nutritional know-how to those in need. In fact they have delivered one-third of a million meals to people unable to leave their homes to go shopping, or people too weak to prepare food for themselves. These days in London, the vast majority of people with HIV are living well as a result of successful antiretroviral therapy. A typical user of The Food Chain's services might have become unwell, tested HIV positive, commenced on ARVs, and also started receiving meals and groceries at the same time. The ARVs gradually do their job: the HIV in the bloodstream is controlled. The meals and food parcels from The Food Chain provide the nutrients needed for the immune system to reconstitute. Gradually the person's health improves, and eventually they will not need to receive support from The Food Chain any longer.
A few months back I was delighted to hear that The Food Chain was embarking on some pilot projects looking at supporting people returning to good health. One project is looking at volunteers from The Food Chain helping people learn how to shop and cook in a way that will support their long-term health. Another project involves people recovering from HIV related illnesses growing their own fruits and vegetables in an allotment in East London. I think this is a wonderful idea, as growing your own produce helps with nutrition, of course, but also enables muscle-building exercise vital to support immune function.
Here in Southern Africa, growing fruits and vegetables is important for the same reasons. However, this is a region where perhaps the majority of people living with HIV have uncertain access to even basic foodstuffs due to poverty. This food insecurity seemed most prevalent in Lesotho where there are no state benefits, where drought has hit food production, and where medicines other than HIV are not provided free. In South Africa, unemployment amongst HIV positive people is estimated to be over 60%. Even in diamond-wealthy Botswana with its well-developed state benefit system some people with HIV were struggling to eat a variety of foods.
For many years now, projects in sub-Saharan countries have been supporting development of home gardens. Now in the era of the ARV roll-out there seems to be a resurgence in these projects. This is entirely appropriate. Helping food-insecure HIV positive people produce their own fruits and vegetables is the most practical and sustainable way forward.
I met with John Nzira, a wonderful man originally from Zimbabwe, who others talk of as "Mr Permaculture". Permanent agriculture as a concept has been around for a while. In this context in Southern Africa, it encompasses a simple, low energy and sustainable way to for HIV positive people to produce food using recycled and inexpensive materials. John trains trainers to go out and work with people with HIV in developing their own gardens.
The concepts are beautiful in their simplicity and harmony. Gardens are laid out to be accessible to people with limited energy and ability. Trees are used as windbreaks – not just any old tree, but trees from the pea family that naturally add more nitrogen to the soil, and trees that produce nutrient-packed fruits such as avocados or mangoes. A variety of vegetables are encouraged: pumpkins to provide vitamin A-packed flesh, and iron and protein-packed seeds; iron and vitamin-rich spinach and chard; mineral-rich beetroot. Variety helps achieve optimal nutritional intake at the same time as ensuring high yields and reduced pest numbers through crop rotation. Herbs are grown in between vegetables plants. These act as natural pest deterrents as well as providing medicinal qualities. Ducks and hens are ideal slug and snail killing-machines, and provide eggs and meat. Rabbits kept in pens can be easily looked after by children, and provide high quality manure for the gardens as well as vital protein-rich meat. Recycling is integral in permaculture: water is captured from roofs, and grey water used for irrigation; old tin cans are used to grow on seedlings, and once too rusty to use for this are crumbled into compost to add more minerals.
One of John Nzira's messages has stuck with me: he encourages those who have learnt about his gardening methods to pass on his ideas to others, and to children in particular. I hope you will do the same.
(Extracted with permission from www.hivnutrition.org.uk)