Nap - Food For Pla

FOOD
For people living with

HIV/AIDS
Volume 3
Network of African People Hope for African

Living With HIV/AIDS (NAP+) Children Initiative
Third Edition
Compiled and Edited by NAP+ Secretariat Staff:
Dorothy Odhiambo
Mike Angaga
Steve Amolo Amolo
Assited by
Dr. Bactrim Kilingo
Nairobi 2005
Published and Printed by

Macleons Enterprises
P. O. Box 1516-00200
Nairobi, KENYA
All rights reserved. No reproduction in part or whole in any form is

allowed without written permission of the publisher
ISBN 0-620-19384-0
FOOD
For people living with
HIV/AIDS
Network of African People Living

with HIV/AIDS (NAP+)
Food for People living with HIV/AIDS
Acknowledgement
This publication has truly been a joint effort, and my warm gratitude goes to those who have contributed
their time, skills and expertise to take it from idea to distribution.
Without the generous financial support from HACI, the publication would not have been possible. With
its three fundamental principles being child focused, community-based and being committed into
ensuring that their programs are integrated, HACI has ensured full financial support to this publication.
Invaluable critical support was provided by those who reviewed chapters or sections of this edition or
provided other technical advice and support: Luanne Epstain and Dr Bactrim Killingo, whose
contribution around Nutrition and Treatment is remarkable.
Staff at NAP+ secretariat contributed in a variety of ways, not least facilitating some release of their time
to work on this publication. The text has been compiled and edited by Dorothy Odhiambo, Mike Angaga
and Steve Amolo. Special thanks go to Veronica Omunga and Hyrine Omollo who did the typing of
materials. Richard Ong'alla ensured the much needed materials were made available in good time.
Inevitably the gaps that remain in coverage of this wide and fast changing field, and any errors in the text
is highly regretted.
I
CONTENTS
Abbreviations and acronyms III
Preface IV
Executive summary 1
Introduction 2
Foods to avoid 5
Getting the nutrients you need. 7
Getting enzymes, antioxidants, and friendly flora. 13
Food Safety. 23
Salad dressings 27
Pregnant women and the baby 37
Food and drug interactions 45
II
Abbreviations/acronyms
NAP+ Network of African People Living with HIV/AIDS
HIV Human immunodeficiency virus
AIDS Acquired Immunodeficiency syndrome
ARV Antiretroviral
ART Antiretroviral therapy (treatment)
MTCT Mother-to-child transmission of HIV
NRTI Nucleoside reverse transcriptase inhibitor
NNRTI Non-nucleoside reverse transcriptase inhibitor
PI Protease inhibitor
PLHA Person living with HIV/AIDS
III
Preface
HIV/AIDS is one epidemic that has threatened and continues to threaten the basic core of human
existence. It has posed serious questions to many experts in the medical field who continue the struggle
to find a vaccine; the lasting solution. However, this feat has not yet been accomplished. How then can
we deal with the situation at hand? Nutrition as a Science has widely dealt with issues surrounding
Food, one basic human need. But what is food in relation to human health? There are many aspects
about it that if well understood can be used as a means of slowing down the progression of HIV-caused
diseases. It is imperative for you to take care of your diet for the first 30 years of life--and your diet will
take care of you, for the rest of your life (Lucy et al). Nutrition thus plays a role, long before ARVS do in
the management of HIV.
In view of the prevailing HIV/AIDS situation in the African region and the current food crisis, appropriate
strategies should be adapted to urgently and effectively address these. It has emerged that addressing
the nutrition situation in the region is a key intervention that will impact positively on the health and well-
being of the general population including, children, people living with HIV and other vulnerable
populations.
Nutrition plays a major role in the growth and development of the human body and in maintaining vital
processes which sustain life. The development of a strong immune system starts right before birth, a
process which relies heavily on maternal nutritional wellbeing.
In a comprehensive approach to HIV care, treatment and support, it is important to promote the
integration of nutritional services throughout the continuum of HIV/AIDS care. Nutritional status and the
progression of HIV are strongly interrelated. HIV infection increases the bodies energy needs while it
diminishes appetite and decreases the body's ability to digest food and absorb nutrients. Nutritional
status can affect both the efficacy of ARV drugs and the patient's ability to adhere to a treatment
regimen. HIV related illnesses can also indirectly influence nutritional status by limiting a household
ability to generate income, purchase food and raise crops
It is based on this realization that nutritionists have come up with nutritional guidelines that if followed,
can ensure good health even for those living with HIV/AIDS. The nutrition guidelines are dynamic and
keep evolving to ensure that people get the most in terms of value from the Food they consume. This
surely gives credibility to the common phrase You Are What You Eat!
Michael Angaga
NAP+ Regional Coordinator
IV
Executive Summary
The Network of African People Living with HIV/AIDS (NAP+) has produced a Manual Food for People
Living with HIV/AIDS which gives a general overview of Foods and Nutrition Practices that are
recommended for a healthy living.
The Manual was reviewed and Updated after it was realized that there were certain key issues not fully
explored. The new version is comprised of 8 chapters all which serve to broaden the scope of Nutrition
and HIV/AIDS.
The first Chapter gives a brief introduction to Nutrition and Healthy eating. It gives a better
understanding of Food and its components. The second chapter talks about the kind of foods that a
person infected with HIV should try to avoid in his or her daily menu.
How to get the nutrients needed for proper body functions comprises the third chapter. It gives detailed
list of food substances that would provide the body with the required nutrients.
Chapter four in the Manual talks about importance of the Enzymes in the body. It describes the role
played by the anti-oxidants and the friendly Flora. This chapter gives details of fruits, legumes, grains
and other food substances providing the body with vital vitamins and minerals.
The fifth Chapter highlights issues concerning Food Safety and Hygiene. Food needs to be kept safe to
avoid contamination which could lead to food borne illnesses that serve to further weaken the immune
system. Measures that ensure Food Safety and Hygiene are also highlighted.
Chapter Six discusses Food salad dressings and types of water that would help in solving digestive
problems in the absence of medication. This chapter covers other food remedies for such problems. In
chapter seven the book talks about nutrition for HIV infected pregnant and lactating mothers and the
unborn baby. It discusses the feeding options for the baby taking into considerations the possibility of
MTCT of HIV. The book gives some cues to lactating mothers which is fundamental for healthy nursing.
Chapter eight of the manual covers Food and Drug interactions including nutrition and anti-retroviral
therapy. This is a pertinent issue for many PLHAs who are on treatment. It is true that many of those
infected by the virus in Africa have an irregular adherence pattern. This can be attributed in part to poor
nutrition. At some point during treatment you may have to take some medicines. The food we eat can
affect how the medicines work. Also, the medicines we take can affect how our bodies use the food we
eat. There are new and different medicines for HIV/ AIDS being tried everyday. This booklet cannot tell
you all that you need to know about food and drugs. It is important that you ask your doctor about each
medicine you are taking and any foods you should or shouldn't eat with them. You can also read from
other available resources.
'The More You Look, The More You Find'.
1
CHAPTER One
Introduction
Let thy food be thy medicine

Some people who have HIV/AIDS are living healthy lives for long periods of time. Some adults have
remained healthy for over 20 years after they were infected with the virus. It is still unknown why some
with HIV survive for long periods, while others do not. Some people fall in the category called non-
progressors. This is a group of individuals who are infected by the virus but do not develop AIDS related
ailments within a known period of time.
There seems to be many factors that help people with HIV to live long lives. The belief that they will
survive, support from family and friends, little stress, enough money, low exposure to the virus, early
medical treatment for infections, gentle exercise and healthy eating are some of these factors. This
book deals with healthy eating. It talks about good nutrition as a management component of HIV/AIDS.
Nutrition is defined as the Science of food that deals with how food is taken into our bodies, its digestion,
and absorption and how it is thus excreted from our bodies. It's all about food in relation to Health.
HIV is the virus that causes AIDS. HIV is a micro organism, as are all bacteria, viruses, and fungi that
cause disease. Micro-organisms are very small. You can only see them if you use a microscope.
When most micro-organisms that cause disease enter the body of a healthy person, the body's immune
system destroys the micro-organisms so that the person does not get sick. HIV, however, attacks the
body's immune system. The immune system cannot destroy micro-organisms and so the body may
become sick with many different diseases. A person may, however, remain healthy for many years
before the immune system begins to weaken. If you have the AIDS virus, you can use good food as a
therapy. If you are not sick, good food may help to keep you strong for a long time. If you are sick, the
right food may help you to get well.
People living with HIV/AIDS may have problems with digesting food. It seems that their digestive
systems do not work properly and that they cannot absorb what their bodies need from food. They also
have difficulty with eating. All this leads to serious weight loss. Malnutrition, which is the lack of healthy
food, is often the cause of death of people with AIDS.
This book tells people with HIV about healthy eating. It explains which foods both keep the body healthy
and are easy to digest. It also tells you how to buy and cook these foods and give recipes for healthy
dishes. It looks at the specific health problems of people with AIDS and offers food remedies for these
problems.
Food is said to be medicinal that is cheap and easy to get. It takes time and patience to see the benefits
of good food. It is not an over night cure. By eating foods that heal the body, you are choosing to live a
stronger and healthier life. Exercise is also very important. The two together help people with HIV to
improve their health.
2
Role of good Nutrition.

Food plays an essential role in our bodies. This includes;
Develop, replace and repair cells and tissues in our bodies.
Provides energy that keeps the body warm, helps in movement and work.
Carries out chemical processes such as digestion, absorption and assimilation.
Gives the body protection to resist and fight infections and recover from illnesses.
Digestion begins in the mouth, so remember to eat slowly and chew your food well. Listen to your body.
It can tell you what kind of food it needs. If you feel uncomfortable after eating a particular kind of food,
then it is better not to eat it. Listen to your body, love an nourish it.
Importance of good nutrition

One is said to have poor nutrition when the body is not receiving optimal nutrition, that is, the person is
eating less food in relation to what the body requires This therefore means that the body is receiving
less nutrients hence the above roles are not met resulting to malnutrition.
The body cannot function properly if one or more of the nutrients are missing. A healthy and balanced
diet provides food in the right amounts and combinations that are safe and free from diseases and
harmful substances.
Good nutrition therefore gives ones body immunity that helps reduce incidences of infections thereby
keeping the body healthy. Malnutrition and HIV are inter-related in that malnutrition fuels HIV/AIDS and
HIV in-turn aggravates the rate of malnutrition. Therefore good nutrition plays a major role in the
management of HIV/AIDS.
Good Nutrition helps to build the immune system.
Poor Nutrition leads to a weakened immune system.
This in due course leads to decreased appetite and negative effects on digestion and
absorption of nutrients and thus micro-nutrient deficiencies
3
Vicious Cycle
of Malnutrition and HIV
Poor Nutrition
resulting in weight loss,
muscle wasting, weakness,
nutrient deficiencies
4
Impaired immune system
Increased Nutritional
Poor ability to fight HIV
needs,
HIV and other infections,
Reduced food intake Increased oxidative
and increased loss of stress
nutrients
Increased vulnerability to
infections e.g. Enteric
infections, flu, TB hence
Increased HIV replication,
Hastened disease progression
Increased morbidity
Source: Adapted from RCQHC and FANTA 2003

CHAPTER Two
Foods to avoid
Traditional African food can give you a healthy diet. The foods that you can buy in shops are often less
healthy than those that your grandparents ate. To eat a healthy diet, avoid eating the following types of
foods.
Foods that are processed: Processed foods are those that are changed in food factories. The more
the food is changed, the less healthy it is likely to be. This is because many of the nutrients in food are
destroyed when it is processed. For example, when fruit and vegetables are canned, most of the health
giving nutrients is destroyed. There are many different types of processed foods.
Refined foods: Refined foods have a part of the food removed when they are processed. For example,
to get white rice, the husks and the germ of whole rice grains is removed; to get refined maize meal, the
husks and germ of whole maize grains are removed before the maize is milled. Refining removes the
protein, vitamins, and fibre from foods. Fibre is important for the bowel to work properly. Refined foods
are more expensive than unrefined foods, yet they are less healthy as they have lost their goodness.
The protein, vitamins, and fibre that are removed from whole grains during the refining process, are
used to make animal feeds. When you buy refined grains, you are paying extra to have the goodness of
the grain put into animal feed that someone else will buy!
Foods that contain preservatives, artificial flavors and artificial colorants.

Preservatives are chemicals that are added to food to stop the food from rotting. Most processed meat
and foods in bottles and tins contain preservatives. Artificial flavors are chemicals that are addend to
food to change the taste of the food. For example, potato chips have chemicals added to them to give
them flavors such as tomato sauce or cheese. Stock cubes and seasonings also contain artificial
flavors. Artificial colorants are chemicals that are added to food to make the food look more attractive.
These chemicals that are added to processed foods

are not themselves food. They are harmful to the
body and may interfere with digestion and stress the
immune system. Read the label. If the food
contains chemicals such as tartrazine or
monosodium glutamate, it is better not to eat that
food.
Canned foods: Canning involves heating food at

high temperatures. The heating causes the food to
lose many of its nutrients. Canned foods usually
contain preservatives. Canned fish, meat, and
beans are healthier than other canned foods
because canning destroys many of the vitamins but
not the protein or minerals.
5
Junk foods: Junk foods are foods that are made in factories. They contain preservatives, artificial
flavors and colorants and few nutrients other than refined
sugar, starch and fat. Cool drinks, sweets, chocolates and
chips are examples of junk food. Avoid eating junk foods as
they stress the digestive and the immune systems.
Foods grown with pesticides

Many farmers use pesticides to grow their crops. Pesticides
are poisons that kill pests and diseases that damage crops.
These pesticides often go into the food or remain on the food
after harvest. Pesticides stress the body and may lead to
cancer and babies that are born with something wrong with
them. Try to buy fruit and vegetables that are grown without
pesticides. Those that come from small farms and home
gardens are less likely to have pesticides on them than those
that come from large farms. Always wash fruit and vegetables
before cooking or eating them, to remove any pesticides that
may be on them.
Alcohol: Drink alcohol in small amounts. In large amounts,

alcohol damages the body. It prevents the body from using
the nutrients in food, stresses the digestive system and stops
the immune system from working properly.
The beer and other alcoholic drinks that are made in large
factories contain large amounts of alcohol. Home made
traditional African beer contain less alcohol. It is healthy to
drink small amounts.
6
CHAPTER Three
Getting the nutrients you need.
When you swallow food and it goes into your stomach, it is broken down into six different types of
nutrients. These are water, protein, fats, and oils, carbohydrates, vitamins and minerals. The body
needs all these nutrients to be healthy.
Water
Water makes up about 70% of the body. If you do not drink enough water, you can have problems with
every part of your body. Drink at least eight glasses of water each day. Spice teas are a good way to
drink water.
Water is the basis of good health. It is, however, also often a carrier of harmful chemicals and disease
causing micro-organisms. When your immune system is weakened, you can get sick from water that
others can drink without a problem. There are a few ways to clean the water that you use for cooking
and drinking.
Boiling
Boiling water for five minutes kills micro-organisms. Boiling does not remove harmful chemicals from
water. Filtering water removes chemicals but it may not remove all micro-organisms. Filtering and
them boiling the filtered water will both remove chemicals and kill micro-organisms
Filtering
There are a few different ways to filter water for home use. A good filter to buy is a portable jug filter. You
filter the water into a jug and use this water for drinking and cooking. You need to replace the filter
cartridge every six to eight weeks. You can buy jug filters and new cartridges from supermarkets,
hardware stores, ad pharmacies.
If you do not want to buy a filter, you can make a sand filter from a drum in the way shown in the picture.
Change the sand and gravel every six months.
Vitamins and minerals

The body needs minerals and vitamins to work properly. There are at least 17 different vitamins and 14
different minerals. Each one has a special use in the body. The body cannot work properly if any one is
missing. As the immune system weakens, so the body's need for vitamins and mineral increases.
Vegetables are an important source of vitamins and minerals. They clean and build the body and are
easy to digest. You cannot eat too many vegetables.
The mineral and vitamin chart on the next page shows:

The vitamins and minerals that people with HV/AIDS are often short of, or need the most.
The foods that contain the nutrient
The ways in which the body uses the nutrient
What happens to the body if you do not have enough of the nutrient? These are called
deficiency symptoms.
7
Mineral and Vitamin chart

Nutrient Food sources Use in the body Symptoms if deficient
Vitamin A All yellow and orange fruit & To make white blood cells, for Eye problems and night blind-
vegetables, alfalfa, milk, garlic, vision, healthy skins, teeth and ness, sensitivity to light, scaly
green vegetables, egg yolk, liver bone development, protection and dry skin and hair, poor teeth
against infection, antioxidant and nails, colds
Vitamin B6 Sunflower seeds, whole grains, Breakdown of protein and fats, Tiredness, anaemia, irritability,
seeds and nuts, cabbage, eggs, production of antibodies and depression, sore tongue, nausea,
leafy green vegetables, alfalfa, red blood cells, production of muscle twitching, dizziness, skin
banana, liver, legumes, chicken, protein and nerve transmitters, problems, nerve problems
meat and fish antioxidant
Vitamin B12 Seafood, liver, kidney, heart, Formation of red blood cells, Tiredness, anaemia, confusion,
sardines, whole grains, tuna, affects white blood cells, main- numbness, nerve problems, ring-
yorghut, eggs, cheese, meat, tains nerve and gastro- ing ears, dementia, memory
chicken intestinal tissue problems
Folic acid Kidney, liver, nuts, legumes, Works together with vitamin Diarrhea, sore red tongue, anae-
eggs, green vegetables, whole- B12, aids red blood cell forma- mia, heartburn, fatigue, confu-
grains, avocado, oranges, fish tion, for cell division, and sion, depression, dementia.
growth
Vitamin C Guavas, sweet peppers, alfalfa, Builds healthy bones, teeth Bleeding gum, bruise easily, slow
leafy green vegetables, oranges, and gums, helps fight infection, to heal, anaemia, muscle and
potatoes, all fruits, tomatoes helps iron absorption, anti - joint pain, frequent colds.
oxidant
Vitamin E Vegetable oils, nuts and seeds, Increase disease resistance, Tiredness, dry hair, leg cramps,
whole grains, eggs, legumes, protects fats and vitamins A infertility, muscle weakness, im-
dark green vegetables, alfalfa and C from oxidation, prevents portance, nerve problems, heart
aging, treats scare tissue, anti- disorders
oxidant
Zinc the mineral Leafy green vegetables, seafood, Protects the immune system, Slow growth, loss of smell or
most deficient in oysters, nuts, meat, pumpkin needed for digestive and im- taste, loss of appetite, diarrhea,
people with seeds, milk, liver, whole grains, mune system enzymes, mus- prostrate gland problems, poor
HIV/AIDS egg york, garlic, chicken, fish, cles, wound healing, vitamin A wound healing, skin problems,
legumes, popcorn metabolism, antioxidant ringing ears
Selenium Brown rice, nuts, seafood, liver, Prevents oxidation and break- Weakness, pancreas damage,
eggs yolk, onions,, garlic, alfalfa, down of fat and other body impaired growth, heart problems
meat, whole grains, milk cells, antioxidant
Magnesium Seafood, legumes, nuts, seeds, For muscles, nerves and the Spasm, cramps, tremors, consti-
whole grains, avocado, dark release of energy from fats, pation,(strained bowel move-
green leafy vegetables, avocado, proteins and carbohydrates ments)
potato skins
Iron Meat, liver, kidneys, eggs, green Needed for oxygen exchange Headaches, tiredness, irritability,
Vitamin C leafy vegetables, seeds, whole in the blood, needed by en- place color, dizziness.
helps the body grains, legumes, potatoes, nuts, zymes
to take up the apricots, alfalfa, fish, seafood
iron in food
8
For examples, if you are tired and confused and you have anaemia, numbness, nerve problems, ringing
in the ears, dementia, and memory problems, you probably have a shortage or deficiency of vitamin
B12. You must eat lots of foods that contain vitamin B12 such as seafood, liver, kidney, heart, sardines,
whole grains, tuna, yogurt, eggs, cheese, meat and chicken.
Proteins
Protein builds and repairs the body. When you do not eat enough protein, the body begins to break
down and the immune system does not work properly. With HIV/AIDS, the body often has an extra
need for protein. Protein comes from plants and animals.
Protein is made up of building blocks called amino acids. There are 20 different amino acids. Some
proteins do not have all the amino acids. These are called incomplete proteins. Proteins that do have
all the amino acids are called complete proteins. Most plant proteins are incomplete. If you eat certain
plant proteins together, they make a complete protein. If the foods are not combines, such of the protein
is wasted. The chart below shows how you can combine plant foods to get complete protein for your
body. Soya beans (and the foods made from soya beans such as soya mince, and soya milk) and
alfalfa (Lucerne) sprouts contain complete proteins.
Complete protein combination chart
Food Combine with

Legumes: lentils, beans, peas Grains, nuts, seeds
Grains: rice, maize, barley, oats, wheat, rye, sor- Legumes, milk products
ghum, millet
Nuts and seeds Legumes, milk products
You can also combine grains with animal products. You need eat only a small amount of an animal
product for your body to be able to use the protein in a large amount of grain. Animal products are
sources of complete protein. These include fish, eggs, milk products, meat, and poultry
Meat
Meat is a good source of protein and it contains the minerals zinc and iron. People with HIV/AIDS may
find meat difficult to digest.
Minced meat is easily to digest, but it is more exposed to bacteria. Ask your butcher to mince meat
freshly for you and use it as soon as possible. Make minced meat and vegetable stews.
9
Organ meats heart, liver, kidneys, tripe, blood, and gut contain the same nutrients than meat. Liver,
especially, is an excellent source of many nutrients.
Poultry - birds such as chickens and turkeys - is a good source of protein, fat and minerals, and it is
easier to digest than meat.
Dairy products
Dairy products that are cultured, such as sour milk, yogurt, and cottage cheese, are the best. Cultured
foods are foods that are changed by micro-organisms into a different food. For example, certain
bacteria change milk into yogurt.
Hard, yellow cheese and milk are more difficult to digest than cultured dairy products. Avoid processed
cheeses such as cheese spreads and cheese wedges. Avoid canned milk.
Use full fat milk products. When milk is dried to make milk powder, the B and C vitamins are destroyed.
Most of the milk's protein, fat, calcium and vitamins A and D are still found in the milk powder. Low fat
milk powder has no fat and vitamins A and D, so it is better to use full-fat milk powder.
Some people find milk difficult to digest and should avoid milk products
Fish
Fish is a good source of protein. It is easy to
digest and contains good fats as well as minerals.
Seafood
Seafood is a source of easily digestible protein. It
also contains minerals, especially zinc and
copper. Oysters, especially, contain high
concentrations of zinc. Seafood spoils very
quickly and may then cause food poisoning. Eat
seafood only if you know that it is very fresh.
Otherwise, it is better to eat frozen or canned. Do
not eat raw seafood.
Carbohydrates
Carbohydrates are starches and sugars, which provide the body with energy and are cheap and easy to
fine. Foods rich in carbohydrates are fruit, grains (maize, wheat, millet, sorghum, rice barley, rye, oats),
nuts, seeds, sugars, potatoes, cassava, sweet potatoes, yams, and dry legumes (beans, peas, lentils).
Fruit
Fruit is easy to digest and contains natural sugars as well as many vitamins and minerals. Steam and
mash fruit if you have sores in your mouth or your body is cold. Eat what is freshest and in season. Fruit
cleans the inside of the body. Dried fruit is rich in nutrients, easy to digest and good for gaining weight.
10
Grains
Grains build the body and contain important vitamins and minerals. Eat a variety of grains such as rice,
maize, millet, sorghum, oats, barley, wheat and rye. When combined with legumes, milk and animal
products, grains, also add protein to the diet.
Eat whole grains rather than refined white grains. Refining removes the protein, B vitamins, and fibre
from grains. Brown rice is healthier than white rice and brown or whole wheat is healthier than white
bread. Refined maize meal only contains starch, so rather eat unsifted maize meal, maize kernels, or
maize rice
Sugars
Sugars that are natural and unrefined, such as honey and molasses, also contain minerals, and
vitamins. Eat sugars in small amounts, however, if you may have problems with Candida, which is a
fungus that feeds off sugars. Candida, which is also called thrush or yeast, infects the mouth, digestive
tract and vagina. Avoid sugar is you have candida. Avoid white sugar as most of its nutrients are
removed when it is refined. Too much sugar damages the body and stops the immune system from
working properly.
Fats and oils

Fats and oils are good sources of energy. They help the body to absorb some of the vitamins. The body
uses fat to make other chemicals that it needs to work properly.
Fats and oils are good for gaining weight. Good sources of fat and oil are mat, chicken, coconut,
avocado, peanut butter, olives, seeds and nuts.
The building blocks of fats are called fatty acids. There are many different types of fatty acids. A few of
the fatty acids are called essential fatty acids. If the body can get the essential fatty acids from food, it
can make all of the other fatty acids it needs.
Essential fatty acids are very important for helping the immune system when there is infection. They
help to stop inflammation.
As the immune system of people with HIV/AIDS weakens, the body needs greater amounts of essential
fatty acids because of difficulty with fat digestion and the increased chance of infection. Skin problems
can be a symptom of a shortage of essential fatty acids in the diet.
Good sources of essential fatty acids are fatty fish, especially salmon, mackerel, herring and sardines,
raw nuts and raw seed.
Using oils
Do not use large amounts of processed cooking oil and fat because it stresses the immune system.
Butter is preferable to margarine because it is not processed. Oils are usually processed through a high
temperature extraction process that destroys essential fatty acids and produces high levels of free
radicals. Free radicals are unstable chemicals that damage the body and cause it to age.
11
Excess fat also causes heart, liver and digestive problems. Diarrhea can be worsened, or be caused,
by too much fat. Do not eat a lot of fried foods. Stir frying, which uses little oil, is healthier than deep
frying.
If you have problems with digestive fats, add fresh lemon juice or the grated skin of oranges or lemons
to your meal.
Using good to control your body temperature
Normal body temperature is 37C. HIV often lowers the body temperature. This is caused by frequent
infections, the side effects of drugs, incorrect diet and toxins.
If your body temperature is low:-

You body have less energy because your body is trying to get warm.
Your body is more easily infected as the immune system works at a lower level when the body is
cold
Your digestive system does not function properly
If you feel cold and your hands an feet and cold, you probably have a lowered body temperature. To
raise your body temperature, use warming spices: garlic, cayenne, ginger and cinnamon. Also eat
foods with lots of protein such as meat, fish, chicken and chicken soup. Eat steamed foods rather than
cold foods and raw foods.
Use a clinical thermometer to find your body temperature accurately. You can buy thermometers at
pharmacies. Before getting out of bed in the morning, place the thermometer under your tongue for 10
minutes. Normal body temperature is 37C. if your temperature is half a degree below this, it is low.
If your temperature is above 38C, you feel hot and have a red face and tongue, then eat cooling foods
such as milk, raw fruit and raw vegetables.
12
CHAPTER Four
Getting enzymes, antioxidants and friendly flora.
Besides nutrients, certain foods also contain enzymes, antioxidants and friendly flora, all of which
improve health. These are explained below.
Enzymes
The digestive organs use enzymes to digest food properly. Enzymes start the breakdown of food into
nutrients. Enzymes are found in live foods and fermented foods. Live foods include fresh raw
vegetables and fruit, sprouts, raw nuts and raw seeds. Most of these contain their own enzymes which
help you to digest them. Processing food destroys its enzymes.
Antioxidants
Free radicals are unstable chemicals that combine with and damage stable chemicals. Free radicals in
the body damage the body and cause aging. Radiation, food additives, drugs, pesticides, pollution,
poor nutrition, frequent infections and stress can create large amounts of free radicals in the body.
Free radicals can be blocked by antioxidants. Antioxidants are part of our defense system. HIV
increases the number of free radicals in the body, an so it also increases the need for antioxidants. If you
have HIV/AIDS, you need extra antioxidants in your diet.
Antioxidants are very important. Eat as many foods that contain antioxidants as is possible. Some
vitamins, minerals, and enzymes such as Vitamin A, vitamin C, vitamin E, selenium and zinc, act as
antioxidants.
Friendly flora
There are bacteria that keep away infections in the digestive tract. These are called friendly flora. They
can be destroyed by stress, antibiotics, birth control pills, aspirin, bad diet and diarrhea. When you do
not have enough friendly flora in your digestive tract, you are more likely to get infections such as
candida and food poisoning. The friendly flora also helps with the absorption of nutrients and can even
make nutrients such as the B Vitamins. Friendly flora are very important for a weak immune system.
Food sources of friendly flora are:-

Cultured milk products such as yogurt, sour milk and cottage cheese.
Sour porridge
Sour water
Garlic and onions promote the growth of some friendly flora
Power foods
Power foods are rich in heath giving nutrients. Many power foods also contain enzymes, antioxidants
and friendly flora.
13
Garlic
Garlic strengthens the immune system. It helps
fight infections caused by viruses, bacteria and
fungi. Eat garlic every day to prevent and fight the
infections that come with HIV/AIDS.
You can eat both raw and cooked. Ear raw

garlic sprinkled over your food. Cooking
garlic destroys some of its properties, but
cooking makes it easier to digest. Use it in stir-
fries and stews. Eat garlic finely chopped
because chopped garlic works better and is
easier to digest. An excellent digestible way
to eat garlic is to first steam the cloves and
then to chop them finely. Garlic can also be
baked to improve its flavor and smell. Eat garlic
with other food, especially with cooling foods such
as yogurt, sour milk, raw fruit and raw vegetables. You
can lessen the smell of garlic by steaming it, baking it or eating it
with parsley.
Eat as much garlic as you can tolerate in a day. If you get wind and stomach upsets, reduce the
quantity. When you are sick, eat five large cloves or eight small cloves every day. If you have difficulty
eating garlic, make garlic tea or garlic oil or use garlic implants or garlic ointment. Garlic tea is a good
way to give garlic to children.
Garlic implants
Garlic is very easy to grow. Divide up a garlic bulb into separate cloves. Plant the cloves in the soil and
water them. The clove will produce leaves. When the leaves become brown and die down, lift the new
garlic bulbs from the soil.
Yogurt
Yogurt is made by adding certain friendly bacteria to milk. The bacteria change he milk into yogurt
when eaten, these friendly bacteria live in the intestines and complete with a range of micro organisms
that can cause disease in the intestinal tract. Yogurt is often digestible for those who cannot digest
other milk products.
By eating yogurt daily, you can help to prevent diseases like diarrhea and Candida. Yogurt is a good
source of protein, the minerals calcium, potassium and phosphorus and B vitamins.
Antibiotics, the medicines that kill bacteria, destroy the good as well as the bad bacteria in the body. It is
especially important to eat yogurt when you are taking antibiotics, so as to replace good bacteria.
14
Buying yogurt
Buy unsweetened plain yogurt because Candida feeds off sugar. Add your own fruit and nuts if you do
not like plain yogurt.
Lemons
Lemons stimulate the liver, clean the digestive tract and help prevent infections. They aid digestion,
especially of proteins and fats. The skin of lemons and oranges contains pectin which helps the body to
absorb fats and oils and, therefore, to gain weight.
Put grated lemon skin or fresh lemon juice over fatty foods such as chicken, meat, fried foods and nuts to
help gain weight. Lemon juice in hot water first thing in the morning improves digestion and cleans and
stimulates the liver. Use only fresh lemons but do not use too much. If you drink lemon juice regularly,
drink it through a straw to protect your teeth and do not drink orange juice as the body may become too
acid. Drink milk to balance the acid of the lemons.
Alfalfa/Lucerne
Alfalfa or Lucerne, which is usually grown as a livestock feed, contains almost every vitamin and
mineral. It contains complete protein and live enzymes. Alfalfa is an excellent tonic for a healthy body.
In Arabic it is called Al falfa which means father of all foods. It is best eaten as alfalfa sprouts in
salads, soups and stews. The seeds can be bought from health shops and shops that sell farmers'
supplies.
Fermented foods
Foods, like sour milk and sour porridge, which are left to stand for a period of time before they are eaten,
are called fermented foods. These foods are commonly found in Africa. Fermenting changes the taste
and nutrient content of foods and helps to preserve them. Special harmless bacteria multiply in the food
before or after cooking. They change some of the starch and sugar in the food to a weak acid that gives
the food a sour taste.
Fermenting makes foods easier to digest. Fermented foods are also a source of friendly flora, which
further help digestion. They are good for all
digestive problems, especially diarrhea,
candida and weight gain.
Harmful bacteria cannot multiply in sour

fermented foods, so these foods remain
safe to eat for longer than fresh foods do.
You can use sour water for all digestive
problems.
Fruit and vegetables

All fruit and vegetables are healthy foods.
Eat wild indigenous fruit and vegetables as
well as those you buy in markets and shops.
15
Cabbage
Cabbage has been shown to help prevent cancer, control infections and heal ulcers. It strengthens the
immune system. You can use the leaves for external inflammation of the skin and eyes. Cabbage
contains calcium, vitamins A and C and sulphur. It is best to eat raw. Sour cabbage water is an
excellent remedy for digestive problems. It controls infection, heals ulcers and inflammation and
contains friendly flora. It is easy to make and costs little.
Carrots
Carrots are high in beta carotene; B Vitamins, Vitamins C, D, and E and K, and the minerals iron,
calcium, phosphorus, potassium, magnesium, manganese, sulphur, and copper. The body changes
beta carotene into Vitamin A which is an important antioxidant. Carrots raw, as part of mixed vegetable
dishes or as soup. Carrot soup is excellent for diarrhea.
Dark leafy greens

Dark leafy greens are nutrient rich. They contain beta-carotene. Vitamin C; essential fatty acids and
the minerals calcium, iron, copper, zinc, manganese, potassium and magnesium. They strengthen the
liver. The darker the green of the leaves, the more nutrients they usually have. You can eat many
different types of greens: pumpkin, beetroot, sweet potato, and cassava greens; kales; greens that you
can collect. Eat greens cooked and raw. Cooked greens are easier to digest but cooking destroys less
nutrients than boiling does. The longer you cook green, the more nutrients you destroy, so cook greens
for a short time.
Beetroot
Beetroot is a green tonic and cleanser. It helps the liver to work well and it helps to treat blood problems.
Beetroot contains the minerals calcium, phosphorus, sodium, potassium, iron, and magnesium and
vitamins A, B, and C.
Avocado
Avocados contain high-quality oils that are easy to absorb. They are good for blood tissue regeneration
and weight gain. They are rich in protein and contain most vitamins and minerals.
Yellow and orange fruit and vegetables

All yellow and orange fruit and vegetables contain lots of beta-carotene. The body changes beta-
carotene into vitamin A. Vitamin A is a good antioxidant and important for the immune system to work
properly. Examples of these fruit and vegetables are pumpkin, squash, yams, sweet potatoes, carrots,
butternut, mangoes, paw-paw, apricots and melons. Squash helps to heal inflammation. It relieves
pain in and soothes the stomach.
Squash and pumpkin seeds.

You can eat squash and pumpkin seeds, so do not throw away the seeds. They contain protein; zinc
and essential fatty acids and they expel worms. Eat the seeds raw or steamed, after you remove the
hard outer shell.
16
Onions
Onions re a strong antioxidant and they promote the growth of friendly flora in the large intestine. They
are good for colds, coughs and bronchitis. To treat a cold, place a slice of onion in hot water for a few
minutes and then drink the water. Take a few cups a day. Use onions in cooking and raw in salads.
Sprinkle finely chopped raw onions over your food.
Pineapple
Pineapples contain enzymes that
help digestion. They help to treat
nausea, vomiting and diarrhea.
Pawpaw
Paw-paws contain enzymes for
the digestion of protein. If you
have problems digesting meat,
eat pawpaw with meat to help you
digest it. Paw-paws also break
down toxins in the body and are
good for treating ulcers.
Guavas
Guavas are very rich in vitamin C. They are good fruit to steam.
Coconut
Coconuts contain large amounts of good quality, digestible fats, and so are excellent for weight gain. It
is best to eat them fresh, but dried coconut is also good. Sprinkle coconut on porridge, stews and soups
for weight gain and a delicious taste. The liquid from fresh coconuts is good for digestive problems,
dehydration and fever.
Bananas
Bananas are rich in potassium and vitamin C. They are good for diarrhea and weight gain. Bananas
are easy to eat if there are sores in the mouth.
Nuts and seeds

Nuts and seeds contain protein, essential fatty acids and many vitamins and minerals. They are a good
source of energy and can help with weight gain. Examples of health giving seeds are sunflower,
pumpkin, and squash. Eat seeds and nuts raw.
A poisonous fungus grows on the shells of groundnuts (peanuts). If there is a blue-black mould in or on
the shells, do not eat them.
Seaweed.
Seaweed is high in protein, contains essential fatty acids and many minerals and vitamins. It prevents
harmful chemicals from damaging tissues. Seaweed helps the body to heal if it has been exposed to
17
radiation or chemotherapy. Seaweed also stimulates the immune system and provides energy.
Seaweed is an excellent all round tonic.
Legumes
Beans, peas, groundnuts, and lentils are legumes. Legumes are a cheap source of protein if they are
correctly combined with grains, nuts, seeds or milk products. Legumes also contain vitamins and
minerals. They are easier to digest if they are cooked until they are mushy. Legumes are best eaten
sprouted
Eggs
Eggs are easy to digest. They contain protein; Vitamins B6, B12, and E; Zinc, selenium and iron.
Fish
Fish is a good source of easy digestible protein. Fish contains essential fatty acids that help to reduce
the inflammation which comes with infections. Fish therefore helps the immune system. Fish also
contains the minerals calcium, phosphorus, iron, potassium and magnesium. Fatty fish from cold deep
waters, such as sardines, mackerel, herrings, salmon, tuna and hake are best.
It is best to eat fresh fish. If you do not live by the coast or are not sure whether the fish you are buying is
fresh, buy frozen fish so that there is less risk of contamination from disease causing bacteria. It is okay
to eat canned fish, because their protein and minerals are not destroyed by the canning process.
Sardines are cheap and easy to use.
Liver
Liver contains vitamins A and B, zinc, copper, selenium and iron. These nutrients are often deficient in
people with HIV/AIDS. Eat liver finely chopped in stews or stir fries.
Soya
Soya beans are easy to digest and they are the only type of bean that contains complete protein. Soya
can be bought in many forms: beans, soya milk, soya mince or soya sausages.
Millet and sorghum

The traditional grains of Africa contain many vitamins and minerals and they are not refined. Of all the
grains, Millicent has the most protein. Sorghum and millet are good for indigestion, vomiting and
diarrhea. Grain dishes are not given in the recipes in this book as there are many excellent grain dishes
in Africa.
Rice
Rice helps control diarrhea, is good for fever and is high in selenium and B vitamins. Brown rice is the
most nutrient rich. Basmati rice is good if you have digestive problems. You can probably find basmati
rice in Asian shops. Avoid pre-cooked rice, instant rice and while rice, which contain few nutrients. If
you cannot get brown rice, rather use millet or sorghum. However, eat white rice if you have diarrhea.
18
Popcorn
Popcorn contains lots of zinc. Zinc is the mineral that most often deficient in people with HIV/AIDS
Cooking spices
Spices add flavour to food. They also have strong medicinal properties that can help to heal the body.
Spices:-
Stimulate the appetite

Assist digestion
Are a source of many nutrients
Preserve foods
Help with ailments of the digestive tract
Make food taste delicious
Spices are an excellent alternative to bought seasonings and stock cubes which contain artificial
flavors and chemicals such as monosodium glutamate (MSG). These chemicals damage the body and
stress the immune system.
Use spices in cooking to prevent diseases. Generally, spices work to improve digestion. Use garlic as
much as you can. Look at the spice sections at your shops and the fresh produce markets to see what
spices are available.
For a mild curry, try cinnamon, cloves, coriander, ginger, fennel, tumeric, and a pinch of cayenne. Look
for these spices in Asian shops.
If other spices are not available, use curry powder. Yellow curry powder is mild. It contains tumeric,
which gives the yellow color, and spices such as cinnamon, cloves and ginger. Red curry powder is
strong. It contains cayennel/chilli, which gives the red color, as well as the spices found in yellow curry
powder. If you find red curry powder to be strong and difficult to digest, rather use mild yellow curry
powder.
The spices in the chart below all taste good, help digestion have to toxic effects and are easy to find.
Spice teas
Tea and coffee contain caffeine which stresses the body and interferes with the absorption of nutrients
from food. Spice teas are a wonderful alternative. If you have an imbalance such as diarrhea, drink
about four cups of spice tea per day.
For example, to make cinnamon tea, add teaspoon powdered cinnamon to 1 cup boiling water.
You can also make tea from seeds or whole spices:-
19
Put the whole spice or seeds in 1 cup boiling water

All to steep for five minutes
Strain and drink
Spice/herb Use in the body Use in cooking
Cayenne Stimulates circulation, stimulates the appetite, Very strong. Add a pinch to cooked or
heals ulcers and intestinal inflammation, helps raw foods. For an energizing drink, add
fight infections, stimulating, warming cayenne to fruit juice or water (
teaspoon in 1 cup)
Cinnamon Warming, diarrhea, nausea, cramps, weak Stick or powdered. Use in soups, stews,
digestion, as a rinse or gargle for mouth desserts, milk, warmed fruit juice, tea (
sores, for skin fungi, controls infections teaspoon in 1 cup of water)
Cloves Warming, stimulates appetite, for weak diges- Whole or powdered. Use in soups,
tion, diarrhea, vomiting, nausea stews, warmed fruit juice, tea (4 cloves
or teaspoon in 1 cup of water)
Coriander Flatulence, indigestion, controls bacteria and Fresh dried seeds, or powdered. Excel-
fungi, stimulates the appetite lent flavor. In salads, stews, and soups.
Fennel (barishap) Cramp, flatulence, expels gas, stimulates Seeds or powdered. In stews, tea (1
appetite teaspoon seeds in 1 cup of water)
Ginger Improves digestion, warming, energizing, Fresh, dried, or powdered. Fresh is
nausea, diarrhea, stomach cramps, gas, pro- best. In stir -fries, stews, soups, tea
motes gastric secretions, cleanses the colon, (Fresh 1 teaspoon finely chopped in 1
colds, flus, stimulates appetite cup water, simmer for 10 minutes. Pow-
dered: teaspoon in 1 cup of water
Tumeric Digestive aid, antiseptic, antioxidant Powdered. Gives yellow color to curry
and rice
Sprouting
Sprouts are germinating seeds. A germinating seed is one that is starting to grow into a new plant. You
can sprout grains, legumes, and edible seeds. Sprouting is found in traditional African culture. For
example, sprouted millet and sprouted sorghum. Sprouting is common in the making of traditional beer.
There are many advantages to sprouting:-

Sprouting increases the vitamin, mineral and protein content of the foods that you can sprout
Sprouts contain many live enzymes that help them and other foods to be digested
Sprouting cuts down on cooking time, so it saves fuel
Sprouting is an easy cheap way of raising your own fresh food. You do not need a garden
Sprouts are grown free of pesticides and other chemicals.
Sprouts are a way to eat fresh, living foods.
Growing your own sprouts
What you need
A large jar with a wide mouth
A piece of wire or nylon mesh or cheese cloth, mesh is better than cheese cloth
A rubber band
20
Food for
Food for People
Peopleliving
livingwith
withHIV/AIDS
HIV/AIDS
Method
1) Put the amount of seed given in the chart into the jar.
2) Fill the jar half-way with water
3) Use a tight rubber band to secure the cheese cloth or mesh over the jar
4) Allow seeds to soak for the amount of time given in the chart below
5) Drain off the water
6) Place the jar mouth down at an angle so the water can drain. A dish rack is perfect for this. Keep
the jar in the dark until sprouting begins.
7) Rinse the sprouts twice a day, morning and evening. If it is very hot, rinse more often.
8) Eat the sprouts after the length of time given in the chart.
9) Rinse the sprouts to remove the shells.
10) Place in a cool place or in a fridge ready for use.
Causes of spoiled sprouts: bad seeds, not rinsing enough, too much heat, unclean water, not enough
air.
Grow different kinds of sprouts at the same time. Use a different jar for each kind. Sprouts are great in
salads, in stir-fries, with scrambled eggs, sandwiches, soups and stews. See the recipes. Cook
sprouted beans, legumes and maize as you would normally cook these foods. If sprouted, these foods
take less time to cook, are more nutritious and more easily digested.
21
Sprouting chart
Types of seeds Amount of seed Time to soak seed Approximate time until ready Length of sprout
per jar when ready to
eat.
Alfalfa/Lucerne 3-4 tablespoon 4 hours 4-6 days or until they develop 3 cm
green leaves
Beans 1 cup 12 hours 4-7 days 1 cm
Lentils 1 cup 12 hours 2 5 days - 1 cm
22
Peas 1 cup 12 hours 2 5 days 1 cm
Sorghum or millet 1 cup 8 hours 2 3 days cm

Food
Maize 1 cup 12 hours 3 4 days 1 cm

Foodfor
Sunflower (without shells) 1 cup 12 hours 1 3 days - 1 cm

Groundnuts/peanuts (whole) 1 cup 12 hours 1 2 days Swells, does not
forPeople
sprout.
Peopleliving
living with
with HIV/AIDS
HIV/AIDS
CHAPTER Five
Food Safety.
Germs on food can cause illness. Take care in the following ways to prevent infections from food:-
Always wash your hands before and after touching food.

Thoroughly clean you dishes and utensils with hot water and soap immediately after you use
them.
After shopping, put the food in the fridge or in a cool place
Keep hot food hot and cold food cold, otherwise disease-causing bacteria can start to grow on
the food.
Never thaw and then refreeze foods.
Be very careful with left overs. Cover left overs and put them in the fridge or in a cool place
immediately. Reheat at high temperatures and do not taste before it is heated.
Uncooked animal products

Raw fish, meat, poultry, and eggs
can carry germs that cause food
poisoning. Take the following
precautions with animal products:
-
Cook all raw animal

products at high
temperatures until they are
very well done because
cooking destroys germs
Wash the surfaces and
utensils where you placed
these foods before you
prepare other foods that will not be cooked
Cut animal products on plastic or paper and then throw it away. Wash the knife before using it
on other foods.
Put meat, poultry, or fish into plastic bags before putting them into your shopping basket so as
to stop them from dripping.
Raw vegetables and fruit

To kill bacteria on the skins of fresh fruit and vegetables, wash them in water in which you have put
23
lemon juice and salt, or you can add one teaspoon of household bleach or hydrogen peroxide to each
litre of water. Buy hydrogen peroxide from pharmacies
Cooking methods
Cooking food destroys some of its nutrients, particularly the B vitamins and Vitamin C. Frying and
boiling destroy many valuable nutrients and the enzymes that help digestion
The best ways to cook vegetables are by steaming and stir-frying. Cook vegetables at low
temperatures so that you destroy any bacteria on the food.
Steaming
Steaming involves placing the food to be cooked above boiling water. The steam rising from the water
cooks the food. You can buy a steamer in which to place the food. A steamer is a metal or bamboo
basket that fits inside or on top of a pot. Put water in the bottom of the of the pot. Place cut vegetables or
fruit into the steamer basket. Put the lid on, bring to boil and allow to steam.
If you cannot get a steamer, you can use a strainer or you can cover the base of a pot with a small
amount of water. Add the vegetables or fruit and steam until they are tender (10 15 minutes). Be
careful not to burn the food.
It is best to eat vegetables when they are still slightly crunchy. The longer you cook vegetables, the
more nutrients you destroy. If you have trouble digesting crunchy vegetables, steam them for longer.
Fruit and vegetables are good steamed if you have diarrhea or your body is cold. They are easier to
digest than raw foods. Fruits that are good steamed are guavas, bananas, and peaches.
Stir-frying
Stir frying involves cooking food in a large frying pan, in small amount of oil for a short time. Use two
tablespoons of oil in the bottom of the pan. First, fry the onions, garlic and spices. While the pan is still
hot, add cup of water and the chopped up vegetables, cover, turn heat down and cook the vegetables
for about five minutes. Do not overcook the vegetables. Eat them when they are still crisp.
If you use meat, poultry or fish in such a dish, cut it up into thin, small pieces and cook with the onions
and spices until it is well done.
Recipes for health

Healthy meals are provided by many of Africa's traditional dishes especially the grain and legume
dishes. The following recipes can give you more ideas for healthy meals.
When preparing the recipes that follow, remember:-
Cook meat at high temperatures. Cook vegetables at low temperatures for a short time, so that they
remain crisp.
Combine protein foods to eat complete protein
Add lemon juice or grated lemon or orange skin to your food to help digestion
24
The spices given in the recipes are examples of what you can use. You can use others in their place.
Use whatever spices are available. If you do not have the spices, you can still use the recipes.
You can add a small amount of salt to all the dishes.
Power drink
Drink 1 cup daily to strengthen the immune system. If you are sick, drink up to 4 cups per day.
1 large garlic clove; teaspoon tumeric; 1 teaspoon finely chopped fresh or teaspoon ground ginger;
cup water; cup milk. Replace milk with water if you have diarrhea or difficulty digesting milk.
Boil together all the ingredients
Simmer for 10 minutes
Cool slightly. Add a teaspoon of honey if you want it sweet.
Garlic tea
Use the same method as for the power drink, but use only garlic
Ginger drink
A healthy drink to use instead of cool drinks. You can drink it anytime. Ginger is especially good for
digestive problems. Drink during and after meals to help digestion.
8 cups warm clean water; 3 teaspoons powdered ginger; 2 teaspoons sugar. You can add a small cut-up
pineapple and the pineapple skin.
Mix all the ingredients together

Cover with a lid
Leave in a warm place for 1 day
Drink. You can eat the pineapples.
Scrambled eggs with greens

Eggs, onions, finely chopped dark leafy greens you are use sprouts instead of greens.
Lightly oil a pan in medium heat

Fry the onions until brown
Add greens and cook for 3 minutes
Add the eggs and scramble with the other ingredients
Avocado dip
Mashed avocado, yoghurt or thick sour milk, lemon juice, finely chopped raw onion, garlic and tomato.
Mix all the ingredients together
Eat the dip with brown bread and fresh or steamed vegetables such as green beans, peas, carrots,
mushrooms, cucumbers, red and green sweet peppers, squash and pumpkin.
25
Garlic oil
Make garlic oil to eat with salads. The oil contains the healing properties of garlic
Vegetables oil, crushed garlic
Place the crushed garlic into the oil

Leave in the warm place for 3 days
Strain off the garlic
Keep the garlic oil in a fridge or in a cool place
Salads
Salads are made from fresh uncooked fruit and vegetables. Cooking fruit and vegetables destroys
some of their nutrients. You get more nutrients from salads than from cooked fruit and vegetables
You can pour a dressing over the salad. The dressing adds flavor to the uncooked fruit or vegetables.
You can also add protein foods and grains to salads. Salads are a good way to use left over cooked
beans, chicken, fish, rice, maize or millet.
To make a salad, chop and then combine any of the following ingredients:-
Cabbage, carrot, green beans, peas, greens; tomato, onion, sweet pepper, sprouts, avocado,
26
CHAPTER Six
pineapple, banana, coconut, cooked fish, cooked chicken, cheese, nuts.
Salad dressings
Oil dressing:-
Oil, lemon, garlic, salt, pepper;
Sour milk dressing

Sour milk or yogurt, a few drops of oil, garlic, salt, pepper
Examples of salads
1) Cabbage, carrots, and nuts with sour milk dressing

2) Greens, onion, tomato, sprouts and boiled egg with oil dressing
3) Onion, tomato, avocado and left over beans and millet with oil dressing
4) Carrots, cabbage, pineapple, coconut and nuts with orange juice
Tomato and onion salad

Tomato, onion, garlic, vinegar, sugar
You can also add sweet peppers
1) Finely chop the tomatoes, onions, garlic and sweet peppers and place them in a bowl.
2) Add sugar to the vinegar
3) Pour the vinegar over the finely chopped ingredients
This salad is good to eat with curries and stews.
Three spice mixture

6 tablespoons ground cinnamon, 6 tablespoons ground ginger, 2 tablespoons ground cloves
Put the spices in a container with a lid.

Mix and store
For tea: use teaspoon in 1 cup boiling water. Add honey or a little sugar if you want a sweet taste,
unless you have thrush.
In cooking: use about 1 teaspoon in soups, stews, and stir fries
Chicken soup
This soup is good when you are sick, especially for a cold or a low body temperature
Chicken (you can use chicken necks, bones and feet)

Pumpkin, greens, garlic, onion, ginger, a lemon, salt
Stick cinnamon, 5 cloves or three spice mixture
27
Finely chop the onion and spices

Grate the pumpkin
Cut the chicken into small pieces
Fry the onion and spices in a little oil, until they are brown
Add the chicken and cook until it is brown. If it begins to burn, add a little water
Add water and the grated pumpkin
Cook until the pumpkin and chicken are soft
Add the finely chopped greens 10 minutes before service
Add salt
Add lemon juice and grated lemon skin
Vegetable and sprouted millet soup

Sprouted millet (you can replace the millet with rice, sorghum or barley, you do not have to sprout the
grains)
Legume sprouts such as bean, pea, or lentil sprouts, onions, ginger, garlic, salt, pepper, meat bones,
meat or chicken
Tomatoes, cabbage, carrots, potatoes, pumpkin, leafy greens or whatever vegetables you have.
Chop the onions, garlic and ginger

Finely chop or grate the vegetables
Lightly oil the bottom of a large pot
On medium heat, fry the meat, the chopped onions, garlic and ginger and the spices until brown.
Add the tomatoes
Add the other chopped vegetables, except the greens
Add the grain and legume sprouts. If you do not want to sprout the grain and/or legume, cook them
separately before adding them to the other ingredients.
Add water and allow to cook at medium heat (not boiling)
Add the chopped greens 10 minutes before the soup is ready.
Pumpkin soup
Pumpkin or butternut, onions
Garlic, oil, coconut, cinnamon or three spice mixture
Chop the pumpkin, onions, and garlic

Fry the onions, garlic and spices in a little oil
Add the chopped pumpkin
Add water and bring to boil
Simmer until the pumpkin is very soft
When ready, you can sprinkle coconut on top
Greens stew
Chopped meat (you can cook this dish with bones, mince, or with no meat); onions, tomatoes, potatoes
Greens or other vegetables such as cabbage, pumpkin, squash, green beans, carrots, peas or
28
sprouted beans or peas

Garlic, ginger, three spice mixture and coriander or mild curry powder, cayenne, if you want a hot taste.
Chop and fry the onions and spices at medium heat in a little oil
When the onions are brown, add the meat and a little water
Cook the meat at a high temperature until it is well done and soft
Chop and add the tomatoes, potatoes, and vegetables other than greens
Cover and simmer until the potatoes are almost soft
Chop and add the greens 10 minutes before the dish is ready
Add lemon juice to help digestion
Eat with rice, millet, maize, or sorghum
Fish curry and yellow rice

Fish, onions, tomatoes, garlic, ginger, mild curry powder, rice, tumeric, dried coconut, jam, lemon juice,
salt, any vegetable.
Chop and add the tomatoes

Add the curry powder, fish and vegetables
Cook until soft. Add water if you need to
Add lemon juice, coconut, jam, and salt to taste
Rice: prepare the rice as you normally do, but add tumeric to the water when you start cooking it.
Tumeric makes the rice yellow.
Vegetable and sprout stir fry
Carrot , green bens, leafy greens, (you can use one vegetable or any combination of vegetabes),
onions, ginger, garlic, legume sprouts, three spice mixture, squeeze lemon juice.
Heat 2 tablespoons oil in a pan at medium

heat
Fry onions and spices till brown
Add chopped up vegetables and sprouts
Add cup water
Cover, turn heat down to low
Cook for about 5 minutes. The vegetables
must still be crisp
Add lemon juice
Eat with rice, millet, sorghum or maize.
High protein stir-fry
29
Fish, chicken, meat, or liver, onions, ginger, garlic

Three spice mixture, any combination of vegetables, squeeze of lemon juice
Heat 2 tablespoons of oil in a pan at medium hat

Cut the meat or fish into small pieces and fry with the onions and spices until brown
Add chopped up vegetables and cup of water
Cover, turn heat down to low
Cook for about 5 minutes, so that the vegetables are still crisp
Add lemon juice
Eat with rice, sorghum, millet or maize.
Simple sprout stir fry

Vegetable oil, legume sprouts
Put a small amount of oil in a pan

Add the sprouts and a small amount of water
Cover and cook for about 10 minutes
You can squeeze lemon juice over the sprouts
Eat with grains to get complete protein
Sprouted bean stew

Onions, garlic, ginger, three spice mixture, bean or lentil sprouts (sprouted beans and lentils cook more
quickly and are easier to digest ), pumpkin, greens
You can add coconut and, if you want it hot, cayenne
Fry the onions and spices in a little oil until brown

Add the bean sprouts
Add water to cover
Cook the beans until they are almost soft
Add pumpkin and more water, if needed
Cook until soft
Mash the cooked pumpkin with the back of a spoon so that it becomes a sauce
Add the finely chopped greens and cook for 5 minutes
Sprinkle with coconut
Serve with millet, rice, sorghum, porridge or maize.
Peanut sauce
A high protein sauce to eat with grains an draw or steamed vegetables.
cup finely chopped onions, 3 crushed garlic cloves

1 tablespoons oil, cup boiling water, 1 cup peanut butter, juice and rind of lemon, tablespoon
30
grated fresh ginger, 1 tablespoon honey or sugar, 1 cups milk, teaspoon cayenne, if you want it
hot.
Fry the onions and garlic in oil until brown

Stir in all the other ingredients, except the milk
Slowly stir in the milk
Cook for a few more minutes
Healthy biscuits
1 cup cooked mashed yams or sweet potatoes, cup oil,
2 tablespoons honey or sugar, teaspoon cinnamon
2 cups whole wheat flour
2 teaspoons baking powder, cup yogurt or thick sour milk
Preheat oven to 180C

Mix well the sweet potato or yams, oil and honey or sugar
Mix until a soft dough is formed
Mould the dough into balls
Place on a baking tray
Bake for 20 minutes
Recipes for difficult limes
Carrot soup
Excellent for diarrhea
Carrots, salt, ground cinnamon, water

Chops carrots finely
Steam until soft
Strain through a fine strainer
Add water to form a soup
Add a pinch of salt and ground cinnamon
Rice soup
Rice soup is good for treating diarrhea, vomiting and other digestive problems
Basmati or white rice, water
1 cup rice to 5 6 cups water. The amount of water to add depends on how watery you want the soup.
Cover the pot and simmer for 1 hour
You can make different rice soups by adding other ingredients

Add grated carrot and cinnamons
Add coconut and ginger
Add finely chopped garlic, grated liver and grated carrot
31
Sour water
Excellent for all digestive problems. It contains friendly flora, enzymes,
Vitamins and minerals. Sour water is good for diarrhea, thrush, weight
gain and ulcers. Drink if for two weeks after taking antibiotics to
replace friendly flora. Drink it regularly to prevent digestive infections.
To make sour water, you can use any grain millet, sorghum, rice or
barley. It is best to use sprouted grain. This recipe is for millet.
Millet; clean water (if possible, filter and boil the water)
Wash the millet

Soak 1 cup millet in 3 cups water.
Cover tightly and leave for 2 3 days
Strain the water from the millet. Store the sour water in a cool place or in the fridge
Drink cup, 3 times a day for all digestive problems
The sour water is ready to drink when it starts to form

bubbles. The warmer the sooner it will be ready.
Sour water has a strong smell. For a better tasted

and smell, mix it with lemon, fruit juice or spice tea.
Do not heat the sour water.
If the sour water makes you feel nauseous, drink it
with food.
Make the second batch from the same grain as the

first batch. After straining off the liquid of the first
batch, add more filtered boiled water, cover and leave
it to soak for one day. You can make a third batch
from the same grain. After the third batch throw away the grain and start again with fresh grain.
Sour cabbage water
To make sour cabbage water, use the same method as the sour water, except use raw chopped
cabbage instead of a grain.
After straining the water from the cabbage, throw away the cabbage. To make a second batch, pour
cup of the first batch into the second batch, and leave it to stand for 24 hours instead of 48 hours.
Rice, millet or barley water

A nutritious drink for diarrhea, fever and other times of sickness, when it is difficult to eat. Rice, millet or
barley, water will be handy.
32
Cook 1 cup brown rice or barley in 6 cups water. If you use white rice or millet, cook it in 4 cups water. If it
is difficult for you to drink, use less water to get more nutrients without having to drink too much. When
the grain is cooked, strain off the excess water and drink it.
Food remedies for digestive problems
Weight loss, malnutrition and wasting

Serious weight loss is a problem for many people with AIDS. This is caused by HIV infection, other
infections and medical treatments. You body needs extra nutrients to fight off infection. Weight loss is
also caused by not eating enough food for your body's needs. This can be the result of nausea, or sore
mouth, no appetite, diarrhea, vomiting, nausea, poverty, or depression.
The absorption of nutrients into the blood mainly takes place in the small intestine. With AIDS, the body
may lose its ability to absorb nutrients properly. It is not yet clear why this is so. Diarrhea is once cause,
because food does not stay long enough in the system to be absorbed.
When your body does not get enough nutrients or cannot absorb the nutrients it does get, it must use its
stored energy, your fat and muscle, to keep functioning, so you lose weight. The muscles start to break
down and there is wasting of the body.
Many people with AIDS suffer from malnutrition, which is a shortage of nutrients. This is caused by:-
The body needing extra nutrients to fight infections

Not getting enough food
No getting enough nutrient-rich food
Not properly absorbing the nutrients that you are getting
High fat foods stress the immune system. Increase your muscle weight, not your fat, by eating high
protein foods.
Exercise is important for preventing weight loss and wasting because it:-
Stimulates the appetite

Reduces nausea
Improves the functioning of the digestive system by increasing the blood flow to the digestive
organs
Builds muscles.
Foods good for weight gain

Avocado, coconut, full cream milk or milk powder, yoghurt, soya products, cheese, meat, fish, chicken,
peanut, butter, nuts and seeds, dried fruit, eggs, beans, lentils, potatoes, sweat potatoes, sweet
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potatoes, yams, bananas, olives, plantain, cassava, millet, sorghum, oats, rice, barley, wheat, maize.
Ways to help weight gain

To help digestion, squeeze fresh lemon juice over fatty foods like meat, chicken and nuts
To help the absorption of fats, ad the grated skin of oranges and lemons to fatty foods
To increase your appetite and to help digestion, use spices, cook with spices, sprinkle ground
spices over your food before eating, make spices tea
To help digest meat, eat paw-paw with the meat
To make your food easier to digest, chew your food well
Eat many small meals a day
Drink between meals, not with meals
To help digestion, eat fermented or sour foods such as sour mil, sour porridge, and sour water.
Diarrhea
There are several different causes of diarrhea, parasites, allergies, infections, medical treatments and
unclean drinking water. Diarrhea causes weight loss because food does not stay long enough in the
digestive tract to be absorbed.
There are a few types of food that you can eat to help treat diarrhea
Diarhoea disturbs the friendly flora. Replace them by drinking sour water, sour milk, sour
porridge or yoghurt.
Carrot soup helps to replace vitamins and minerals. Carrot soup coats and soothes the bowels
and stimulates the appetite
Garlic helps to kill infection. Eat garlic raw and in soups and tea. Use it anally. Take 4 8 cloves
per day
Drink lots of fluids. Drink as much as you can. Drink water, soups, and diluted fruit juices
Other foods that help ease diarrhea are water melon, potatoes, white rice, barley, millet,
sorghum, pawpaw, bananas, while bread toast, pumpkin, rice or barley water, sweet potatoes
and steamed fruits.
Many spices help diarrhea. See the spice chart and the recipe for three-spice mixture on the
previous pages
Avoid raw foods, cold foods, fatty foods, high fibre foods and milk products. Too much fat can
cause diarrhea.
Check your water source. It can cause you to have diarrhea when others can drink it without
problems.
Vomiting
Vomiting has similar causes and remedies to diarrhea. If you are vomiting, drink small amounts of fluids
like juices, spice teas and soups at first. You can eat solid foods once the vomiting stops
34
Nausea
The following ways of eating can help ease nausea:-
Drink fresh lemon juice in hot water to cleanse the digestive organs. This is especially effective
first thing in the morning.
Many spices help ease nausea. See the spice chart
Drink lots of clean water
Avoid fatty and sweet foods
Eat frequent small meals and rest after eating
Exercise can relieve nausea. Try swimming and fast walking
Eat pineapples and other sour foods
Allergies
Allergies to food such as milk, soya, and gluten found in wheat, oats, and barley can cause on-going
diarrhea and other digestive problems. Watch yourself. If you feel that you may be allergic to a food, cut
it out of your diet or reduce the amount you are eating to see if it makes a difference.
Candida/thrush
Candida is a common infection of people with AIDS. Candida causes white patches on the gums and on
the sides of the tongue' burning, swelling and redness in the mouth, changes in taste, lots of bad
smelling gas (farts), indigestion, diarrhea, night sweats, sore throat, difficulty in swallowing, chest pain,
and vaginal yeast infections in women
The candida fungus is found naturally in the digestive tract and is usually part of a healthy bacterial
balance in the body. Candida can, however, grow out of control. Then the friendly flora cannot keep it in
balance. The friendly flora are often destroyed by antibiotics or birth control pills. It is important to
control candida.
Use these foods to prevent and to help treat candida:-
Sour water. Drink in and use it as a mouth rinse

Plain unsweetened yogurt
Fermented foods like sour milk, and sour porridge
Garlic. Eat 4 8 cloves per day if you have candida symptoms
Insert garlic in the anus or the vagina. Use garlic ointment in the mouth and vagina.
Candida feeds off sugar, so avoid eating sugar, alcohol, honey and too much sweet fruit
Sore mouth
A sore mouth is a symptom of the infections associated with a weakened immune system. Use these
foods to help ease sore mouths:-
35
Drink nutrient-rich liquids such as vegetable and fruit juices and soups
Eat soft or mashed foods like avocado, squash, pumpkin, potato, yogurt, sour milk, sour
porridge, soya mince, cooked fruits, banana, pawpaw, soft cooked eggs, minced fish, chicken
and meat.
Avoid over spiced, salty and acid foods such as oranges and vinegar. Use garlic in the anus rather than
eating it. Put garlic ointment on mouth sores.
Focus your attention on the mid area of your body. Hold your hands on your chest and take a deep
breath in, opening up your chest by pushing your hands up. When this feels comfortable, move your
hands into the mid region. The mid region is the area below the ribs and above the belly-button. Inhale
deeply into this area and push your hands up. The last area is the belly, below the belly button. Hold
your hands there inhale deeply and bring a deep breath into your belly while pushing your hands up.
Now, inhale deeply and smoothly bringing the breath into the chest, flowing it continuously into the mid
region and into the belly. Hold for one second and then exhale. Firs from the chest, flowing out of the
mid section and then out of the belly in a continous motion
This is the complete breath. Try this, first, for a minute and them build up to half an hour. You can do
deep, complete breathing anytime waiting in a line, before you go to sleep, while taking a walk. If you live
in a city, try to breath in a place in nature like, a park or by a lake where the air is clean and oxygen rich.
Positive thinking
Positive thoughts that create love, joy, and laughter produce substances in the body that help the
immune system to work well. Negative thoughts that produce anger, hate, fear, and sadness,, stress the
immune system.
Your thoughts shape your reality. The way that you think is the way that things will be. If you think that,
because you have HIV, you are going to get sick and die, and then you probably will get sick and die. If
you believe that you will be strong and healthy, then there is a chance that you will be strong and healthy.
36
CHAPTER Seven
Pregnant women and the baby
Lack of good nutrition and poor eating habits in HIV-infected mother during pregnancy may increase the
risk of HIV transmission to the unborn baby. Eating well can help strengthen the immune system,
prevent weight loss during lactation, prevent maternal malnutrition and delay disease progression
thereby allowing the woman to remain productive and prolong her quality of life.
During pregnancy the mother gains weight, the fetus grows and milk forms in the mothers breasts. All
these changes require energy, protein and various micronutrients increase to meet the demands. HIV
infection causes excess nutrient loss and interferes with the process by which nutrients enter the tissues
of the body (malabsorption). If the woman is suffering from other opportunistic infections the
requirements are even higher. Additional food is required as a result of the combined needs to meet the
extra demands for nutrients during pregnancy and the demands HIV infection imposes to the body.
Nutritional risks of HIV infected pregnant and lactating women
Increased need for energy, protein and other nutrients secondary to the demands of pregnancy
and lactation.
Increased risk of opportunistic infections.
Increased risk of weight loss and delivery of low birth weight babies as a result of HIV infection.
Increased risk of inadequate dietary intake and hence malnutrition as a result of depression,
isolation or stigmatization.
Increased risk of transmitting the virus to the baby through breastfeeding.
Goals of nutritional care and support

Expectant and lactating mothers need nutritional support to prevent weight loss and preserve lean body
mass, ensure that the required nutrients which include carbohydrates, proteins, important
antioxidant nutrients and other vitamins and minerals necessary for the functioning of the
immune system and enhance the quality of life by promptly treating infections and managing
the symptoms that affect food intake to minimize the impact of secondary infections on
nutritional status.
Nutritional Needs. HIV-infected asymptomatic stage
Recommended increase in energy intake for HIV infected pregnant and lactating mother is
the same as for a non- pregnant, non-lactating HIV infected women. An increment of
10percent is normally recommended during this phase while HIV- infected in
symptomatic stage requires energy by 20-30 percent over the level recommended for
healthy non HIV-infected pregnant women. Thus an infected woman will require
approximately 428-642kcal more daily.
37
a) Protein Requirements: Meeting protein requirements for the HIV-infected pregnant woman will
help prevent muscle wasting and support additional protein demands of pregnancy including
the growth of the placenta and increased red blood cell mass.
b) Micronutrient Requirements: Optimal intake of micronutrients will bring the following
improvements into play:
Increased maternal weight gain during the pregnancy.

Increased haemoglobin concentration.
Improved fetal birth weight.
Decreased mortality particularly among the nutritionally vulnerable women with advanced HIV
disease.
Slow progression from HIV to AIDS.
Iron Pregnant women are the most vulnerable to iron deficiency. Anemia during pregnancy is a risk
factor for infant. Iron and folic acid supplementation and adequate dietary intake is therefore
recommended during pregnancy and lactation for six months in pregnancy. Anemia may be as a result
of poor dietary intake, poor absorption of iron or other vitamins such as folate and B12 and co-infections
such as malaria and hookworms. The mother should therefore seek medical treatment in case she has
infections.
Generally the use of high levels of supplements is not recommended because it can lead to nutrient
toxicity that can be harmful to the body. Other nutrients that may become toxic if taken in large amounts
include zinc, selenium, and vitamins B C and D (Semba and Gary 2001).
Multivitamin supplementation is associated with health benefits for both the mother and their infants and
should therefore be provided where available.
Recommended Care Practices:
Food safety and hygiene.

Proper food handling and practices are the same for all. HIV-infected pregnant women should always
remember that they are more susceptible to harmful bacteria and viruses in contaminated food and
water as result of their HIV infection. Food poisoning can cause weight loss and further lower their
resistance to future infection.
Psychosocial support.
Psychosocial support is an important part of nutritional care and support for the HIV infected pregnant
woman. Malnutrition and wasting has an impact on self esteem, which can lead to depression, isolation,
lack of appetite and an aversion to food. This can increase the risk of malnutrition. They should be
counseled and supported to cope with possible stigmatization and discrimination especially those who
have not disclosed their status to their partners.
38
Antenatal and Post -natal Care
Pregnant women are encouraged to visit the antenatal clinics as they are good places to start early
nutrition interventions to minimize the impact of HIV on their nutritional status and will help improve
overall pregnancy outcomes.
Medications and ARV therapy.

Medications used to treat opportunistic infections may result in negative drug nutrient interactions or
cause side effects. Many ARVs and medications prescribed to treat opportunistic infections have side
effects and may affect dietary intake .These side effects include nausea, vomiting, diarrhea,
constipation, anorexia and changes in taste.(Management of these side effects has been discussed
later in this booklet)
Safer Sex and Reproductive Heath Practices: Unprotected sex may expose HIV infected pregnant
adolescents and women to sexually transmitted diseases and/ or re-exposure to HIV resulting in
increased viral load which in turn results in an increased risk of MTCT. It can speed up disease
progression to AIDS by further weakening the immune system making the woman to be nutritionally
vulnerable.
Food Taboos: Pregnant women may observe culturally dictated dietary guidelines that prohibit certain
foods. These food taboos may restrict nutrient dense foods such as eggs or specific type of meat.
Pregnant women should know that avoiding such foods deprives them of important source of proteins
and micronutrients and can therefore predispose them to malnutrition. This calls for proper nutritional
knowledge on the part of the mother.
Cultural Beliefs: In some communities women restrict food intake during the final months of pregnancy
for Fear Of Having a Big Baby. This will limit the weight gain to reduce the size of the baby and thus
decrease the risk of obstructed labor. However inadequate diet can contribute to a low birth weight
infants and weakened immune status of the mother with resulting increased risk of morbidity and
possibly mortality of both the mother and the baby.
Inequity in Intra-household Food Distribution: In many cultures women serve themselves last and give
priority to their husbands and male children. For HIV infected pregnant women and adolescent girls
these food distribution patterns may compound already existing inadequate dietary intake due to
increased energy needs of HIV infection and pregnancy.
1. CHILDREN (5-12 YEARS)
Increased Energy Needs: HIV infected children have greater energy needs compared to their
counterparts who are not infected just like the cases discussed above. A child who is symptomatic and
losing weight, energy requirements increase by 50-100 percent.
Protein and Micronutrient needs: Protein and energy requirements remain the same unless the child has
39
pre-existing micronutrient
deficiencies or inadequate
protein intake. In such cases
micronutrient supplementation
and increased protein intake
becomes paramount.
Pre-existing Malnutrition: Many

children who are HIV-infected
are already underweight and
malnourished. Families need to
address the underlying issues
malnutrition and also address
the additional nutrient
requirement caused by the HIV
infection. Health care givers
should encourage children to eat additional energy dense and micronutrient rich foods when periods of
illness subsid
2. INFANTS FEEDING OPTIONS(Birth to Six Months)
Breastfeeding contributes to a significant risk of mother to child transmission of HIV. The transmission
risk for a child born to HIV-infected mother in an African setting without interventions for prevention of
MTCT is about 30-40%. HIV passes via breastfeeding to about 14 percent of infants born to HIV
positive mothers, at least if breast feeding is not exclusive.
Mother-to-child transmission of HIV from breastfeeding is influenced by the stage of HIV condition of the
mother. The chance of transmission is higher if there are symptoms of AIDS or signs of opportunistic
infections, high viral load and vitamin A deficiency in the mother and the child during breastfeeding
period. Health condition of the breast may also influence the transmission of the virus. Such conditions
include mastitis, bleeding nipples and breast abscess or if the infant has oral or gastrointestinal
diseases such as thrush. The period of breastfeeding and lower parity are also risk factors.
i) Exclusive Breastfeeding
Preliminary research suggests that HIV may be transmitted through breast milk at much lower levels
and perhaps hardly at all during exclusive breastfeeding, that is, when the babies are receiving nothing
but breast milk, not even water.
A new acute infection during breastfeeding is considered to be very powerful risk for MTCT highlighting
the need for the mother to avoid any new infections during the breastfeeding period. Breastfeeding can
be made safer by:
Breastfeeding by HIV negative mothers i.e. the infant is breast fed by other women who are
lactating and willing to feed the infant.
Expressing the milk and boiling it briefly and allowing it to cool before feeding with a cup.
40
Exclusive breast feeding for

six months.
Core breastfeeding information
Breast milk alone is the best

possible food and drink for a
baby .WHO/UNICEF
recommends that all infants
be exclusively breastfed
from birth to six months of
age, and complementary
feeding only afterwards.
Virtually every mother can
breastfeed her baby. It is
helpful to have support and assistance from family, friends, health workers and employer.
Babies should start to breastfeed as soon as possible after birth. Baby should be breastfed
whenever she or he wants to.
Frequent suckling at breast is normal, satisfies and comforts the baby, and cause more milk to
be made. The time between feedings gradually lengthens as the baby gets older.
Breastfeeding helps babies to grow normally and protects them from getting sick. Other baby
foods do not give protection and can cause illness especially if not made properly and given
alongside breast milk among those infected with HIV/AIDS.
Points to note when Breastfeeding exclusively

Give the infant breast milk only from birth if replacement feeding is not acceptable, feasible, affordable,
sustainable and safe. Breast fed infants who receive other foods or liquids in addition to breast milk
(mixed feeding) may increase their risk of HIV transmission. Mixed feeding is thought to irritate the
infant's stomach lining and allow easier access of the virus through the infants gut.
Mother should help the baby become well attached at the breast. Poor attachment leads to incomplete
removal of milk which could result to sore nipples, inflammation of the breast, mastitis. This can
increase the risk of transmission of HIV through the breast milk.
Mother with breast conditions should stop breastfeeding from infected breast and seek prompt
treatment. Mother should also seek medical care immediately when she is ill.
Mother should frequently check baby's mouth for sores and should get them immediately treated.
Mother is encouraged to eat well to maintain and build body stores of proteins and important nutrients.
ii) Wet nursing

Wet nursing is breastfeeding by a woman who is not the infant's mother. HIV positive mothers may
want to try this option to reduce the risk of transmitting HIV to their babies. The person to be chosen as a
41
wet nurse;
Should be HIV negative

Should practice all optimal breastfeeding behaviors applying to HIV negative mothers who
practice exclusive breastfeeding
Can breastfeed the infant frequently including the night and as long as needed.
Should be provided with information about practicing safe sex to ensure that she is HIV negative
while she breastfeeds the infant.
iii) Replacement feeding

Replacement feeding could be another intervention to reduce mother-to-child transmission of HIV.
However the following points should be put into consideration.
Acceptable: The method should be acceptable to the mother who should make informed choice about
replacement feeding for cultural or social reasons or for fear of stigma and discrimination.
Feasible: The mother or the family has adequate time knowledge skills resources and support to
correctly prepare breast milk substitutes and feed the infant 8-12 hours in 24 hours.
Affordable: The mother and family with the available community and/health system support, can pay
for the costs associated with the purchase/production, preparation, storage and use of replacement
feeds without compromising the health and nutrition of the family. Costs include ingredients, fuel, clean
water and medical expenses that may result from unsafe preparation and feeding practices
Sustainable: A continuous uninterrupted supply and dependable system for distribution of all
ingredients and products needed to safely practice replacement feeding are available for as long as
needed.
Safe: Replacement feeds are correctly and hygienically stored and prepared and fed with clean hands
using clean cups and utensils-bottles and teats should be avoided.
This is feeding the infant on appropriate breast milk substitutes which include:
Commercial infant formulas.

Modified animal milk.
A. Commercial infant Formulas: This should only be chosen only if:
Adequate and sustained safe formula feeding can be guaranteed and the socio-economic
circumstances of the mother are satisfactory to support formula feeding for at least six months.
A mother is seriously with advanced AIDS or has signs of AIDS and is in obvious poor health.
If there is no family history of sibling morbidity or mortality from poverty related illness.
Mother has severe breast pathology such as severe mastitis or infant has severe oral pathology
42
(thrush, infections) which does respond to treatment.
The mother can meet the following requirements:
Clean water to prepare the food and clean the utensils.

Adequate supplies of fuel to prepare the formula and boil water to wash the utensils.
Time to prepare the feeds eight times a day if refrigeration is not available.
Ability to follow instructions on the tin for mixing the formula to ensure that it is mixed to the right
concentration. For mothers with low education, they should have someone who can read and
write to assist them in preparation.
Availability of utensils to prepare and feed the formula(pan, cups, measures for water and milk,
spoon, tongs to remove utensils from hot water)
Good hygiene; proper sanitation and a clean surface to prepare the formula.
The mother can comfortably formula feed without feelings of stigma
The mother has access to health care services and general utilization of child health/infant
monitoring clinics.
B. Modified animal milk

In situations where the mother is not able to breast feed or afford formula, one can modify animal milk
(fresh animal milk, full cream milk, pasteurized milk, or powdered, evaporated milk or ultra heat treated
milk.) and feeds the infant. Infant receives no breast milk or any other feeds.
Modifications of animal milk should be adopted when the supplies of animal milk are reliable and family
can afford to buy about half a liter per day for at least six months and for buying micronutrient
supplement formulated for infants.
Points to note when modifying various types of milk
a) Fresh animal milk
Dilute milk with water that has been boiled vigorously for a few seconds.
Bring the mixture to boil and remove it immediately from the heat.
Add sugar and a micronutrient supplement.
Boiling the milk makes the proteins easier to digest; diluting the milk reduces the concentration of the
proteins and salts which reduces the stress on the infant's immature kidneys. Addition of sugar
increases the energy concentrations to an appropriate level.
b) Full cream powdered milk or evaporated milk
Add cooled boiled water to make the equivalent of fresh cow's milk and then add sugar.
43
c) Ultra high temperature (UHT) milk
Add boiled water and sugar to make the equivalent of fresh cow's milk formula.
Important points to remember

When preparing these formulas it is imperative for the mother to avoid over dilution or over
concentration to ensure that the infant is receiving optimal nutrients and in a form that is easily digestible
and absorbed.
If refrigeration facilities are not available the mother should prepare the milk just before each feed,
consume any left over or gives it to an older child. She should not use the milk for later feeding to avoid
food poisoning as a result of contamination.
The infant should be accustomed to feed from a cup as it is the most hygienic mode of feeding.
Appropriate semi- solid and solid foods plus clean drinking water in circumstances where milk is
not available.
Breast milk substitutes and appropriate semi solid an
Food and Nutrition for healthy Nursing.
Zinc supplement: According to a British study, pregnant and nursing women also often lack zinc. They
should consume 15 to 20 milligrams per day. Zinc is found in eggs, meat, flour and oats. Choose the
combination that will not aggravate on the basis of your HIV-status. If a woman had a vitamin A
deficiency during pregnancy, the problem may worsen after childbirth. Instead of rushing to buy vitamin
A supplement, anyone who eats enough carrots, vegetables, butter, fish, and meat will absorb enough
vitamin A.
Some people say that garlic increases milk production; others say it gives the baby gas. There is no
universal rule. Moreover, different cultures prefer foods that others consider to be 'bad' for nursing
mothers. Each baby reacts differently to the foods his mother consumes. If your baby is particularly
disturbed one day, try to remember what you have eaten in the past twenty-four hours. If one food
seems suspect, eliminate it from your diet for a while.
44
CHAPTER Eight
Food and Drug interactions
Many health problems can be treated and cured by medicines. The medicines must be taken properly to
ensure that they are safe and effective. Many medicines have powerful ingredients that interact with
human body in different ways, and diet and lifestyle can sometimes influence the ability of drug to work.
Certain foods, beverages, alcohol, caffeine and even cigarettes can interact with medicines. This may
make them less effective or may cause dangerous side effects or other problems.
Food and drugs interaction can affect medication efficacy, nutritional status and adherence to drug
regimens. Drug-food interactions consist of:-
The effects of food on medication efficacy

The effects of medication on nutrient utilization
The effects of medication on side effects on food consumption
The unhealthy side effects caused by medication and certain foods.
Service providers can help address these implications by working with PLHAs and care givers to
identify the specific food and nutrition requirement of the medication.
Access to anti retroviral drugs (ARVs) is increasing among PLHAs in developing countries as a result of
local, national and international efforts. Managing the interactions between ART and food and nutrition
is a critical factor in the extent to which the
treatment is effective in slowing down the
progression of HIV/AIDS and improving
the quality of life of PLHAs.
Persons infected with HIV have special

nutritional needs, such as increased
energy requirements, irrespective of
whether they use ART.
It is recommended that asymptomatic PLHA increase energy intake by 10% over the requirement for
healthy, non HIV infected of the same age, sex, and physical ability level and that symptomatic PLHA
increase energy intake by 20 30% over the requirement for healthy, non HIV infected.
In addition to ARVs, PLHAs often take other drugs to treat opportunistic infections, such as tuberculosis,
thrush, pneumonia and intestinal infections, which occur as a result of weakened immune systems.
Such drugs are equally affected by certain food substances.
45
Food and drug effects
These occur in four ways:-
Absorption: The process by which nutrients enter the tissues of the body
Metabolism: The chemical process in the body resulting in growth, production of energy and
elimination of waste
Distribution: the process of delivering food nutrients to all parts of the body
Excretion: The discharge of waste matter from the body such as urine, sweat, or faeces.
Food and nutritional implications of ART
Food can enhance the strength of some ARVs and reduce the strength of others. For example, foods
with high energy, high fat and protein decrease the absorption of some ARVs like indinavir (protease
inhibitor). Food with a lot of fat increases the bioavailability of some ARVs like tenofovir (NRTI).
It is important to note that some ARVs should be taken with food, others on empty stomach and others
with or without specific types of foods.
Certain medications can also affect absorption, metabolism, distribution, and excretion of certain food
nutrients. Some Protease Inhibibors (PIs), such as ritonavir and nelfinavir can cause changes in the
metabolism of lipids (fats) thereby increasing cholestoral and trigyceride can cause heart disease. This
can be taken of by taking foods with less saturated fats like Kimbo.
Some ARVs belonging to PIs and NRTIs class can cause poor fat distribution in the body usually called
Lipodystrophy. Some of these drugs may cause diabetes because they can cause insulin resistance
as a result of changes in carbohydrate metabolism.
Side effect of medication interferences with:-

Food consumption Side effects like nausea, taste changes, loss of appetite, may reduce food
consumption
Nutrient absorption
Side effects like diarrhea and vomiting may increase nutrient losses. Drugs like zidovudine causes
nausea, then taking it with light meal, eating dry salty foods and drinking fluids between meals may help
to prevent nausea.
Didanosine: If didanosine (ddI) causes diarrhea, drinking plenty of fluids and eating foods rich in
energy and other nutrients as is recommended for diarrhea generally, will help reduce the impact of
diarrhea.
Some ARVs may cause conditions that result to poor bone health (studies still on). Adequate vitamin D
and calcium intake is recommended nutritional response.
46
Food and drug combination
Certain combination of medication and certain foods can produce unhealthy side effects. Consuming
drinks that contain alcohol while taking didanosine (ddI) can cause pancreatitis and inflammation of the
pancreas that can be fatal. It is important that PLHAs be aware of the foods contraindicated with drugs
they are taking in order to avoid such foods.
Fresh Fruits and Vegetables can be found in many african villages and are a healthy source of Vitamins.
47
Table 1: Food and drug interactions.
Table 1: Food and drug interactions.

Use Interactions/guidelines Examples
Allergies antihistamine To relive or prevent the Food: Take prescription on an Diphenhydramine/BENADRYL

symptoms of colds, hay empty stomach to increase its Fexofenadine/ALLEGRA oratatide/
fever and allergies effectiveness. CLARITIN, cetirizine/ZYRTEC
Alcohol: Avooid alcohol because
it increases the sedative effects
of the medications.
ARTHRITIS and Analgesic/ Antipy- To treat mild to moder- Food: For rapid relief, take on Acetaminophen/TYLLENOL,TEMRA
PAIN retic ate pain empty stomach.
Alcohol: Avoid or limit the use of
alcohol because chronic alcohol
use can increase the risk of liver
damage or stomach bleeding
Non-steroidal Anti To reduce pain, fever Food: Take with food or milk Asprin/BAYER, ECOTRIN, Ibuprofen/
inflammatory & inflammation because medications can irritate MOTRIN, ADVIL, naproxen/
drugs (NSAIDS) the stomach. ANAPROXALEVE, NAPROSYN
Alcohol: Avoid or limit the use of
alcohol because chronic alcohol
use can increase the risk of liver
damage or stomach bleeding
Corticosteroids To relieve inflamed Food: take with food or milk to Methyprednisolon/MEDROL, predni-
areas of the body decrease stomach upset. sone/DELTASONE, prednisolone/
To reduce swelling and PEDIAPRED PRELONE, cortisone,
itching acetate/CORTEF
To relieve allergies,
rheumatoid ar thritis,
and other conditions
Narcotic Analge- To provide relief for Alcohol: Avoid alcohol because Codeine combined with acetamino-
sic moderate to severe it increases the sedative effects phen/TYLENOL, Morphine/
pain of the medication. ROXANOL, CONTIN.
ASTHMA bronchodilators to treat the symptoms Food: high- fat meals may in- Theophylline/SLO-BID, THEO -DUR,
of bronchial asthma, crease the amount of theophyl- UNIPHYL, Albuterol/VENTOLIN
chronic bronchitis and line in the body, while high car- PROVENTIL, COMBIVENT, Epi-
emphysema bohydrate meals may decrease nephrine/PRIMATENE MIST
it. It is important to check with
the pharmacist about which form
you are taking because food can
have different effects depending
on the dose form.
Caffeine: Avoid alcohol because
it can increase the risk of side
effects such as nausea, vomit-
ing, headache and irritability.
48
CARDIOVAS- Diuretics To help elimi- Food: Some diuretics cause Furosemide/LAXIX

CULAR DIS- nate water, loss of potassium, calcium Triamterene/hydrochlorothiazide/
ORDERS sodium and and magnesium. Triamtene DYAZIDE, MAXZIDE
chloride from is known as Potassium spar- Hydrochlorothiazide, HYDRODI-
the body ing diuretic. When taking URIL
triamterene avoid eating Trimterene/DRYENIUM
large amounts of potassium - Bumetamide/BUMEX
rich foods such as bananas, Metolazone/ZAROXOLYN
oranges and green leafy
vegetables or salt substi-
tutes.
Beta Blockers To decrease Alcohol: Avoid drinking alco- Atenolol/TENORMIN
the nerve im- hol with propranolol/ Metoprolol/LOPRESSOR
pulses to blood INDERAL because these Propranolol/INDERAL Nadolol/
vessels drugs lower blood pressure CORGARD
too much
Nitrates To relax blood Alcohol: avoid alcohol be- Isosorbide dinitrate/ISORDIL,
vessels and cause it may add to the blood SORBITAT
lower the de- vessel-relaxing effect of ni- Nitroglycerin/NITRO NITRODUR,
mand for oxy- trates and result in danger- TRANSE NITRO
gen by the ously low blood pressure
heart
Angiotension To relax blood Food: Take one hour before Captopril/CAPOTEN
converting en- vessels by or two hours after meals. Enalapril/VASOTEC
zyme (ACE preventing May increase the amount of Lisinopril/PRINIVIL, ZESTRIL
Inhibitors) angiotension II potassium in the body. Too Quinapril/ACCUPRIL
A vasoconstric- much potassium can be Moexipril/UNIVASC
tor, from being harmful. Avoid eating large
formed amounts of potassium -rich
foods such as bananas, or-
anges and green leafy vege-
tables or salt substitutes
HMG-CoA Known as Food: lovastatin (Mevacor) Atorvastatin/LIPITOR
Reductase statins should be taken with the Cerivastatin/BAYCOL
inhibitors To lower cho- evening meal to enhance Fluvastatin/LESCOL
lesterol absorption Lovastation/MEVACOR
To reduce the Alcohol: Avoid drinking large Pravastatin/PRAVACHOL
production rate amounts of alcohol because Simvastation/ZOCOR
of LDL (bad it may increase the risk of
cholesterol) liver damage
49
Anticoagulants To prevent Food: vitamin K producers Warfrin/COUMADIN

formation blood blood-clotting substances and
clots may reduce the effectiveness
of anticougulants. High doses
of vitamins E may prolong
clotting time and increase the
risk of bleeding
INFECTIONS Antibiotics and To treat infec- General guidelines: Tell the
antifungals tions caused by doctor if antifungals by bacte-
bacteria and ria or fungi. You experience
fungi skin rashes or diarrhea. If you
are using birth control, con-
sult with you health care pro-
vider because some methods
may not work when taken
with antibiotics. Be sure to
finish all of your medication
even if you start feeling bet-
ter. Take medication with
plenty of water
Antibacterials/ To treat infec- Food: Take on empty stom- Penicillin V/VEETIDS
penicillin tions caused by ach unless it upsets your Amoxicillin/TRIMOX, AMOXIL,
bacteria and stomach, take with food. ampicilin/PRINCIPE OMNIPEN
fungi
Quinolones To treat infec- Food: take on empty stom- Ciprofloxacin/CIPRO
tions caused by ach 1 hour before or 2 hrs Levofloxacin/LEVAQUIN
bacteria and after meals. If your stomach Ofloxacin/FLOXIN
Fungi gets upset, take with food. Trovafloxacin/TROVAN
Caffeine: Taking these medi-
cations with caffeine-
containing products may
increase caffeine levels, lead-
ing to excitability and nerv-
ousness
Macrolides To treat infec- Food: take on empty stom- Azithromycin/ZITHROMAX
tions caused by ach 1 hour before or 2 hrs Clarithroycin/BIAXIN
bacteria and after meals. If your stomach Erythromycin/ERY-TAB, ERYC,
fungi gets upset, take with food Erythromycin sulfisoxazole/
PEDIAZOLE
Sulfonamides To treat infec- Food: take on empty stom- Sulfamethoxazole + trimethoprim/
tions caused by ach 1 hour or 2 hrs after BACTRIM SEPTRA
bacteria and meals. If your stomach gets
fungi upset, take with food.
50
Tetracyclines To treat infec- Food: Avoid taking tetracy- Tetracycline/ACHROMYCIN,

tions caused by cline with dairy products, SUMYCIN
bacteria and antacids and vitamin supple- Doxycycline/VIBRMYCIN
fungi ments containing iron Minocycline/MINOCIN
Nitromidazole To treat infec- Alcohol: avoid drinking alco- Metronidazole/FLAGYL
tions caused by hol and taking medications
bacteria and that contain alcohol while
fungi taking metronidazole and for
at least three days after you
finish the medication
Antifungals Food: it is important to avoid Fluconazole/DIFLUCAN
taking these medications with Griseofulvin/GRIFUL
dairy products. Ketocozanazole/SPORANOX.
Alcohol: avoid drinking alco-
hol and taking medications
that contain alcohol while
taking keroconzole and for at
least days after you finish the
medication
MOOD DIS- Monoamine To treat depres- Food: these medications Pheneisine/NARDIL
ORDERS Oxidase (MAO) sion, emotional have many dietary restrictions Tranycypromine/PARNATE
Inhibitors and anxiety and people taking them need
disorders to follow the dietary guide-
lines and physicians instruc-
tions very carefully. A rapid,
potentially fatal increase in
blood pressure can occur if
foods or alcoholic beverages
containing tyramine are con-
sumed while taking MAO
inhibitors
Alcohol: Do not drink beer,
red wine, other alcoholic bev-
erages, non -alcoholic and
reduced alcohol beer and red
wine products
Anti-anxiety To treat depres- Caffeine: May cause excit- Lorasepan/ATIVAN
drugs sion, emotional ability, nervousness and hy- Diazepam/VALIUM
and anxiety peractivity and lessen the Alprazolam/XANAX
disorders anti-anxiety effects of the
drugs
Alcohol: May impair mental
and motor performance
Antidepressant To treat depres- Food: These medications Paroxetine/PAXIL
drugs sion, emotional can be taken with or without Sertraline/ZOLOFT
and anxiety food. Fluoxetine/PROZAC
disorders Alcohol: although alcohol
may not significantly interact
with these drugs to affect
mental or motor skills, people
who are depressed should
not drink alcohol.
STOMACH Histamine To relieve pain, Food: these medications can Cimetidine/TAGAMET
CONDITIONS blockers promote healing be taken with or without food. Famotidine/PEPCID AC
and prevent Caffeine: Caffeine products Ranitidine/ZANTAC
irritation from may irritate the stomach Nizatadine/AXID
returning
51
Table 2: Food and Nutrition implications of two classes of ARVs: Reverse Transcriptase Inhibitors
ARV Class: Reverse Transcriptase Inhibitors
ARV Type: Non -Nucleoside Reverse Transcriptase Inhibitors (NNRTI)
Medication Ge- Food recommendations Avoid Possible side effects

neric Name
(Abbreviation)
Efavirenz (EFZ) Can be taken without regard to Alcohol Elevated blood cholesterol levels, elevated
meals, except do not take with triglyceride levels, rash, dizziness, anorexia,
high fat meal (fat meals increase nausea, vomiting, diarrhea, dyspepsia, abdomi-
drug absorption) nal pain, flatulence.
Nevirapine (NVP) Can be taken without regard to St. Johns wort Nausea, vomiting, rash, fever, headache, skin
food reactions, fatigue, stomatitis, abdominal pain,
drowsiness, presthesia, high hepatotoxicity.
ARV Class: Reverse Transcriptase Inhibitors
ARV Type: Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI )
Abacavir (ABC) Can be taken without regard to Nausea, vomiting, fever, allergic reaction, ano-
food rexia, abdominal pain, diarrhea, anemia, rash,
hypotension, pancreatitis, dyspnea, weakness,
insomnia, cough, headache
Didanosine (ddI) Take 30 mins before or 2 hrs after Alcohol, do not Anorexia, diarrhea, nausea, vomiting, pain, head-
eating. Take with water only take with juice. ache, weakness, insomnia, rash, dry mouth, loss
(taking with food reduces absorp- Do not take with of taste, constipation, stomatitis, anemia, fever,
tion) antacids contain- dizziness, pancreatitis.
ing aluminum or
magnesium
Lamivudine (3TC) Can be taken without regard to Limit the con- Nausea, vomiting, diarrhea, headache, abdomi-
food sumption of alco- nal pain, nasal symptoms, cough, fatigue, pan-
hol creatitis, anaemia, insomnia, muscle pain, rash
Stavudine (d4T) Can be taken without regard to Limit the con- Nauses, vomiting, diarrhea, peripheral neirapa-
food sumption of alco- thy, chills, and fever, anorexia, stomatitis, ane-
hol mia, headache, rash, bone marrow suppression,
pancreatitis. May increase the risk of lipodystro-
phy
Tenofovir (TDF) Take with a meal Abdominal pain, headache, fatigue, dizziness
Zidovudine (ZDV/ Better to take without food, but if Alcohol Anorexia, anemia, nausea, vomiting, bone mar-
AZT) it causes nausea or stomach row suppression, headache, fatigue, constipa-
problems, take with a low -fat tion, dyspepsia, fever, dizziness, dyspnea, in-
meal. Do not take with high fat somnia, muscle pain, rash
meal
Indinavir (IDV) Take on an empty stomach 1 Grapefruit Nausea, abdominal pain, headache, kidney
hour before or 2 hrs after a meal, St. Johns wort stones, taste changes, vomiting, regurgitation,
or take with a light non - fat meal. diarrhea, insomnia, ascites, weakness, dizziness.
Take with water. Drink at least May increase the risk of lipodystophy.
1500 ml of fluids daily to prevent
kidney stones.
Lopinavir (LPV) Can be taken without regard to St. Johns wort Abdominal pain, diarrhea, headache, weakness,
food nausea. May increase the risk of lipodystrophy.
May increase the risk of diabetes
Nelfinavir (NFV) Take with a meal or light snack. St. Johns wort Diarrhea, flatulence, nausea, abdominal pain.
Taking with acidic food or drink May increase the risk of lipodystrophy
will cause a bitter taste
Ritonavir (RTV) Take with a meal if possible St. Johns wort Nausea, vomiting, diarrhea, hepatitis, jaundice,
weakness, anorexia, abdominal pain, fever, dia-
betes, headache, dizziness. May increase the
risk of lipodystrophy.
Saquinavir (SQV) Take with a meal or light snack. Garlic supple- Mouth ulceration, taste changes, nausea, vomit-
Take within 2 hrs of a high fat and ments ing, abdominal pain, diarrhea, constipation, flatu-
high calcium meal St. Johns wort lence, weakness, rash, headache, insomnia.
May increase the risk of lipodystrophy
52
Table 3: Nutritional Management of Common ARV Side Effects

Side effect Recommended Nutritional management
Anorexia Eat small and frequent meals. Eat favorite foods. Select foods that are energy dense. Avoid strong
smelling foods.
Change or loss of taste Use flavor enhancers such as salt, spices, or lemon. Chew food well and move around in mouth to stimu-
late receptors.
Constipation Eat foods high in fibre content. Drink plenty of liquids. Avoid processed or refined foods. Exercise regu-
larly according to capacity.
Diarrhea Drink plenty of fluids. Continue eating during and following illness. Prepare and drink rehydration solu-
tion regularly. Avoid fried foods.
Fever Drink plenty of fluids. Eat energy and nutrient dense foods.
Flatulence Avoid gas- forming foods such as beans, cabbage, broccoli, and cauliflower
High blood cholesterol Eat a low fat diet and limit intake of foods rich in cholesterol and saturated fat. Eat fruits and vegetables
daily. Exercise regularly according to capacity
High triglycerides Limit sweets and excessive carbohydrates and saturated fat intake. Eat fruits, vegetables, and whole
grains daily. Avoid alcohol and smoking. Exercise regularly according to capacity.
Nausea or vomiting Eat small quantities of food at frequent intervals. Drink after meals and limit intake of fluids with meals.
Avoid having an empty stomach. Avoid lying down immediately after eating. Eat lightly salty and dry
foods to calm the stomach. Rest between meals.
Belief and hope

Have hope. Believe that you can live a healthy life. Think of love. Think of light. Think of God. Listen
and talk to God in whatever way you do. It does not matter what religion you follow. Know that your
God will love, guide and protect you. Have the light of God in your heart and things will be better. Think
of a good future. Others have done so and have remained strong.
Ten tips for getting started

Think positive thoughts
Avoid preservatives and processed foods
Eat garlic
Start sprouting
Start steaming
Use spices
Start eating power foods
Try the recipes
Start deep breathing
Start exercising
53
54
References:
HIV Medications-Food Interactions Hand Book

Second Edition
By Zaneta M. Pronsky et al
Nutrition in HIV-Disease
http://www.foodmedineractions.com/hivinfo.html
WHO-Guidelines on Care Treatment and Support for

Women Living with HIV/AIDS and their children in Resource-Constrained Settings.
US Food and Drug Administration

National Consumers League 1998 Http://vm.cfsan.fda.gov/~lrd/fdinter.html
Food for People Living with HIV/AIDS

2nd Edition of NAP+ Nutrition Manual.
Some people living with HIV, the virus that causes AIDS are living
healthy lives for long periods of time. It is still unknown why some with
HIV survive for long periods, while others do not.
There seems to be many factors that help people with HIV to live long
lives. One of these factors is food. This booklet tells people with HIV/
AIDS about healthy eating.
People living with HIV/AIDS can use food as medicine. If they are not
sick, good food may help them to keep strong for a long time. If they
are sick, treatment and the right food may help them to get well faster.
People living with HIV/AIDS often have problems with food digestion.
They often experience difficulty in absorbing nutrients from the food
they eat. They also have difficulty with eating. This may lead to
serious weight loss.
This nutritional manual explains which foods can keep the body
healthy and are easy to digest. It also explains how to buy and cook
these foods and gives recipes for healthy dishes. It looks at the
specific health problems of people with AIDS and offers food
remedies for these problems. Finally, it suggests ways of living to
help those with HIV/ AIDS along a pathway to health.
Food can enhance the strength of some ARVs and may reduce the
strength of others. Foods with high energy and fats may decrease
the absorption of protease inhibitors. However while some ARVs
should be taken with food, others must be taken on an empty
stomach.
ISBN 0-620-19384-0

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FOOD

For people living with

Network of African People Hope for African

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All rights reserved. No reproduction in part or whole in any form is

Network of African People Living

Abbreviations and acronyms III

Getting the nutrients you need. 7

Getting enzymes, antioxidants, and friendly flora. 13

Pregnant women and the baby 37

Food and drug interactions 45

NAP+ Network of African People Living with HIV/AIDS

HIV Human immunodeficiency virus

AIDS Acquired Immunodeficiency syndrome

ART Antiretroviral therapy (treatment)

MTCT Mother-to-child transmission of HIV

NRTI Nucleoside reverse transcriptase inhibitor

NNRTI Non-nucleoside reverse transcriptase inhibitor

PLHA Person living with HIV/AIDS

'The More You Look, The More You Find'.

Let thy food be thy medicine

Role of good Nutrition.

Importance of good nutrition

Source: Adapted from RCQHC and FANTA 2003

Foods that contain preservatives, artificial flavors and artificial colorants.

These chemicals that are added to processed foods

Canned foods: Canning involves heating food at

Foods grown with pesticides

Alcohol: Drink alcohol in small amounts. In large amounts,

Vitamins and minerals

The mineral and vitamin chart on the next page shows:

Mineral and Vitamin chart

Complete protein combination chart

Food Combine with

Fats and oils

Using good to control your body temperature

If your body temperature is low:-

Food sources of friendly flora are:-

Garlic and onions promote the growth of some friendly flora

You can eat both raw and cooked. Ear raw

Harmful bacteria cannot multiply in sour

Fruit and vegetables

Dark leafy greens

Yellow and orange fruit and vegetables

Squash and pumpkin seeds.

Nuts and seeds

Millet and sorghum

Stimulate the appetite

You can also make tea from seeds or whole spices:-

Put the whole spice or seeds in 1 cup boiling water

Spice/herb Use in the body Use in cooking

There are many advantages to sprouting:-

Lentils 1 cup 12 hours 2 5 days - 1 cm

Sorghum or millet 1 cup 8 hours 2 3 days cm

Maize 1 cup 12 hours 3 4 days 1 cm

Sunflower (without shells) 1 cup 12 hours 1 3 days - 1 cm

Always wash your hands before and after touching food.

Uncooked animal products

Cook all raw animal

Raw vegetables and fruit

Recipes for health

When preparing the recipes that follow, remember:-

Mix all the ingredients together