Women's Voices, Women's Choices

The Society for International Nutrition Research sponsored a Symposium titled "Women’s Voices, Women’s Choices: The Challenge of Nutrition and HIV/AIDS in Asia and Africa" at Experimental Biology 2004 to highlight the challenges facing HIV-positive women living in resource-poor settings of Asia and Africa. This introductory paper summarises the rationale for this session, including a summary of the evidence for women’s increased vulnerability to HIV, the nutritional impacts of HIV infection, and the special infant feeding and nutritional concerns facing HIV-positive pregnant and lactating mothers in Africa and Asia.

According to the paper, women are shouldering much of the burden of HIV infection in the developing world in terms of their numbers and in their responsibilities for providing food and care for orphans and other family members who become sick or die from HIV/AIDS. At the same time, programmes directed at preventing mother-to-child HIV transmission (PMTCT) are increasing throughout the world and women enrolling in these programmes face a number of decision points. As a result of these expanding PMTCT programs, it is often women who are the first to learn about HIV in the family.

The paper proposes that nutrition is an important component of comprehensive care for the HIV-infected woman, and it is particularly important in resource-limited settings where malnutrition and food insecurity are endemic. An HIV-infected woman’s nutritional status prior to and during pregnancy influences her own health and survival, as well as the health and the survival of her newborn children. The article suggests that malnutrition during pregnancy results in low fetal stores of some nutrients, which impair immune function and fetal growth and may make the young infant more vulnerable to HIV. Furthermore, poor nutrition during pregnancy may impair the integrity of the placenta, the genital mucosal barrier, and the gastrointestinal tract. In each of these cases, transmission of HIV from mother to infant may be facilitated, although data confirming these relationships, independent of maternal HIV disease progression, are limited.

The paper also mentions that the HIV epidemic has challenged health systems and public health programmes throughout the world, and balancing the risks of HIV transmission during breast-feeding with the risks of not breast-feeding in settings where access to safe replacement foods, health care, and support are limited is one of the most difficult issues facing HIV-affected families today.