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The Role of Nutrition & Traditional Medicine in Treatment
Good nutrition is an essential part of health for anyone. In people who are malnourished with HIV/AIDS, good nutrition is an essential part of care. Nutrition is never an alternative to antiretroviral therapy or treatments for opportunistic infections. 'Nutrition' is complex - 'supplements' - tablets, processed high-energy porridges and drinks - are not food and should never be used as an alternative to real food. They may have a role in malnourished people who require additional energy, but a healthy person should generally focus on improving the quality of the food they eat rather than using unproven supplements.
When a person is infected with HIV, their immune system is compromised and becomes increasingly vulnerable to opportunistic infections. These infections cause conditions such as weight loss, fever and diarrhoea - conditions that reduce a person's appetite or block the body's ability to absorb nutrients (WHO).
The body also experiences increases in metabolic demands and uses more nutrients to fight opportunistic infections.
These factors cause the body to become malnourished - making the person more susceptible to further opportunistic infections and further malnourishment. This downward spiral can accelerate the development of AIDS.
The relationship between HIV/AIDS and nutrition is cyclical. If nutrition is poor, the body's ability to fight HIV and other infections is worsened. These new infections cause further malnourishment, increasing the possibility of new infections.
Conversely, good nutrition may improve an HIV-infected person's quality of life by
"improving the function of the immune system and the body's ability to fight infection
extending the period from infection to the development of the AIDS disease
improving response to treatment; reducing time and money spent on health care
keeping HIV-infected people active, allowing them to take care of themselves, their family and children
keeping HIV-infected people productive, able to work, grow food and contribute to the income of their families." - (FAO and WHO)
The dietary needs of HIV-positive people are similar to those of those without HIV: "A balanced and diverse diet consisting of starchy staples (e.g., rice, maize, potato, cassava, banana, yam) with cooked legumes (e.g., beans, peas), nuts and nut butters, animal foods, fat and oil, fruits, and vegetables", according to the US Food and Nutrition Technical Assistance (FANTA) HIV/AIDS: A Guide for Nutritional Care and Support 2004.
However, an HIV-infected person needs a larger energy intake than non-infected individuals:
to fight the HIV infection and opportunistic infections
to compensate for nutrients which are not absorbed properly
The amount of extra energy needed depends on the progression of the virus. At the asymptomatic stage, an HIV-infected person should increase their energy intake by 10% over the recommended energy intake for a similar, but non-infected individual. Once showing symptoms, this should increase to 20-30%, according to FANTA.
The role of nutrition in the treatment of HIV/AIDS (as described in this fact sheet) must not be confused with the claims of vitamin proponents who believe nutrition by itself is an effective treatment for HIV/AIDS and that antiretroviral drugs are highly toxic and dangerous.
The Dr Rath Health Foundation Africa and the Treatment Information Group advertise "natural health" treatment responses to the AIDS pandemic including the use of multi-vitamins. Their adverts also claim that antiretroviral drugs are highly toxic and dangerous (see advert).
The adverts have been condemned by The South African Medical Association (source), the Southern African HIV Clinicians' Society (source), the WHO and the United Nations (source). The Advertising Standards Authority of South Africa ordered the withdrawal of some of the newspaper advertisements and fliers published by the group because they contained unsubstantiated claims.
While the WHO acknowledges that good nutrition can "help bolster the immune system, boost energy levels and maintain body weight and well-being," it cautions that "there is no evidence that food and/or dietary supplements alone will stop people who are infected with HIV from progressing to AIDS.
"Comprehensive care for people living with HIV and AIDS needs to include prophylaxis and treatment for opportunistic infections and antiretroviral therapy, where indicated and a healthy, balanced diet."
However, Minister of Health Manto Tshabalala-Msimang has not publicly condemned Rath's activities, prompting the TAC to file court papers against the minister, Rath and some of his associates, the Medicines Control Council (MCC) and the Western Cape MEC for Health in late November (see TAC newsletter).
Minister of Health, the Medicines Control Council (MCC), the Western Cape MEC for Health, as well as pharmaceutical proprietor Matthias Rath and several of his employees and associates, including AIDS denialists Anthony Brink, David Rasnick and Sam Mhlongo
Traditional Medicine
Overview
Traditional healers are people recognised by their communities in the use of indigenous medications (aka traditional medicine) and therapies in health care.
Traditional medicine remains strong in developing countries such as South Africa due to its affordability, availability and role in predominant belief systems. It is also growing rapidly in developing countries in the form of complementary and alternative medicine (CAM), where patients use both biomedical and traditional forms of medicine.
In South Africa, traditional healing practices include "acupuncture, divination, herbalism, reflexology, shiatsu, and 'spiritual healing'", according to the American Journal of Nursing. African traditional medicine is most closely liked to herbal medicine.
Sangomas and iNyangas are popular traditional healers in South Africa.
Sangomas believe that they build relationships with ancestral spirits that can assist them in the diagnosis and cure of physical and psychological illnesses
iNyangas are essentially herbalists, working mainly with indigenous plants to provide medical treatments and cures
Both groups of healers are often consulted by people living with HIV/AIDS when they exhibit symptoms. Because healers are skilled at treating secondary or opportunistic infections, many South Africans and healers assume that they can treat and/or cure AIDS, though there is no known long-term cure for AIDS.
Tension Between Medical Disciplines
Most friction between biomedical and traditional arms of medicine stems from the conventional science notion of "material causation". Biomedical doctors generally look at the physical causes of an illness and treat them accordingly. Traditional healers generally look at other factors including spiritual causes.
The WHO has recommended that traditional healers and practitioners of Western medicine share their knowledge and collaborate where possible.
As with nutrition, these approaches should not be seen as alternatives to antiretroviral therapy or opportunistic infection treatments.
Legislation
In 2003, the South African Parliament passed the Traditional Health Practitioners' Bill, giving formal recognition to traditional health practitioners in South Africa. The Bill also provides for a "regulatory framework to ensure the efficacy, safety and quality of traditional health care services" and gives patients recourse in instances of malpractice.
The Bill allows traditional healers to issue prescriptions for medications and give sick leave.
The Bill prevents traditional healers who are not registered with the Traditional Health Practitioners' Council from offering treatment or cures for AIDS or other terminal diseases.
Research
The WHO states that "traditional medicines need to be evaluated for safety, efficacy and quality before they can either accepted or rejected from national health policies". (WHO Traditional Medicine Strategy 2002-2005)
