Committee on Foreign Affairs
Subcommittee on
Hearing:
PEPFAR: Is It Fulfilling the Nutrition
and Food Security Needs of People Living with HIV/AIDS?
October 9, 2007
Chairman Donald M. Payne
Opening Statement
Good afternoon and welcome. This afternoon the subcommittee will examine
whether or not the
As members of the subcommittee are
aware from the prior hearings we have held on food security in
According to the FAO, since 1985
AIDS has killed 7 million agricultural workers in 25 of the countries most
heavily affected by HIV/AIDS. As many as
16 million more may die by the year 2020.
This of course has a huge impact on food availability in
However the relationship between HIV and food availability-- and by extension nutrition-- is not limited to the impact on food production. The impact that poor nutrition has on HIV/AIDS prevention, care and treatment must also be considered. And the relationship, while not unnoticed, remains insufficiently addressed.
People who are not getting enough food are vulnerable to HIV/AIDS infections in two ways. First, hungry people are more likely to engage in risky behavior in order to get food. Second, malnutrition weakens immunity to infections of all sorts, including HIV. Therefore I would argue that adequate food and nutrition has a role to play in prevention.
Adequate nutrition also has a very significant role to play in treatment. People who are malnourished when they begin an anti-retroviral regimen are six times more like to die. And they are more likely to suffer from side affects that may cause them to stop taking medications. Additionally, we must be sure that we are attending to the nutritional needs of those who are receiving palliative care.
The Office of the Global AIDS Coordinator has attempted to deal with this issue. OGAC has convened an interagency working group to incorporate nutrition into HIV activities, and is funding programs to support pre- and post school meals, community gardens, and some small scale agricultural activities.
As I understand it, the cornerstone of OGAC’s approach to integrating food and nutrition is the so called “wrap around” concept, whereby the programs of various U.S. government agencies are supposed to be jointly planned and programmed at the country and central level so that when needs are identified they can be met by the agency with the greatest ability to do so. Based on what I am hearing from our NGO partners on the ground, however, our efforts are not enough.
While OGAC funds a range of activities, it is not clear to me that these activities are regularized, institutionalized and fully incorporated into PEPFAR activities across the board. And while the wrap around concept may be intellectually sound, when it comes to food aid, it does not work as well in practice as it does in theory. Part of this is because our food aid programs are not as well funded on the development side as they should be, so USAID does not always have adequate resources to respond.
In addition, USAID and the Department of Agriculture are not operational in all of the areas in which PEPFAR programs are located. I know that there are some concerns with the provision of food as a part of a comprehensive response to the AIDS pandemic. I am under no illusion that food assistance is a silver bullet to HIV prevention, but I do believe we must increase our efforts to use it as a means of prevention.
Likewise, we must step up our actions in terms of nutritional support when it comes to treatment. We cannot limit our response to therapeutic feeding in cases where patients have a body mass index of less than 16.5. By doing so, we run the risk that patients will stop taking life-saving drugs, or that the drugs will work less efficiently. I am pleased to hear that OGAC is in the process of revising the use of 16.5 as a cut-off for patients to be eligible for therapeutic feeding.
Let me be clear about what I am not suggesting. I am not suggesting that OGAC turn into the Food for Peace Office, or that the President’s Emergency Plan for AIDS relief become the President’s Emergency Plan for Food Relief. What I am advocating is for nutritional and food support to be fully integrated into our prevention, care and treatment programs. I think that we can do more to achieve that aim.
I thank our witnesses for coming today, and turn to the ranking member for his opening statement.