Responding to Gender Issues to Improve Outcomes in Nutrition Assessment, Counseling, and Support Services

Adherence to a nutritious diet maintains the immune level, decreases susceptibility to opportunistic infections, improves the effectiveness of antiretroviral drugs (ARVs), and sustains healthy physical activity and productivity, which facilitates improved health outcomes and quality of life. Food access, availability, and utilization remain a challenge for many people living with HIV (PLHIV), which can increase vulnerability to the virus and its progression into AIDS. Nutrition assessment, counseling, and support (NACS) is an approach to integrate evidence-based nutrition interventions into health services, including the prevention, categorization, and treatment of malnutrition and sustained improved nutritional status. Nutrition assessment helps determine the nutritional status of women, men, girls, and boys using information about the patient's medical history, eating habits, current health, and social and economic status. Nutrition counseling involves a discussion about the results of the nutrition assessment, identification of barriers and issues leading to poor nutrition outcomes, and key activities that could improve the nutritional status of those affected by HIV. Gender inequality is a major driver of vulnerability to malnutrition and food security, especially for PLHIV. The nutrition and food security needs of women and children are often neglected at the household level due to social, cultural, and economic inequalities between males and females. Food access, availability, and utilization can be different for men, women, boys, and girls. In many countries, women comprise a large percentage of the agricultural labor force but have limited access to information, resources, and credit; little say in how to use the land; and limited access to markets. In communities where gender inequality is pervasive, women and girls tend to eat lower quantities and varieties of food that are generally less nutritious than the food eaten by their male counterparts. As a result, twice as many women suffer from malnutrition as men. Gender-based violence (GBV) can affect HIV vulnerability and impact food security and nutrition of affected persons and their families. GBV increases the risk of contracting HIV, is sometimes a consequence of disclosing HIV status, and affects ability to cope with the infection. HIV can also decrease a person's ability to harvest quality food or engage in waged labor to purchase food, dramatically affecting household food security. Women and girls are often responsible for taking care of sick family members, so they might not have time to focus on food production, which can affect the nutritional status of the whole family. Livelihood insecurity can put people—especially women and girls—at risk of contracting HIV and violence as they are forced to migrate for waged labor or engage in transactional sex work for income or goods to support their families. Nutrition assessment and counseling services often have different levels of access and utilization for males and females, which can be influenced by social, cultural, and economic norms and practices. Women and girls tend to be less economically independent and have less decision-making power, which can prevent them from accessing health services. Male partners and mothers-in-law can play an important role in a woman's nutrition status and decision to access or be retained in nutrition services. Harmful gender norms can lead communities to stigmatize males and females for accessing services, but in different ways. Nutrition counselors need to be trained to identify how malnutrition affects men, women, girls, and boys differently, and how to respond to their different needs, including identifying high-risk patients who have a higher nutrient requirement. While women tend to be in charge of food preparation, male partners and mothers-in-law are more likely to be in charge of food allocation. Counseling women who are HIV-positive requires consideration of their specific needs and challenges, including the need for extra care and support during pregnancy and lactation.