Abstract:
HIV/AIDS status and food system interact in a vicious cycle which influence nutrition at
individual and household levels. Safety nets are important mechanisms to promote health and
nutrition among People Living with HIV/AIDS (PLWHA), however, these mechanisms are
being weakened following dwindling resources among other factors. Understanding the food
system and safety net types of PLWHA is important to promoting nutritional status and
improved treatment outcomes. This study was designed to assess food system, safety nets and
nutritional status of PLWHA in Kaduna city, Nigeria.
Descriptive cross-sectional and a mixed-methods approach were used. A total sampling of
consenting 532 PLWHA across 14 support groups in Kaduna was conducted. Three key
informant interviews and three focus group discussion sessions were conducted among support
group leaders and male/female members, respectively using structured guides. Intervieweradministered questionnaire was used to collect information on socio-demographic
characteristics, CD4 cell count, safety net types, food system and dietary intake of PLWHA. A
24-hour recall was conducted to assess dietary intake and analysed using adapted Total Diet
Assessment software and dietary diversity according to the FAO standard. Body weight and
height were assessed to determine the Body Mass Index (BMI) and categorised using WHO
standards. Qualitative data were analysed thematically. Quantitative data were analysed using
descriptive statistics, and Chi-square tests at α0.05.
There was declining involvement of PLWHA in food production following poor productive
capacity. Respondents expressed understanding of the link between nutrition and treatment
outcomes and identified poor income as a constraint to food access. Respondents’ age was
38.1±9.7 years, 78.0% were females, 44.9% were married, and 40.3% earned <₦5000
monthly. About 20.0%, 25.0% and 55.0% had CD4 cell count (cells/µl) of ≥500, 200-499 and
<200, respectively. Safety net types included counselling (39.2%), treatment for opportunistic
infections (27.5%), food and nutrition aid (15.7%), prayer (15.7%), and drug aid (1.9%).
Majorly produced staple was cereals (93.7%), 40.3% raised livestock/poultry, and 27.4% had
vegetable garden. Majority (58.1%) experienced hindrances to market access, 45.2% skipped
meals and 59.7% consumed street foods. Rice (71.0%), beans (61.3%) and maize (50.0%);
orange (61.3%), banana (25.8%) and watermelon (24.2%); and pumpkin leaves (ugwu)
(41.9%) and okro (9.7%) constituted the widely consumed staples, fruits, and leafy vegetables.
Intakes of energy, protein, vitamin A, zinc and iron were 1065.1±148.1Kcal, 50.3±42.7g,
10491.5±1510.6mcg, 6.7±6.1mg and 8.9±7.5mg, respectively. Mean dietary diversity was
4.8±1.12, reflecting a poor-quality diet. Prevalence of underweight, overweight and obesity
was 5.1%, 28.9% and 12.4%, respectively. Among respondents with normal BMI, 80.0% had
received financial empowerment, 64.5% received counselling /psychosocial support and
63.6% had food support. Body Mass Index was significantly associated with age, dietary
diversity, income, and intakes of energy, protein and zinc.
Access to food among people living with HIV/AIDS is constrained by poor income, reduced
productive capacity and limited support mechanism and this reflect in form of poor diet
quality, overweight and obesity. Household economic strengthening activities and food and
nutrition support are hereby recommended for PLWHA in Nigeria.
