AFRICAN SCIENCE ACADEMIES DEVELOPMENT INITIATIVES (ASADI V)

1. Applying scientific thinking in the service of society AFRICAN SCIENCE ACADEMIES DEVELOPMENT INITIATIVES (ASADI V) 8 – 12 NOVEMBER 2009 ACCRA, GHANA ROBIN CREWE,

2. ACADEMY OF SCIENCE OF SOUTH AFRICA (ASSAf) HIV/AIDS, TB AND NUTRITION: Scientific enquiry into nutritional influences on human immunity, with special reference to HIV infection and active TB in South Africa (See at www.assaf.org.za)

3. BRIEF BY ASSAf COUNCIL • (HIV, TB focus) • Impact of nutritional status on immunity • Impact of infections on nutritional status • Impact of nutritional interventions • Recommendations for policy and practice • Recommendations for research

4. HIV-NUTRITION CONTROVERSY- DAMAGING TO S A AND PEOPLE • Self-initiated consensus study • Panel of 15 members (12 SA; 2 USA; 1 Tanzania), chaired by Barry Mendelow • Wide spread of expertise, perspective,etc • Study Director : Boitumelo Mabina • Think-tank meetings; commissioned drafting (internal, external); forum-type workshop on HIV-gut relationship • Report 300 pp plus; peer reviewed and revised; • Released August 2007 in full and condensed versions; press/media launch; govt.departments; dissemination of 3000 copies

5. Academy of Science of South Africa Consensus Study:HIV/AIDS, TB, and Nutrition • 14 members (2 US and 1 Tanzanian) • Chaired by Professor Barry Mendelow, ASSAf member • Duration – 18 months • Workshop on HIV immunology of the gut • Ten recommendations • Eight priorities for research THE NATIONAL ACADEMIES Advisors to the Nation on Science, Engineering, and Medicine

6. MAIN FINDINGS • 3 Concurrent, inter-dependent pandemics • Under-use of existing scientific knowledge • Remarkable lack of reliable evidence (“the debate is so bitter because the evidence-base is so small”) • Lack of randomised, controlled trials (RCTs), as against many observational studies; lack of embedded explanatory capacity: most done out of context

7. Study released on the same day that the following headline appeared: Our Health Minister a “drunk and a thief”

8. Academy of Science of South Africa Consensus Study:HIV/AIDS, TB, and Nutrition • Extensive national and international media coverage • Nhanhla Nyiade, spokesperson for the Department of Science and Technology, told SciDev.Net that future briefings will be carried out to incorporate the recommendations into policymaking. • ASSAf requested by DST to provide annual review of the state of HIV/AIDS research • Health Ministry spokesperson Sinbani Mngadi said the report confirmed the correctness of the Health Department’s focus on nutrition • ASSAf continues conversations with the Medical Research Council to realize a broader research agenda THE NATIONAL ACADEMIES Advisors to the Nation on Science, Engineering, and Medicine

9. HIV-NUTRITION CONTROVERSY- DAMAGING TO S A AND PEOPLE The KwaZulu-Natal Health Department is actively promoting Aids denialists and quack Aids cures — with the blessing of Health Minister Manto Tshabalala-Msimang. Last Friday, the department hosted an “information workshop on HIV treatment” at a Durban hotel, where speakers condemned antiretroviral drugs and called for traditional medicine to be promoted instead. The meeting was opened by the KwaZulu-Natal Health MEC Peggy Nkonyeni. Tshabalala-Msimang delivered the keynote address. 18 May 2008

10. HIV/AIDS, TB and Nutrition: Special Considerations of Infancy and Childhood;Findings from the Academy of Science of South Africa Report and its Impact onPolicy

11. Findings of the Study • South Africa is in the grip of three concurrent epidemics, HIV/AIDS caused by the Human Immunodeficiency Virus, TB caused by Mycobacterium tuberculosis, and malnutrition, brought about by a variety of socio-economic factors. • Although caused by separate factors, there is evidence that each epidemic acts synergistically to aggravate the other two. • Recent studies investigating the pathogenesis of HIV infection have provided the paradigm-shifting insights that the gastrointestinal tract is the anatomical front line of the disease, and that lymphocyte activation is a key step in the CD4+ T cell depletion that defines AIDS.

12. Findings of the Study Cont. • Together, these insights have major implications for our dawning understanding of the intersection between nutrition and HIV/AIDS, both in terms of the potential impact of HIV infection on nutritional status, and in redefining our conceptions of how nutritional intervention might impact on HIV/AIDS pathogenesis. • Systematic review of the clinical literature has inter alia identified macronutrient-related issues of importance in relation to HIV infection in infants and pregnant mothers: • Systematic review of the clinical literature has identified the following micronutrient-related issues of importance in relation to HIV infection in infants and pregnant mothers

13. Recommendations of the Study • The possibility of augmenting standard school feeding schemes and other childhood feeding schemes with ready-to-use fortified, therapeutic foods, as an integral part of their feeding regimens, should be actively explored in terms of cost, feasibility, and general logistic requirements. • Resources should be directed to ensure food security based on locally available, affordable and traditional foods to vulnerable populations. • The nutritional care of people infected with HIV should focus on diversified diets including locally available, affordable and traditional foods, and should be complemented by appropriate, locally acceptable macronutrient supplements.

14. Recommendations of the Study • Promote and support adequate dietary intake of micronutrients at RDA levels while recognizing that this may not be sufficient to correct nutritional deficiencies in all HIV-infected individuals. • In situations where micronutrient deficiencies are endemic, these nutrients should be provided through food fortification or micronutrient supplements • HIV infected women should be offered multivitamin supplementation at RDA levels. • The existing legislation and regulations should be revised to require adequate and controlled testing and evaluation of all products claiming medicinal benefits with respect to HIV infection or active TB.

15. Recommendations of the Study • Government should identify accessible, scientifically valid ways to accelerate the investigation of promising traditional or herbal products. • An urgent national expert consultation should be convened to develop national guidelines for infant feeding. • More nutritionists and dieticians should be trained, employed and utilized in all programmes addressing HIV/AIDS and tuberculosis, and • the nutritional knowledge of all health care workers in community, clinic and hospital settings should be improved and extended.

16. Recommendations for Policy/Practice • Implement and properly resource integrated national nutrition programme • Train, mobilise more nutritionists, dietitians • Urgent national meeting of experts on breast-feeding of babies of HIV-infected mothers • Enforcement of regulations on all claimed medicinal benefits of non-ARV agents • Micronutrient supplements - food fortification important; judicious use of (expensive) supplements, but never more than 1-2X RDA

17. The Challenge All children are vulnerable, no matter the continent or country or community into which they are born. But African children face an additional and terrible challenge that most children in the world will never know: the threat of HIV and Aids. Graça Machel

18. Applying scientific thinking in the service of society THANK YOUSIYABONGA www.assaf.org.za +27 12 349 6606