Annotated Bibliography

Please feel free to skip over this post. It wasn't much fun to write, so I don't imagine it'll be much fun to read.

ANSA (2002). Nutrition guidelines for agencies providing food to people living with HIV disease, second edition. Retrieved from http://www.aidsnutrition.org/documents/ansanutritionguides.pdf

The purpose of this document is to establish guidelines for those involved in feeding people living with HIV/AIDS. I felt like it provided some good general knowledge about AIDS nutrition that may be useful in determining how much of what kinds of foods the women I interview should be getting daily, but most of what they had to offer was extremely broad and intended for a target audience assumed to have access to adequate nutrition. I felt like this slant made a lot of what was said irrelevant to my project.

Duggal, S., Tulsi, D. C., Duggal, A. K. (2012). HIV and malnutrition: effects on immune system. Clinical and Developmental Immunology, 2012. doi: 10.1155/2012/784740

This source is a compilation of other research that discusses mechanisms through which malnutrition adversely affects the human immune system. These concepts are important for those working with HIV-positive individuals to understand, because if those specific things can be prevented, there is great potential of being able to improve the quality of life of HIV-positive individuals. Knowing specific ways in which malnutrition affects the immune system gives me specific things that I can look for and ask about in my research. For example, the article discusses the effects of protein-energy malnutrition (PEM) on the immune system. I know from other research that those infected with HIV have a greater dietary protein requirement than their uninfected counterparts, but protein rich foods may be more difficult to come by in South Africa than other foods of lesser protein quality. In my interviews, I may want to be specific about individuals’ abilities to obtain protein rich foods as opposed to food in general. One of the biggest drawbacks of this article is that parts of it are extremely technical and beyond my ability to thoroughly understand.

Irlam, J. J. H., Visser, M. M. E., Rollins, N. N., Siegfried, N. (2009). Micronutrient supplementation in children and adults with HIV infection (review). Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD003650.pub2.

I found this article at the beginning of my research, and while it was valuable in guiding me through project development, I am not sure how valuable it will be to me as I continue forward from this point. This study found that even though HIV/AIDs has been found to be linked to certain micronutrient deficiencies, treating those specific deficiencies with supplements made no difference in the well being of HIV/AIDS patients. This was surprising to me because I expected supplements to have at least a low level of efficacy, but I was wrong. Just based on what I know from Nutrition 100, I imagine this is because it is more important for HIV/AIDS patients to meet their increased requirements for macronutrients than it is for them to eat specific micronutrients.

Musita, C. P., Ariga, E. S., et al. (2009). Impact of HIV and aids on household food and nutrition security in Suba district, Kenya (report). African Journal of Food, Agriculture, Nutrition and Development, 9(7).

This is another study conducted to explore the relationship between AIDS and food insecurity. However, unlike many of the articles I have found that discuss how malnutrition and food insecurity worsen the progression of disease and therapy non-adherence, this study explores the opposite—how living in a household with AIDS patients affects the ability of the family to obtain sufficient food. The study found that households caring for patients in stage 3 of disease progression had the lowest yield of corn, beans and sorghum/millet as compared to the control group. Additionally, households caring for stage 4 patients had the most regular occurrences of children going to bed hungry. This suggests a two way relationship between HIV and malnutrition as opposed to a causal one.

I think this is a valuable resource for my project because it explores the side of the two way relationship that I will be looking at, namely why do HIV-positive individuals have a more difficult time accessing adequate nutrition than other people? Additionally, in the literature review preceding the presentation of research, the author discusses how HIV and malnutrition are more likely to have heightened effects among women. In many rural villages, women whose husbands die of AIDS have no legal rights to their property and are left with no way to support or feed their families. Additionally women who are pregnant, lactation or menstruation may be more likely to experience micronutrient deficiencies that, as we know from the Duggal article, may weaken their immune systems. The biggest drawback of this article is that it was originally published in an African journal, and the English used to explain how the research was conducted and the conclusions that were drawn is at times confusing and difficult to understand.

Weiser, Sheri D.; Tuller, David M.; Frongillo, Edward A.; Senkungu, Jude; Nozmu, Mukiibi; Bangsberg, David R. (2010). Food insecurity as a barrier to sustained antiretroviral therapy adherence in uganda. PLoS ONE, 5(4). doi: 10.1371/journal.pone.00110340

The purpose of this research was to determine the mechanisms through which food insecurity leads to antiretroviral (ARV) therapy non-adherence. Before this study was conducted, scientists and clinicians had observed that food insecurity was correlated with ARV non-adherence, but nobody knew why. After interviewing 47 individuals about their experiences with ARVs and food insecurity, the information was analyzed and boiled down to five mechanisms through which the two conditions are connected. These are: 1) ARVs increased appetite, escalating hunger to unbearable levels in the absence of food; 2) adverse side effects of ARVs were worsened in the absence of food; 3) individuals were led to believe they should not take their medication or should skip doses when they could not meet the additional nutritional burden; 4) individuals had to balance the competing financial demands of food and medication, sometimes giving up one in exchange for the other; 5) in order to obtain food, individuals spent long days working in the fields and sometimes forgot doses, or were unable to take them.

This article is a valuable resource for my research because it explicitly outlines why it is important for HIV-positive individuals on ARVs to receive adequate nutrition. If there were no evidence to support the correlation between food insecurity and ARV non-adherence, there would be no reason for me to explore what barriers are preventing HIV-positive women from getting the food they need. Additionally, the mechanisms identified in this research give insight into what some of those barriers might be. For example, the adverse side effects caused by taking ARVs without food made it difficult for individuals to work for wages or to maintain their gardens. Finally, the methods used to collect and analyze data for this study were similar to those that I plan on using in the field. I hope to use their experience as a guide for developing my research methods.