Project Development

I just finished reading an incredible research article entitled "Food Insecurity as a Barrier to Sustained Antiretroviral Therapy Adherence in Uganda." I'm so glad I found it because I think it has given me a more substantive direction to carry my project idea. South Africa (SA) has a big problem with HIV/AIDS. I don't know how big because I haven't researched any statistics yet, but I know that there are a lot of clinics targeted specifically at HIV patients and that everything you read about SA talks about how big a problem it is. My original project idea was to compare the effectiveness of HIV programs that offer supplemental nutrition programs and those that do not, because I also know that nutrition is an important element of AIDS treatment and I happen to be very interested in the importance of nutrition as well as fascinated by infectious diseases. I thought it sounded like a good fit.

This article discusses how nutrition is not only beneficial to AIDS patients, but they lack thereof may be positively detrimental to their ability to maintain their ARV treatment. Through interviews with ARV patients, they found that there are five ways that food insecurity prevents patients from adhering to their ARV regimen:

1. ARVs increased appetite and made the patients hungrier than usual to the point of being unbearable
2. side effects of ARVs were much worse when taken on an empty stomach
3. patients had been told that they should skip doses if taken an hour or two after the scheduled time
4. there were competing demands between food coasts for their families and medical expenses that forced patients to have to sacrifice one for the other
5. it was hard for patients to maintain their scheduled ARV regimen while working in the fields to obtain food for themselves and their families

They found that often, these factors were more extreme in women than in men. In many cases, women felt obligated to make sure their husbands ate more than they did and to feed their children before themselves. Women were also more likely than men to report being widowed, which reduced their access to food. Many of the women interviewed were in their thirties and widowed with four or five children to feed. Additionally, "women who remained with their husbands or partners sometimes reported that fear of loss of access to food for themselves and their children constrained their freedom of action." I think that there is probably a whole cycle of factors that exacerbate each other and make the effects of AIDS much worse for women.

So now, instead of merely comparing programs that offer supplemental nutrition programs to those that do not, I think I want to compare how the programs that do offer nutritional supplementation actually affect the patient's ability to comply with their ARV regimen and their self efficacy in doing so. How having food affects the mother's ability to take her medications, which in turn will give her more energy to provide food for her family. I want to see if providing nutritional supplements, at least in the beginning, can help to break the downward cycle. I want to do more research to see if there are ways of teaching women how to garden that might be beneficial in providing them with access to food.

While I was reading that article, I came up with a list of 20 more questions. I'm going to follow up on some of these, so you'll probably be seeing some answer discussions in a few days.

1. What are the barriers to ARV treatment that SA face?
2. What is the history of ARV treatment in SA?
3. Through which programs/processes is ARV treatment offered in SA?
4. How many people in SA are food insecure?
5. What are the WHO guidelines for food assistance in HIV ADIS programming?
6. Which populations in SA are most likely to be food insecure?
7. What social factors affect food insecurity in SA?
8. How do people in SA access food? (subsistence farming, gardening, shopping, farming)
9. Are there any agricultural techniques that could easily be implemented to improve yield?
10. Are ARV patients in SA aware that they need to be eating a balanced diet?
11. What are the marriage demographics in SA? (lots of young widows?)
12. Is it true that patients shouldn’t take ARVs if they missed their scheduled dose time by an hour or two?
13. Do ARV patients in SA fear food insecurity to the point of therapy discontinuance?
14. How does having a supplemental nutrition program in addition to ARV therapy increase self-efficacy and ability to comply with ARV regimens?
15. Are there gender inequalities that lead to worse health outcomes for women in SA?
16. How serious of a problem is ARV drug resistance in SA and globally?
17. Does food insecurity affect the age at which patients begin ARV therapy?
18. What is the average ARV therapy timeline? (when do they start, how long do they live etc)
19. What food supplementation programs exist in South Africa?
20. How effective are programs like microfinance, home gardening and animal husbandry/crop production at increasing the ability of patients to avoid food insecurity?