Nutrition Counselling

National AIDS Control Organisation

Objectives
At the end of this session, participants will be able to Explain the relationship between HIV and nutrition Assess and address issues related to nutritional status Identify appropriate nutrition actions to manage HIV-related symptoms Provide comprehensive nutrition counselling to clients

ACTIVITY 1
Group Exercise
Counselling on Weight Loss:

What to Eat when One is Losing Weight

Counselling on Food Preparation:

How Best to Prepare Food

Counselling on Ensuring Food Security:

How Best to Ensure that there is Sufficient Food

Counselling on Ensuring Food Safety:

How to Prepare Food Safely

Malnutrition and HIV: Vicious Cycle

Poor Nutrition

Increase d Nutrition al needs

HIV/ AIDS

Weakene d Immune System

Increased Vulnerabil ity to infection

Need of Nutritional Counselling at ICTC

HIV status usually known only when PLHIVs

present with OIs Food insecurity PLHIVs lack of awareness about increased nutritional needs PLHIVs may have symptoms leading to poor nutrition intake

Nutrition Counselling
Collect Client Information Dietary intake Presence of HIV-related symptoms/illnesses Methods of food preparation Food availability Sanitation & hygiene conditions.

Counselling on Dietary Intake What to Eat?

Diet should be diverse: Different food

groups Energy-giving food Body-building food Protective-food

Food Groups
Energy Giving Food
Body Building Foods

Protectiv e foods

A Guide for Daily Choices

Healthy Adult
Food Items 8-10 servings cereals 2 servings pulses 5 servings vegetables &fruits 2-3 servings milk products & meats One Serving Is 1 roti/1 bread slice/ katori rice 1 katori cooked dal Vegetable- 1 katori cooked vegetable Fruit- 1 medium-sized fruit 1 cup milk/ 1 katori curd 1 egg or 2 pieces of meat/chicken (approx 100g per piece)

Sparing use of sugar and oil

Changes suggested in Recommended Dietary Allowances

For Adult Male

Nutrients Energy( Kcal) Proteins (g) Fats (g) Normal 2400 60 20 2700 60 Not to exceed 40 PLHIV

Micronutrients Iron, vit. A, Also vit. E, 1RDA B1, B2, B3, selenium, B6, Folic acid magnesium & zinc & B12

Changes suggested in Recommended Dietary Allowances

For Adult Female Nutrients Normal Energy( Kcal) 2200 Proteins (g) 50 Fats (g) 20 Micronutrient Iron, vit. s A, B1, B2, 1RDA B3, B6, Folic acid & B12 PLHIV 2500 50 Not to exceed 40 Also vit. E, selenium, magnesium & zinc

Role of ICTC Counsellor

Ask to recall 24 hour menu Assess whether diet is diverse enough Assess whether clients diet is

nutritious Check whether client smokes/drink alcohol Help in modifying diet

Counselling on Managing HIVRelated Symptoms

Diarrhoe a Loss of Appetite Mouth Sores

Nausea and Vomitting

Anaemia Constipat ion

Diarrhoea

Loss of Appetite
Eat small, frequent meals Add flavour to food & drink. Eat nutritious snacks Drink plenty of liquids Take light exercise & do light activity Take walks before meals Having food with family/friends

Mouth Sores
Eat foods cold/at room temperature Eat soft & moist food such as porridge Avoid citrus fruits, spicy, sweet & sticky foods Avoid caffeine, alcohol & smoking Soften your food by soaking it in liquid Clean & rinse your mouth after each meal Drink fluids with a straw to ease swallowing

Nausea and Vomitting

Eat small, frequent meals Avoid an empty stomach Eat bland food Avoid food with strong/unpleasant

odours Drink plenty of liquids Avoid lying down immediately after eating Avoid coffee & alcohol

Constipation
Eat fibre-rich fruits, vegetables &

sprouted food Do light exercises Drink at least eight glasses of fluids a day Drink a cup of warm water in the morning

Anaemia
Eat organ meat, fish & eggs Eat cereals like ragi & bajra Eat variety of green leafy

vegetables with food rich in Vitamin C Eat jaggery & dates between meals

Counselling for Weight loss

What to Eat when One is Losing Weight
Rapid weight loss indicates a need

for nutrition care 10% loss of body weight or 6-7 kg in one month: Serious weight loss Important to regain the lost weight Educate client to start eating normally once infection is over

Counselling on Food Preparation

How Best to Prepare the Food
Enrich foods Add sprouted seeds Use Fermented foods Fortified foods Preserve nutrients during cooking Use spices Change the texture of food for sick people Reduce cooking time & fuel

Counselling on Ensuring Food Security: How Best to Ensure that there is Sufficient Food

Encourage clients to avail local nutrition

schemes Cultivate Easily-grown vegetables in home gardens Easily available & highly nutritious plants Small vegetables in a pot on a kitchen windowsill Rural areas: Hens for eggs Join a community garden

Counselling on Food Safety:

How to Prepare the Food Safely
Maintain clean surroundings Protect food from rodents, insects & animals. Wash hands thoroughly before & after cooking Use clean water for cooking Separate raw & cooked foods Wash all fresh fruits & vegetables thoroughly Cook food thoroughly but avoid over-cooking Eat cooked food immediately Store food carefully Avoid eating outside

Follow-up and Monitoring

Monitor growth of client Observe changes in nutritional status Identify reasons for poor progress
Inadequate intake Health-related problems Limited access to needed food

Help client & family to

Identify options to address problems Identify alternatives meal patterns Choose food items that are more affordable

Points to Remember
Encourage healthy actions client should

continue Discourage unhealthy/harmful actions client should discontinue Ignore actions that neither help nor harm health

ACTIVITY 2

Fish-Bowl on Nutrition Counselling

Practice by counsellors