Food and Nutrition as Prevention and Treatment
Karen Pearl, President and CEO of God’s Love We Deliver, a New York program that delivers 5,500 meals a day to people living with severe illnesses, presented an overview of research and policy surrounding food, nutrition and HIV. Noting that 34-71% of people living with HIV are food-insecure, Pearl explained that research has shown that food and nutrition meet the goals of the prevention, engagement and care cascade as well as the IHI Triple Aim to improve patient experience, improve the health of populations and reduce the per capita cost of health care.
People living with HIV who are food-insecure have lower CD4 counts and are less likely to have undetectable viral levels. They also use emergency room services more frequently, are more likely to miss appointments with their primary care providers and score lower on measures of health functioning. On the flip side, medical nutrition therapy is associated with more energy, fewer symptoms, weight gain, higher CD4 counts and greater quality of life. Food security and better nutrition also help with comorbidities such as cardiovascular disease, diabetes and kidney disease.
In the United States, up to one third of hospitalized patients have malnutrition, which can lead to longer hospital stays and higher costs. Citing results from a study of the MANNA program in Philadelphia, Pearl explained that health costs for patients who received food fell by 80% over three months. In-patient stays for MANNA clients were 37% shorter and hospital costs were 30% less. Rates of hospitalization decreased by 50% overall and MANNA clients were 20% more likely to be released to homes than to another facility.
Pearl concluded by noting that nutrition is an inexpensive intervention, since it’s possible to feed someone for six months for the same price as one day of hospitalization.
Food Security: Impact and Interventions
Spaces of care, spaces of risk: Mapping food as harm reduction
Christiana Miewald, Department of Geography, Simon Fraser University
People who use substances and who are also low-income have profound concerns when it comes to accessing nutritionally adequate, safe, appropriate foods that they can consume in safe, nurturing spaces. Geographical research has highlighted the ways in which low-income people construct routes, pathways and schedules through cities to access food. At the same time, understanding the geographies of food access that are constructed and experienced by low-income people living with HIV who use substances can play an important role in their health and well-being. The project, Food as harm reduction: Documenting the health effects of food provision for people who use drugs, addresses the following questions: 1) in what ways do low-income people living with HIV who use substances experience food insecurity and greater risk of disease; 2) what is the distribution of knowledge and practice around food provision among harm reduction providers in Greater Vancouver; and 3) what are the geographies (routes, pathways, barriers and schedules) that low-income people living with HIV who use substances construct and experience as they access food each day? The geography of food access influences the daily lives and overall health of people living with HIV who use substances including encounters with spaces of care and risk.
Capacity building around food as harm reduction
Grace Dalgarno, Dr. Peter AIDS Foundation
Food as harm reduction is a collaborative, community based research project between Simon Fraser University Geography Department and the Dr. Peter AIDS Foundation, funded by the Vancouver Foundation. Using a community-based research framework, the Food as Harm Reduction project explores the ways in which food provision can mitigate the physical, social and psychological harms associated with substance use. The project consisted of three parts: surveying 60 people living with HIV who use substances, half of whom use the Dr. Peter Centre and half of whom do not; mapping daily routines to learn about daily routes used to access food; and conducting qualitative interviews with harm reduction service providers. Slides describe the project and also address community involvement, lessons learned and recommendations.
Food is medicine: The Ryan White Food and Nutrition Services Program as a model for comprehensive food and nutrition services in the United States
Alissa Wassung, Director of Policy and Planning, God’s Love We Deliver
In a chapter recently published in The Health of HIV Infected People: Food, Nutrition and Lifestyle with Antiretroviral Drugs, researchers reviewed significant research on food programs and health outcomes, demonstrating how access to adequate food and nutrition services helps accomplish the Triple Aim of national healthcare reform for people living with HIV: better health outcomes, lower cost of care and improved patient satisfaction. Researchers examined the structure, funding and delivery methods for the Ryan White Food and Nutrition Services (FNS) Program, arguably the most robust FNS program in the country for people living with chronic illness, through the lens of improving health outcomes and implementing cost effectiveness. Co-authored case studies from six FNS providers around the country showcase the RW benefit in practice over the 30-year history of the providers and demonstrated how each agency has leveraged their core capacity to integrate with state-based health care reform efforts to expand coverage for people living with HIV and other populations. Analysis of the Ryan White FNS Program, in policy and practice, is then used to model how FNS, a relatively inexpensive benefit, could be incorporated into our nationwide health care delivery system to capitalize on the results evident in the outcomes of Ryan White for all people living with HIV as well as for people living with other chronic and severe illnesses.