HIV and Nutritional Knowledge
The outcomes for failing to meet the nutritional needs of a person infected with HIV
include decreased immunity and increased vulnerability to OIs leading to further
malnutrition. However, taking adequate nutritional diets offer the benefits of improving
antiretroviral absorption and tolerance in addition to increasing immunity (Maertens,
2011; Rajshree, Amatya, Pahari, Bam, and Newman, 2015). Therefore, receiving
appropriate nutrition is necessary for improving the quality of life for PLWHA (Anand,
Puri, & Mathew, 2012). Poor nutritional status among PLWHIV has the likely impact of
speeding disease progression, increasing morbidity, and reducing survival time (Hsu,
Pencharz, Macallan, & Tomkins, 2005). But, the most immediate need is iron deficiency;
usually managed through nutrition, transfusion or supplementation.
It is against this backdrop that the study sought to answer the fifth and last question, namely:
What knowledge level do individuals have regarding the value of locally available iron rich
foods as a HIV interventional strategy in Kisii Central Sub-County? To answer this question,
the study asked participants to respond to four items on the questionnaire that probed their
nutritional knowledge of locally available iron-rich foods. These were: (i)
which vegetable among Spinach, Sukuma wiki (kale), and spider flower is a rich source
of iron and locally available? (ii) Which Cereal among wheat, millet and Maize is a rich
source of iron suitable for HIV infected persons? (iii) What number of meals should a
person infected with HIV take per day? For the number of meals, participants were given
to choose from five alternatives: 1, 2, 3, 4, and more than 4; (iv) Are you aware that iron
rich foods can be used to correct iron deficiency in an individual who is infected with
HIV? Table displays the results of the analysis.
Table Knowledge of iron-rich locally available foods
Source Foods T/ Responses No. %
Spinach 194 54.8
Vegetables Sukuma wiki 354 64 18.1
Chinsaga 96 27.1
Wheat 110 32.3
Cereals Millet 341 191 56.0
Maize 40 11.7
1 11 3.0
2 71 19.6
No. of Meals 3 362 241 66.6
4 18 5.0
More than 4 21 5.8
Awareness Yes 356 50 14.0
No 306 86
Table 4.21 shows that the participants who answered the four questions ranged between
362 (98.9%) on the question of the appropriate number of meals per day and 341 (93.2%)
on the question of Cereal rich in iron. Others were 354 (96.7%) on iron-rich vegetable;
and 356 (97.3%) on the question whether participants were on a special diet.
For the question that asked participants to select a locally available iron-rich vegetable,
194 (54.8%) of the participants said that spinach was richest in iron while 96 (27.1%)
said it was spider flower and 64 (18.1%) said it was kales. But as for cereals, 191 (56%),
110 (32.3%), 40 (11.7%) participants said the richest in iron was millet, wheat and maize
respectively. Furthermore, for the number of meals, a majority (241 or 66.6%) said
person infected with HIV should eat three meals per day compared with 71 (19.6%),
21(5.8), 18(5%) and 11(3%) who said they need two, more than four, four-and one meal
per day respectively. Finally, only 50 (14%) participants reported being aware that iron
rich foods can be used to correct iron deficiency in people infected with HIV AIDS.
Despite, PLWHA having varied nutritional needs, the most urgent seems to be energy to
prevent wasting (Raiten, Mulligan, Papathakis, & Wanke, 2011) and iron to prevent one
becoming anaemic (Lutter, 2008). It is here that leafy greens can play a significant role.
There is no mistaking that leafy vegetables are an extremely good source of iron to make an
excellent addition to any diet. In addition, vegetables are a valuable addition to the diets of
nutritionally vulnerable individuals such as those infected with or affected by HIV/AIDS,
pregnant and nursing mothers, young children and the elderly. But, it becomes a bit
complicated whenever one is asked to determine the vegetable that is the healthiest.
When determining the vegetable that has the highest nutritional value, kale, spinach and
Gynandropis gynandra (Chinsaga) differ in their strengths. For example, Spinach has
nearly half as many calories per serving as kale, although none is unlikely to result in
weight gain. Leaves of Gynandropis gynandra are rich in vitamin A and C, β- carotene,
iron, calcium, magnesium, protein, and phosphorus which play an important role in
overcoming nutritional deficiencies (Agbo et al., 2014; Soro, Ocho-Anin AtchibrI,
Armand, & Christophe, 2012). Besides, the vegetable stimulates the restoration of blood
after delivery by increasing the number of red blood cells and the corpuscular
haemoglobin concentration by stimulating the synthesis of iron biomarkers such as
transferrin and ferritin (Bosire, 2014).
The higher fibre percentage in Gynandropis gynandra makes it a better choice for those
suffering from regular dietary issues as the evidence from available studies show a
decreased risk of colorectal cancer by consuming high amounts of fibre. As a source for
iron, Spinach and Gynandropis gynandra lead in their respective percentages per serving
size. But, while spinach’s nutritional content is strong, may not imply that Sukuma wiki
doesn’t have its own health advantages. The vegetable has slightly higher amounts of
protein and calcium —two nutrients also necessary for optimal health compared to
spinach. However, one annoying habit that is characteristic of spinach is that it shrinks on
cooking, unlike Kale and Gynandropis gynandra. Also, spinach is not commonly grown
in plenty as Kale and Gynandropis gynandra. In fact, many towns in Kenya depend on
Kisii County for the supply of Gynandropis gynandra for their dietary needs and hotel
business. Therefore, for Kisii County, Gynandropis gynandra is perhaps the only locally
available vegetable that can be used for the prevention of anaemia in PLWHA.
As for cereals, participants were asked to choose from among maize, millet and wheat, as to
which one is available locally and is an excellent source of iron. The tricky part for this
question was that it asked participants something they had no knowledge of. For instance, a
majority of the respondents know cereals as carbohydrates providing an excellent source of
energy and that they are the staple food consumed by a majority of the people living in SSA.
But, as for iron, many do not know whether cereals can be a source. The results of our
analysis show that the majority said that millet had the highest composition of iron. As
per research evidence, the amount of iron found in maize, millet, and wheat is 14%, 26%
and 24%; whereas calories are 368, 455 and 408 respectively.
Although this statement may be true on paper upon chemical analysis, nothing could be
further from the truth inside the body (in vivo). Accumulating research evidence suggests
that calcium plus iron and zinc, found in millets are poorly assimilated into the body
because of phytates, tannins and other Compounds that impede their assimilation (Suma
& Urooj, 2014). As a result, diets that contain mostly cereals often end up occasioning
multiple nutrient shortages including calcium, iron and zinc; whether millet derived or
not (Carrera-Bastos, Fontes-Villalba, O’KeefeLindeberg, & Cordain, 2011; Cordain,
1999). The implication is that maize rather than millet may be the better choice for some
cereal rich in iron, considering the absorption of the nutrient.
The other question that participants were asked to respond to was ‘how many times do
persons infected with HIV/AIDS need to eat?’ There are a number of reasons why this
question is important: (i) persons infected with HIV/AIDS require 10% more energy
compared with HIV negative persons (De Pee & Semba, 2010); (ii) persons infected with
HIV frequently require minerals that include iron, calcium and Zinc; and, (iii) persons
infected with HIV experience altered nutrient intake, mal-absorption, and metabolic
changes. Taking all these into account, and considering that HIV infected persons lack
appetite, it is important that one takes meals more frequently than the one taken by HIV
negative persons, plus more fruits and a balanced diet.
However, researchers lack an agreed eating plan specifically for people infected with
HIV, even when an overall nutritious diet can help improve their health. Living with the
virus is a sure way of weakening the body's immune system because the body uses up
nutrients to keep up its defences against germs. Consequently, eating well can help the
body fight off infections, by boosting the energy level, keeping one strong, helping avoid
health complications, and easing issues brought about by HIV and its treatments.
Poor nutrition and weight loss increase the risk of illness and even death for people
infected with HIV (Katona & Katona-Apte, 2008). Nutritional status may be
compromised by complications of the disease, as well as the medications used to treat it.
While a healthy diet is a good place to start, diet modifications may be necessary to
manage various aspects of the disease and in people whose HIV condition has progressed
to AIDS. It is important to note that there is no special diet or food that can cure or treat
HIV infection; but, the main aim is to keep the body’s defence system strong.
Due to the effects, the disease has on the immune system, HIV increases the body's
calorie needs. The disease also has a tendency of affecting the appetite and impairing
nutrient absorption. All these factors may make it difficult for one to get sufficiently
enough nutrients required to sustain the weight and the lean mass of their bodies. Regular
visits with a dietarian specializing in HIV, along with close monitoring of diet, are
recommended to help manage weight and the impact of the disease. Thus, a person
infected with HIV requires eating frequently and in small amounts. Therefore, more than
four may be a better choice.
Lastly, while testing the participant’s knowledge as to whether they were aware that
foods can be used to correct iron deficiency for HIV infected persons; 306 (86%)
responded to the negative, implying that many people are ignorant. They continue
suffering from a condition likely to be corrected easily using locally available foods—
probably, not as expensive as iron supplements. Research has shown that food can be
employed as a strategy to combat HIV/AIDS. Only that, it must start early before the
condition has progressed to a point where the disease interferes with nutrient
absorption.
So, what is the knowledge level of the participants? To be able to measure the
knowledge level, the study compared the participants who gave the right answer against
those who gave the wrong answer. Table summarises the number of participants who
gave the right answer to the four questions, and their percentage.
Table Participants Knowledge level
Question Right Answer
No (out of) %
Which vegetable is a rich source of Iron? 96 (354) 27.1
Which Cereal is a rich source of Iron? 40 (341) 11.7
Which number of meals is appropriate for a HIV-positive individual? 40 (362) 11.0
Awareness of whether food can be used to correct iron deficiency in HIV infected
persons 50 (356) 14.0
Table 4.22 shows that for the four questions asked, the percentage of the correct answer
scorers were 27.1, 11.7, 11.0 and 14.0; implying that those with correct knowledge
averaged at about 16%. Therefore, the knowledge level of individuals on locally
available foods that can be used as a strategy to treat HIV is low. A cross tabulation was
done between having testing for HIV and knowledge about locally available foods rich
in iron
as indicated in table 4:23. Have you ever tested for HIV * Which vegetable is a rich
source of iron?
Table Testing for HIV
Which vegetable is a rich source of iron
Variables Total
Spinach Sukuma wiki Chinsaga
Have ever tested for HIV
178 60 84 322
Percentage 50.4%
17.0% 23.8%
91.2%
Never tested for HIV
15 4 12 31
Percentage 4.2% 1.1% 3.4% 8.8%
Total
193 64 96 353
Percentage 54.7%
18.1% 27.2%
100.0%
Table indicates that there is no significant difference between those who had tested for
HIV and those who have never tested in terms of knowledge about vegetables rich in
iron. Further a chi-square test of independence was used to compare the frequency of
vegetables that ere a rich source of iron between those who have ever tested for HIV and
those who have never tested for HIV. Table Shows the results
Table Chi-Square Tests
Value
df Asymp. Sig. (2-sided)
2.415a2 .299
2.301 2 .316
1.445 1 .229
353
The Chi square results shown in table 4.24 indicate that the participants who ever tested
for HIV have insignificantly knowledge relating to locally available iron rich vegetables
— (χ2(2) = 2.415, p >0.05). In conclusion, the two groups considered, whether ever or
never tested for HIV, have cumulatively low knowledge. Similarly, across tabulation was
also done to determine the knowledge level of iron rich cereals among those who had
tested and not tested for HIV table 4.25 shows the results
Table HIV testing and cereals rich in iron
Which Cereal is a rich source of iron
Variables Wheat Millet Maize Total
Ever tested for HIV
101 172 38 311
Percentage 29.7% 50.6% 11.2% 91.5%
Never tested for HIV
8 19 2 29
Percentage 2.4% 5.6% 0.6% 8.5%
Total
109 191 40 340
32.1% 56.2% 11.8% 100.0%
The table shows that those who have tested for HIV have a good knowledge about cereals
rich in iron as compared to those who have not tested. Further a chi-square was done to
determine the goodness of the observed values and those expected theoretically as
indicated in the table 4.26Table 4. 26 Chi-Square Tests
Value Df Asymp. Sig. (2-sided)
1.329a2 .515
1.417 2 .492
.001 1 .972
340
A chi-square test of independence was used to compare the frequency of cereals that are
rich source of iron between those who have ever tested for HIV and those who have
never tested for HIV. Their knowledge was found to be insignificantly related— (χ2 (2)
= 1.329, p >0.05). This means that participant’s cumulatively knowledge is low whether
they have ever tested or never tested for HIV.
The study further sought to find out the number of meals that are sufficient to a PLWHA.
Table shows how participants responded to the issue.
