Nutrition guide for people with HIV
Food and HIV
HIV decreases the nutrition status of infected persons and increases their chances of getting ill. On the other hand, improved nutrition strengthens the immune system and can delay the progression of AIDS.
Eating a balanced diet and in the right amounts for one’s body size and condition of health helps to maintain good body weight and muscles. A good number of the symptoms of HIV can be managed with appropriate nutrition. For people with HIV, it is important to eat adequate nutritious food, to seek early treatment for infections, to exercise and to have plenty of rest.
Nutritious diet
Good nutrition includes a balance of food from the four food groups
1. Proteins
2. Carbohydrates (starch)
3. Fats and oils
4. Vitamins and minerals
No single food contains everything you need. A healthy meal is made up of at least one food item from each of the different food groups.

There are simple rules for making healthy meals:
If in one meal a particular food group is missing, make sure you do not skip that item in your next meal.
Vary the foods you eat. Foods have different properties. Eating different foods help you to cover your needs as well as possible.

Food rich in proteins
Proteins: They build the body and repair tissues.
Meat, chicken, liver, fish, flying ants (ishwa), caterpillars (madora), milk, cheese, eggs, beans, lentils, soya beans, ground nuts, peas, seeds and nuts are rich in proteins.

Food Rich in carbohydrates (starch):
Starch is energy giving.
Grains like maize, wheat, millet, and sorghum, rich and barley, potato, sweet potato, cassava, yam and legumes (beans and peas) are rich in carbohydrates. Food rich in carbohydrates is usually easy to digest. Aim to consume unrefined cereals as much as possible e.g. Brown rice, unpolished sadza, etc.

Food Rich in fat
Fats: fats give extra energy. Oil, butter and margarine are rich in fats. Fats are used in the preparation of your food. Fatty meat, chicken, fatty fish, peanut butter, nuts and seeds also have lots of fats. People with HIV need to limit the amount of fat they eat. Too much fat can cause diarrhea.

Food Rich in vitamins and minerals
Vitamins and Minerals: Food rich in vitamins and minerals are protective foods. The body needs vitamins and minerals in very small amounts. Each one has a special use in the body. Vegetables like cabbage, spinach, pumpkin, rape, tsunga, tomato, squash, green beans, peas avocado, pear, carrots and fruits like mango, orange, guava, banana, marula, mulberries, peach, pineapple, apple, paw-paw, plum, passion fruit and lemon provide the body with minerals. Each of the vegetables or fruits is rich in only a few vitamins and minerals so it is important to eat a variety.

Guideline for handling diarrhea
If the diarrhea is severe, the biggest danger is dehydration.
• Drink a lot of fluid to prevent dehydration, sugar – salt – solution, broth, diluted orange juice are good drinks to restore water and salt lost through diarrhea.

Home recipe for Sugar and Salt Solution:
Boil 1 liter of water
Add 6 teaspoons sugar
Add ½ teaspoon salt
Stir well, cool, drink as required

If the diarrhea lasts a long time the biggest danger is malnutrition.

• Eat soft, liquid foods that are easy to eat and swallow, like porridge and soup.
• Eat small meals, 5 or more times a day
• Eat food that is low in fat. Do not add cooking oil and margarine. Cut away the visible fat of meat or skin of chicken, boil food rather than fry.
• Eat refined foods like white rice, refined maize meal, white bread, pasta.
• Eat soft fruits and vegetables like banana, pawpaw, watermelon, pumpkin, squash, potatoes and carrots. These provide the necessary minerals and vitamins.
• If milk products cause stomach pain, avoid them.
• Prepare vegetable stew/soups. Note prepared soups from packets are not nutritious food.
• Prepare fresh food from fresh ingredients. Store prepared food at the right temperature. Poorly stored food can lead to food poisoning.
• Always reheat foods very well before eating.
• When you do not have diarrhea, whole grain products (straight run mealie meal, whole wheat bread, brown rice) are much better than refined products. The skin of the grain contains important vitamins. If you have diarrhea, avoid these foods and eat well refined foods.
• If the diarrhea is severe, eat porridge or soup in its own. If diarrhea reduces, and you have more appetite, eat the vegetable soups with rice or sadza.

Useful recipes for diarrhea
Rice and Carrot Soup
Rice, Carrots, salt, water
Chop carrots, boil rice and carrots in water cook slowly until the carrots are soft. Mash the carrots. Add a pinch of salt.

Pumpkin Stew
Pumpkin or butternut, beef
Boil beef with chopped pumpkin. Cook slowly until the beef and pumpkin is very soft.

Bean Broth
Beans, Salt
Boil the beans with more water than usual until they are well cooked. Drink the bean broth or use it to make other soups. Do not eat the beans.

Chicken and potato soup
Chicken, potatoes, carrots and salt
Cut potatoes and carrots into small pieces and boil with the chicken in water with slat,
Cook slowly until very soft.
Loss of Weight
HIV increases the body’s need for food and nutrients and weight loss is common. Weight loss is usually the result of inadequate food (loss of appetite, sore mouth, vomiting and depression)

• Diarrhea
• Infections

Weight gain
Regular exercise is important for healthy functioning of your body, it strengthens your muscles and this helps to strengthen your immunity. Exercise is the only way to build muscle, your body’s way to store protein. Exercise also increases you appetite and a sense of well being. Walking, jogging, swimming and dancing are good ways to exercise. Make an effort to find an exercise program that suits you, do you exercise with a friend to motivate each other. When you are sick you can do gentle stretching exercises in your bed. When you feel better, gradually increase the intensity and amount of exercise.

Recommendations for weight gain

• Eat small meals frequently
• Eat snacks between meals
• Consume well like foods

Useful recipes for weight gain

Mutakura
Use beans or peanuts, whole maize (magwere or chibage). Boil maize and beans until very soft.
Mash and serve with vegetables.

Nhopi
Pumpkin, peanut butter
Boil a cup of chopped pumpkin in water with salt for 30 minutes till very soft. Add a tablespoon of peanut butter and mash. Eat with or without sadza.

Bean porridge/rupiza
Cow beans (nyemba), peanut butter
Roast the beans and pound. Boil the pounded beans until soft. Add peanut butter and mix. Eat with boiled sweet potatoes.

Porridge of baobab fruits
Baobab fruits, water or milk, sugar
Break the fruits. Sieve to separate the powder from the seeds. Mix powder with water and boil on medium heat till the mixture thickens. Simmer for 20 minutes. Add sugar to taste.

Matamba/mazhanje porridge
Matamba or mazhanje fruits, mealie meal
Break the fruits and soak in water. Stir with a whisk. Sieve and boil the juice. Prepare porridge with the juice. Mazhanje porridge does not need sugar.

Marula/chakata jam
Marula chalkata fruits, peanut butter
Peal the skin and mash the fruits. Add 4 cups of mashed fruit to 1 cup of water and 2 tablespoons of peanut butter. Mix well and boil slowly for 15 minutes while stirring.

Mahewu
1 cup maize meal, 3 spoons chimera, sugar
Boil a cup of maize meal with 5 cups of water for 30 minutes. Leave to cool. Put in a clay pot or jug and add 5 cups of water and the chimera. Stir well and cover. Leave for a day or two. Add sugar if you like.

Peanut butter sauce
Onion, peanut butter, milk
Finely chop the onion and fry in some oil or margarine. Add 2 tablespoons or peanut butter.
Stir in milk until desired consistency. Add salt, pepper, ginger and garlic to taste. Eat with sadza or rice and vegetables.
Fermented food
Some medicines, like antibiotics and TB drugs, destroy bacteria. The harmful bacteria are killed, but also the good bacteria in our intestines that help absorbing food. Treatment with these medicines can cause diarrhea. To restore good bacteria in our intestines it is helpful to eat fermented food products. Eat the drinks/food listed below as a medicine, three cups a day before or with the meals as long as on antibiotic or TB treatment

• Mahewu
• Sour porridge
• Lacto or unsweetened yoghurt

Lack of appetite
Some hints that help increase appetite.

• Do not prepare food yourself or stay near the kitchen. The smell of food can put you off.
• Eating is a social event. Do not eat alone. Eat with family or friends.
• Eat only nutritious food. Cold drinks, Freezits and snacks like Corn Curls satisfy your appetite but do not provide you with the food you need.
• Drinking liquids is good, but do not drink just before or during meals as this will fill your stomach
• Sit straight up when eating. This removes pressure from your stomach. Do not lie down immediately after eating.
• Start with those foods you like best. Chicken, vegetables, soup, mahewu, sour porridge and fruits like banana are usually liked best
• Some medicines can cause a change of taste.
• Sour food tastes better like lemons and oranges.
• If you feel like vomiting, lemon juice in hot water and tea (without milk) can help. It also helps for a dry mouth. Do not eat fatty food.

Mouth Sores
Although eating is more difficult, the need for nutrients is higher because of the infection. It is important to adjust the food you eat in order to get enough food and prevent weight loss.

Guideline for mouth Sores
Avoid foods that irritate

• Spicy foods, chilies, curries
• Acid foods; oranges, pineapple, cold drinks
• Foods that need a lot of chewing
• Sticky foods, like white bread with peanut butter
• Very hot and very cold foods
• Avoid very sweet foods
• Drink high protein, high energy liquids with a straw.

Thrush (Candida)
This is a yeast infection. It is often a sign of poor resistance. It shows in the mount this white spots on the gums and the sides of the tongue and redness of the mouth. This is responsible for the pain with eating and swallowing. Thrush can also occur in the vagina or in the bowels. It causes poor absorption and weakness.
Garlic Helps for infection such as thrush and herpes.
Garlic can be used in the mouth (chew a clove), in the vagina (insert a peeled clove) or the bowel (swallow the clove). Use 3 times daily for treatment. Daily use of garlic may prevent infections.

Acknowledgements
This leaflet is a summary of the booklet ‘Living positively, nutrition guidelines for people with HIV/AIDS, by Marlou Bijlsma.