By Julian Meldrum

Subtitled 'A manual on nutritional care and support for people living with HIV/AIDS', this excellent online resource is a joint publication of two UN agencies, the WHO (World Health Organization) and FAO (Food and Agriculture Organization).

It is written for people who are directly involved in providing care for people living with HIV and AIDS and includes a series of handout sheets with practical advice on dealing with common problems relating to nutrition. There is also advice on the use of common herbs and traditional treatments, as well as discussion of macronutrients (energy, protein) and micronutrients (vitamins, minerals).

Specifically, the handouts cover: healthy and balanced nutrition; maintaining weight; food safety and hygiene; diarrhoea; loss of appetite; nausea and vomiting; having a sore mouth or throat; colds, coughs, sore throat and fever; looking after yourself in general; and some advice for carers on the need to look after themselves too.

The introduction stresses that the manual can be improved by adapting it to local circumstances, including dietary traditions and levels of access to treatment. It suggests ways this adaptation can be done, for example, through holding a workshop for professionals (such as health and agricultural extension workers) and people working in community organisations, including organisations of people with HIV where these exist, to consider the changes that are needed for local use, the product(s) that need to be developed and how they should be promoted. Checklists are provided to set an agenda for such processes.

The publication makes very little direct reference to medical treatment, since it has been written for use in many settings with widely varying levels of access to treatment. It has therefore been misrepresented by some as suggesting that nutritional intervention is an alternative to medical treatment or (worse) supporting the idea that AIDS in Africa is a crisis of malnutrition, which would disappear if people were adequately fed.

In fact, there is a clear statement in the manual that people living with HIV/AIDS have extra nutritional requirements, because of their illness. However, there is no special diet that can be guaranteed to keep people well. It is also clearly stated that the illness has a direct impact on people's nutritional status as it can limit people's appetite for food, even when supplies of food are adequate. The clear implication is that medical treatment is still required in addition to efforts by and help for individuals, families and communities affected by HIV and AIDS in meeting their nutritional needs.

The manual also observes that one of the aims of nutritional management is to maximise the benefit to individuals of medical treatment available to them. While the manual does not directly discuss the management of drug side effects, many of the recommendations in this manual are in fact practical ways to deal with such problems and the manual is a model of clarity in setting out how such advice should be presented.