Statistical Office [CSO] et al. 2003) to 14.3% in 2007 (CSO et al. 2009). Over
900,000 Zambians are living with HIV, and over 280,000 are receiving
antiretroviral therapy (ART) which allows them to live longer and healthier lives
(Ministry of Health [MOH] and National HIV/AIDS/STI/TB Council [NAC] 2010).
More females (16.1%) than males (12.3%) are HIV positive, likely because of
biological, economic, and social factors (Ibid.). Urban areas have a higher
prevalence (20%) than rural areas (10%) (CSO et al. 2009). Approximately
16.4% of pregnant women are HIV positive (MOH 2010 draft), and an estimated
10% of HIV transmission is from mothers to children during pregnancy, birth, or
breastfeeding (MOH and NAC 2010). In 2009, the country had an estimated
690,000 orphans as a result of AIDS (Joint United Nations Programme on
HIV/AIDS [UNAIDS] 2009). HIV and AIDS have had a negative impact on health
indicators. The 2007 Zambia Demographic and Health Survey (ZDHS) reported
that life expectancy at birth for males dropped from 50.4 years in 1980 to 48.0
years in 2000, although for females the drop was smaller, from 52.5 in 1980 to
52.0 in 2000 (CSO et al. 2009). HIV and AIDS have also increased the disease
burden and increased pressure on the health care system.
The 2007 ZDHS reported that 45% of children 0–59 months old who were
surveyed were stunted (low height for age) in 2006, compared with 47% in
2002; 5% were wasted (low weight for height), compared with the same
percentage in 2002; and 15% were underweight (low weight for age), compared
with 28% in 2002. The 2009 National Nutrition Surveillance Report conducted in
32 districts by the National Food and Nutrition Commission (NFNC) found
global stunting in 54% of boys 6–59 months old and in 44.6% of girls 6–59
months old. The 2007 ZDHS also reported malnutrition (in these guidelines,
“malnutrition” refers to inadequate intake or under-nutrition) in 9.6% of women
of childbearing age surveyed (CSO et al. 2009).
The 2009 National Nutrition
Surveillance Report found 11% of women 15–19 years old in rural areas and
7% in urban areas were underweight and 20% of women in urban areas and
12% in rural areas were overweight.
Research conducted in 2007 by the Centres for Infectious Disease Research in
Zambia (CIDRZ), the World Food Programme (WFP), and the U.S. Centers for
Disease Control and Prevention (CDC) found that malnutrition among people
living with HIV (PLHIV) was much higher than in the general population. Of
adults starting antiretroviral drugs (ARVs), 33.5% were moderatelymalnourished, with a body mass index (BMI) between 16.0 kg/m2 and 18.5kg/m2, and 13.5% were severely malnourished, with a BMI < 16 kg/m2, as
shown in figure 1 (Lusaka District Health Management Team [LUDHMT] and
CIDRZ 2007). The same studies found that 44% of HIV-positive children were
Nutrition Guidelines for Care and Support of People Living with HIV and AIDS
underweight, with < –2 weight for age z-score (figure 2), compared with 15% in
the general population (CSO et al. 2009).