Malnutrition among young children remains high in sub-Saharan Africa where poverty and the HIV epidemic synergistically undermine progress in child health that has been obtained in other regions of the world. HIV may indirectly influence children's nutritional and health status by altering household food security, caregiving practices (such as, breastfeeding), and health-seeking practices. The knowledge gap concerning these mechanisms limits the ability of health professionals to effectively develop and promote services and practical and sustainable recommendations that will support child health, growth, and survival in communities affected with the HIV epidemic. This grant incorporates training and research activities in the area of nutrition and HIV in Ghana. Our long-range goal is to enhance the institutional capacity to provide local training and research opportunities that will lead to policy recommendations and program development for the improvement of the lives of individuals living in communities affected by HIV. The main objectives are: 1) to provide postgraduate training in maternal and child nutrition within the context of HIV through formal US academic programs and intensive short courses in Ghana, and 2) to conduct a pilot study on the mechanisms by which HIV infection indirectly influences child health. The central hypothesis is that the presence of HIV infection in the household increases the risk of childhood malnutrition and mortality through increased food insecurity, decreased time for caregiving practices, and modified expectations of normal child health and well-being. Extensive social networks may mitigate this effect by offering alternative resources to children. The central hypothesis will be tested with 302 women and their newborns who will be followed for one year to collect data on feeding, health, growth, household demographic and socioeconomic characteristics, and family's use of social networks. All women will have used a voluntary testing center for HIV; half of the enrolled mothers will be positive for HIV and the other half will be negative. Statistical analyses will provide an estimate of the effect of HIV on outcomes of infants who are infected and not infected with the virus. These results will provide the knowledge needed to develop appropriate, effective programs and recommendations that will improve child health.
