Manuel Claros
“In my line of work, it is key for people to understand that you cannot talk about eliminating AIDS and providing universal treatment for the 35 million people living with HIV without thinking about their nutrition.”

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Organization: 1,000 Days (previously at World Food Programme)

Country: Italy

Area of Response to HIV: Nutrition and HIV, Multisectoral Response

Interview was originally published in the October 2014 newsletter.

Interview with Manuel Claros

Manuel Claros is a consultant at the World Food Programme who works in the areas of food security, nutrition, and HIV. A physician by training, he moved from Colombia to Washington, DC, to study public health, focusing on global health policy. He then began a career supporting the integration of food and nutrition into global and national responses to HIV and tuberculosis (TB). The HIV Policy and Advocacy Monitor spoke with Dr. Claros about the policy issues related to nutrition and HIV.

HIV Policy and Advocacy Monitor: Tell us about your work with the World Food Programme.

I work in the Nutrition and HIV/AIDS Unit in the Policy and Programme Innovation Division of the World Food Programme (WFP) in Rome, Italy. My main task, in collaboration with our office in Geneva, is to be the liaison for various interagency task teams (IATTs), working on a variety of HIV and nutrition issues. My unit also coordinates the generation and distribution of evidence to both staff and the broader global health community. Recently, I collected evidence on the role of nutrition in HIV treatment adherence as a guest editor for 10 published papers that were released as a supplement to the journal AIDS and Behavior.

My role as liaison involves close collaboration with colleagues at UNAIDS and the Global Fund in Geneva, sometimes providing technical assistance to countries through UNAIDS, or helping find opportunities to procure new funds or funds for reprogramming opportunities. For example, when the Kingdom of Lesotho planned a mid-term review of its national HIV and TB strategy in 2013, I spent nearly four months helping with the review, conducting a funding gap analysis, speaking with stakeholders, and making sure the strategy was ratified and accepted. As a result, the revised National Strategy Plan (NSP: 2011/12-2015/16) has been prioritized, is client-centered, and has integrated nutrition and food security activities in the national response until 2016.

HIV Policy and Advocacy Monitor: How did policy and advocacy become important to you?

It was a reinvention of myself. I went to medical school in Colombia and started working in a small rural town. I later moved to the United States to study for the medical board exams, but, after passing all the exams and learning about the U.S. health system, I realized it was not what I wanted.

My decision to focus on global health was a conscious one; I could use my time doing good not just for one person, but for a whole country. I have had the opportunity to contribute to the WFP's global policies on HIV and nutrition and to collaborate with other agencies to produce global guidance.

Some people don't understand my decision because when you work with patients there is a personal satisfaction from healing someone. The impact of advocacy and policy work with ministries can take months or years. It may be a slower process, but you reach more people. To me, it is more beneficial that way and has a larger impact.

HIV Policy and Advocacy Monitor: What are some of the political or social issues that affect HIV and nutrition concerns globally?

In my line of work, it is key for people to understand that you cannot talk about eliminating AIDS and providing universal treatment for the 35 million people living with HIV without thinking about their nutrition. Without food, people don't take their treatments because the related side effects are more severe, or because they use their money to purchase food instead of medicines. The viral resistance that results from non-adherence to treatment makes it more expensive to treat HIV. Evidence shows that individuals who were malnourished when they started HIV treatment were three times more likely to die from complications than those who were well nourished.

Many national strategies let the prioritization of nutrition fall through the cracks. People say food security is not a priority, and this is where advocacy comes in. People need to understand why food and treatment cannot be separated-that adherence to treatment has been shown to increase when people have good nutrition.

Currently, we are determining how the role of nutrition will be affected by new treatment guidelines. The WFP, Food and Agriculture Organization, and the International Fund for Agricultural Development are advocating for the inclusion of nutrition in the post-2015 agenda.

HIV Policy and Advocacy Monitor: What are the top three priority policy issues that need to be addressed to support HIV and nutrition in the response to HIV?

It all comes back to funding. The Global Fund's New Funding Model requires the integration of HIV and tuberculosis treatment and the prioritization of a client-centered approach that includes food and nutrition as critical enablers in the response. In this integration process, key stakeholders need to be present when national plans are being revised so that nutrition is not forgotten. I think this is one of the biggest issues: the integration of food and nutrition into the HIV response.

There are also political concerns, since WFP cannot go to a country and push for the inclusion of nutrition in national plans due to the conflict of interest. The strategy needs to be country-owned and not driven by outsiders, but people in-country need to be conscious of the importance of food and nutrition.

I would say that acknowledging access to treatment as a right is an issue in many countries, particularly when it comes to the inclusion of key populations. The strong presence of sex workers at this year's International AIDS Conference in Melbourne and the recent Lancet series on sex workers are examples of how things are changing-more people are being included as stakeholders, and those on the sidelines are taken into account and become part of the conversation.

More information on Manuel Claros' work with the World Food Programme's HIV/AIDS and Nutrition Unit can be found here: https://www.wfp.org/hiv-aids/hiv-and-nutrition

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