3 nutrition booklet (english version) by Ma Hoang Hai

Eating Well To Stay Strong Healthy eating for people living with HIV

The Purpose of this Booklet This booklet is intended to answer the most commonly asked questions about food, nutrition and HIV infection. It outlines how to eat well if you are HIV-infected and the sort of foods you should eat to keep well if you experience changes in your body and diet while taking HIV related medications. Information on the sort of foods you need to eat to maximize absorption of HIV-related drugs is also included. It also gives you advice on how to manage common nutritional problems such as weight loss, fatigue, diarrhea, food-borne infections and others.

This booklet is published by Family Health International (FHI/Vietnam) with funding from the U.S. Presidentâ&#x20AC;&#x2122;s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID), under USAID Cooperation Agreement No. 486-A-00-06-00009-00.

Eating Well To Stay Strong Healthy eating for people living with HIV

Contents Section 1: Benefits of good nutrition and nutritional requirements for PLHIV

1. 2. 3. 4. 5. 6. 7. 8.

How does food help me to stay healthy? 7 What should I eat to stay healthy? 8 Do I need to eat more food than people who are not infected with HIV? 10 Are there any foods that I should avoid eating? 11 Do I need to eat special foods when I am sick? 12 Should I eat “fatty” and “sugary” foods to gain weight? 12 What foods will make my immune system stronger? 13 What can I do if I don’t have much money to buy good quality foods, like meats and fish? 13 9. Should I take vitamin and mineral supplements (Micronutrients)? 14 10. What are some signs that I should be worried about my nutrition? 14 Section 2: Nutritional care and support for pregnant women, breast feeding women, and children born to HIV infected mothers (up to age 3) 15 11. Are there any specific recommendations and nutritional requirements for HIV-infected pregnant women? 17 12. Should I take extra vitamins and minerals (micronutrients) if I am HIV infected and pregnant? 17 13. Are there any specific recommendations and nutritional requirements for HIV-infected women who are breast feeding? 18 14. Should I take extra vitamins and minerals (micronutrients) if I am HIV infected and breast feeding? 18 15. Are there any specific recommendations and nutritional requirements for young children born to HIV-infected mothers? 19 16. Are there any specific vitamin supplements for young children born to HIV-infected mothers? 22 Section 3: Management of HIV/AIDS related gastro-intestinal symptoms and weight loss 17. 18. 19. 20. 21. 22.

What can I do to prevent weight loss? What can I do to prevent muscle loss? What should I do if I don’t have any appetite? What foods should I eat to if I have diarrhea? I often feel nauseous and vomit after eating. How can I manage this problem? I often feel tired. What foods should I eat to prevent fatigue?

23 25 26 27 28 29 30

Section 4: Prevention of Food-Borne Illness: Food Safety and Hygiene 23. 24. 25. 26. 27. 28.

How can I prevent food-borne illness? What foods should I buy and how should I shop to avoid food borne illness? Can I eat at street vendors or in restaurants? How should I prepare and cook food to minimize food borne infection? Once food is cooked – how should I store it safely? Common questions about food and HIV

Section 5: Food restrictions, interactions and gastro-intestinal side effects from ART

31 33 34 34 35 36 36

29. 30. 31. 32.

Should I take my anti-retroviral medications with food or without food? 39 Is it good to take herbal and traditional medications when I have HIV? 40 Is it OK to drink alcohol when I am taking ARV medications? 41 I have HIV and have been diagnosed with TB and am taking tuberculosis (TB) medication – are there special foods I should take or avoid? 42 33. Is smoking bad for HIV and does smoking interact with any of the ARVs I am taking? 42 34. I have changes in my body shape after taking ARV drugs – what can I do? 43

Section 1 Benefits of good nutrition and nutritional requirements for PLHIV

How does food help me to stay healthy?

Good nutrition helps you stay strong and live longer Good nutrition makes your immune system stronger and helps to reduce illness and infection Good nutrition prevents body weight loss Good nutrition helps to slow progression of HIV to AIDS Good nutrition helps your body to absorb and use medicines, and can reduce the negative side effects that some medicines cause

good nutrition keeps the body strong 2

Good nutritional status • Weight gain • Muscle size maintained • Strong body

HIV/AIDS 3

Strengthened ability to fight HIV and other infections

Nutritional needs well met • Adequate food intake • Balanced diet

• Reduced vulnerability to infections • Slower progression to AIDS

What should I eat to stay healthy?

PLHIV do not require special or different food to people who are not infected with HIV but it is important for you to have a good healthy diet with a lot of variety. No single food will provide all the energy, protein, vitamins and minerals necessary to remain healthy and to prevent infections. Different foods offer different nutrients and have different roles in protecting health. It is good to try and eat different vegetables, fruits, legumes, and some protein at every meal. This does not need to cost a lot of money. HEALTHY AND BALANCED NUTRITION

A: Eat staple foods with every meal Staple foods include cereals (Rice, noodles, bread), starchy roots (potatoes, sweet potatoes, cassava) and starchy fruit (plantains). These foods are cheap, readily available and supply a good amount of energy. They should make up the largest part of any meal However staple foods are not enough to provide all the things that they body needs to stay healthy 8

B: Eat legumes every day if possible Legumes include beans, peas, lentils, nuts and soy products such as tofu. They provide the body with proteins needed to repair the body, make the body grow and build up strong muscles. They also have many vitamins and minerals to keep our immune system strong. C: Eat animal and milk products regularly Meat, poultry, fish, eggs and dairy products such as milk, yoghurt and cheese should be eaten as often as you can afford them. They supply proteins, vitamin and extra energy and help make the immune system strong. D: Eat fruit and vegetables every day Vegetables and fruit are very important. They supply the vitamins and minerals that keep the body and immune system strong. They help PLHIV fight infection. Eat a large variety of different fruits and vegetables as they all provide different vitamins and minerals. In general, it is a good idea to choose foods that are colorful and strive to make your plate full of colors! E: Fats, oils and sugars Fat and oil add flavor to food and stimulate the appetite. Fats and oils include butter, margarine, cooking oil and coconut cream. They are also found in avocados, nuts, meat, fish and cheese. Sugars and sugary foods include honey, jam, sugar, cakes and biscuits. They can be useful snacks and additives when trying to gain weight. It is important to remember that although fats and sugars are good sources of energy they are not rich in other nutrients. They should be eaten in addition to other foods and not in place of them, and in moderation. F: Drink at least 8 cups of clean, safe water per day Drink at least 8 cups of clean, safe water a day. When it is very hot or if you are sweating a lot, have a fever or diarrhea and vomiting it is important to drink even more fluids. Water should be boiled for 10 minutes and stored in a clean container (see section on food hygiene).

Do I need to eat more food than people who are not infected with HIV? Yes. PLHIV need to try to eat more food than people who are not infected, especially if they have opportunistic infections. The HIV infection uses a lot of energy in trying to fight the HIV infection and this increases your energy and nutrient requirements. It is very important that you eat more than you did before the infection to prevent weight loss. One of the consequences of HIV infection is that food is not always absorbed very well into the body and some of the good things from food can be lost. The presence of opportunistic infections and ARV therapies may also increase your need for more food. Thus the need for food (Calories and other nutrients) is higher. He amount of food will vary depending on the stage of the infection.

If you are not sick and have no symptoms, then you should try eat 10%-15% more food than when you were not infected. This is equivalent to one extra snack (e.g. fruit, nuts, yoghurt, sticky rice, noodles) per day.

He has lost weight and looks sick

Same person

He is healthier

If you are facing a lot of illnesses and recurrent infections, it is very important that you eat as much as 20%-30% more than you normally did when you were not infected. This is equivalent to two to three extra snacks per day. Your body needs extra energy to adequately fight against infection. Symptomatic HIV-infected children who are loosing weight or failing to gain weight need 50-100% more than they would usually eat. This can be achieved by consuming extra ‘balanced’ meals consisting of a staple such as rice plus protein (meat, egg, tofu) and fruit/vegetables plus additional frequent snacks.

Many people are not hungry when they are sick. But it is a mistake to think that just because you are not hungry and not doing much that you don’t need energy and can stop eating. In fact, when you are sick your body is working extra hard to fight infection and needs extra food.

Are there any foods that I should avoid eating?

PLHIV are more vulnerable to infection because their immune system may be weakened. It is very important to avoid foods that can result in infection caused by bacteria or viruses in contaminated food and water. The foods that you need to avoid eating are:

Raw or uncooked foods. Do not eat any meat or fish that is pink or has red juice. Do not eat soft-boiled eggs, raw eggs or foods that contain raw eggs. Do not eat any fruits or vegetables that are bruised or have bacteria growing on it. Do not eat any foods that are spoiled or milk or packaged foods that are past the expiry date.

Also, it is better to limit alcohol and if you smoke, you should ask for help to quit from your home-based care team since these two behaviors can reduce the strength of your immune system and may increase the frequency of opportunistic infections.

Do I need to eat special foods when I am sick?

When you are sick you may not have any appetite and you may even feel too tired to eat and drink. This is very common and it is also a reason why sick people often loose weight. When your body is sick it needs additional energy to fight against the infection in order to repair itself. If the body’s requirement for energy is not met, the body will break down fat and muscular tissue, leading to weight loss. This is a reason why you are sick you should try to:

Continue to eat a healthy meal that has a lot of variety Drink lots of fluids to avoid dehydration Increase the frequency of meals and snacks so that you can provide your body with a continuous source of energy Eat foods that are protective against infection such as fruits and vegetables.

Should I eat “fatty” and “sugary” foods to gain weight? Yes. Fats, oils and sugars are good sources of energy and are important for maintaining weight or regaining weight loss. Fat adds flavor to food and stimulate the appetite. Fats and oils include butter, margarine, cooking oil and coconut cream. They are also found in nuts, meat, fish, eggs, avocados, and cheese. Some forms of fat are healthier than others. Healthier fat are found in nuts, fish, eggs, soybean, vegetable oils and avocados. Sugars and sugary good include honey, jam, sugar, cakes and biscuits. They can be useful snacks and additives when trying to gain weight. It is important to remember that although fats and sugars are good sources of energy they are not rich in other nutrients. Too much fats and sugars can be harmful. They should be eaten in addition to other foods and not in place of them. 12

What foods will make my immune system stronger? A healthy and strong immune system protects and defends your body from “attacks” by bacteria, viruses and fungi that cause infection as well as chronic diseases such as cancers. Foods that are rich in vitamins and minerals are called protective foods because they build up the body’s resistance to infection and sickness. The foods considered protective include dark, grey, leafy vegetables (pumpkin leaves, morning glory, kale, cabbage, potato leaves, tomatoes) and yellow, red, and orange fruits (papaya, pumpkin, orange, lemons, bananas, avocado).

What can I do if I don’t have much money to buy good quality foods, like meats and fish? In Vietnam, people often tend to equate “good quality” with “expensive”. You may also think good quality means meat, fish, seafood. However, good quality food does not have to be expensive and it does not mean meat only. In Vietnam, there are plenty of fresh fruits and vegetables that are very good for your body and do not cost very much. If meat and fish are too expensive, you can get protein from tofu, eggs, lentils and nuts. Package food is often more expensive than fresh food but can be less healthy. Save your money for foods which are fresh and healthy! Make sure you always try to get enough to eat each day.

Should I take vitamin and mineral supplements (Micronutrients)? Recommendations for vitamin and mineral supplements are different for pregnant and lactating women and for young children. Please see the next section for recommendations for pregnant and lactating women and young children. If you are an adult and still very healthy and able to consume a healthy and good quality diet, one with plenty of vegetables and fruits, there is no need to take a multimicronutrient supplement. It is best to try and get all of your vitamins and minerals through food rather than through taking a pill. However, if you are quite unwell and facing many nutritional problems including lack of appetite and weight loss, and you think you need a micronutrient supplement, it is best to ask your doctor for guidance. Micronutrient supplements can be useful but should not replace eating a balanced and healthy diet.

What are some signs that I should be worried about my nutrition?

If you have lost weight without planning to â&#x20AC;&#x201C; either quickly over a short period of time or more slowly over several months (the CHBC team or doctor will always check your weight) HIV infected or exposed children that are not gaining weight or are If you are worried about loosing weight need to be seen the weight or nutrition of urgently at the HIV clinic yourself or your children Chronic diarrhea (Diarrhea please tell the HBC teams or your HIV doctor. They will that lasts more than two weeks measure you and monitor this is considered as persistent or and decide whether you may chronic diarrhea) need additional assistance Nausea or vomiting with food and nutrition Abdominal pain Dental problems Oral thrush Recurrent illnesses or infections If you often donâ&#x20AC;&#x2122;t feel like eating If it hurts to eat or swallow

Section 2 Nutritional care and support for pregnant women, breast feeding women, and children born to HIV infected mothers (up to age 3)

Are there any specific recommendations and nutritional requirements for HIV-infected pregnant women? HIV-infected pregnant women require additional energy due to HIV infection and also additional energy for the healthy growth of the baby. The amount of extra energy needed depends on the stage of the HIV disease. It is recommended that a pregnant woman needs 10% more energy from food (one extra snack per day) if she is well and has no symptoms, 20% more energy from food (two extra snacks per day) in the early stages of HIV infection and up to 30% more energy from food (three extra snacks per day) if she is unwell from her HIV.

Should I take extra vitamins and minerals (micronutrients) if I am HIV infected and pregnant? For all pregnant women (regardless of HIV status) it is recommended:

Iron-folate supplements should be taken to prevent anemia. These will be given to you by the midwives at the antenatal clinic or the HIV OPC. Other multi-vitamin and mineral supplements may be needed may be needed during pregnancy if adequate nutrient intake cannot be achieved through an adequate diet and if prescribed by a doctor. Always check which micronutrient and vitamin supplements you should be taking if you are pregnant and HIV infected woman with your doctor at the outpatient clinic or the ante-natal clinic.

Are there any specific recommendations and nutritional requirements for HIV-infected women who are breast feeding? HIV-infected breast feeding women require additional energy due to HIV infection and also additional energy for the production of breast milk. The amount of extra energy needed depends on the stage of the HIV disease. It is recommended that a breastfeeding women needs 10% more energy from food (one extra snack per day) when they are well and asymptomatic, 20% more energy from food (two extra snacks per day) in the early stages of HIV infection and up to 30% more energy from food (three extra snacks per day) when they are unwell.

Should I take extra vitamins and minerals (micronutrients) if I am HIV infected and breast feeding? For all breast feeding women (regardless of HIV status) it is recommended:

Breast feeding women should eat a variety of fresh fruits and vegetables, and foods from animal origins to meet their micronutrient requirements. That you continue to take iron-folate supplement for an additional 3 months after delivering the baby. This will be provided by the HIV OPC. Check what other vitamin and mineral supplements you should be taking if you are breast feeding and HIV infected with your doctor at the HIV OPC.

Are there any specific recommendations and nutritional requirements for young children born to HIV-infected mothers? Children born to HIV-infected mothers need a lot of special nutritional care and support as they are at great risk for malnutrition. Low birth weight, malnutrition and poor growth are common among children born to HIV-infected mothers. To prevent malnutrition, nutritional care and support is very important.

15 a) HIV exposed infants 0-6 months:

A woman who is HIV infected needs extensive counseling and support to choose the most appropriate form of feeding for her baby. If the mother decides on replacement feeding for her baby, it is very important that the infant only receive replacement feeding. Careful counseling, preparation and ongoing support are required to ensure that formula feeding is feasible, safe and affordable for the woman. It is very important to ensure that proper hygiene is maintained. The woman should NEVER breast feed if the infant is taking replacement feeding (even to quieten it down if crying or to get the baby to sleep).

If the mother decides on breastfeeding for her baby, exclusive breastfeeding should be given to the baby. This means that the infant is not given any supplemental liquids or foods (such as water, formula or any other powdered or animal milk). At six months, the mother should transition COMPLETELY to replacement feeding. HIV-infected mothers should be counseled NEVER to mix feeding methods – if she decides to breast feed she should not use any replacement feeds or complimentary food. If she decides to formula feed she should never breast feed Replacement feeding should be chosen only if all the following conditions for HIV-infected mothers are met:

• Acceptable: No social or cultural barriers to replacement feeding or mother can handle them. • Feasible: Mother (caregiver) has adequate time, knowledge, skills, etc. to prepare up to 12 feeds in 24 hours. • Affordable: Mother (caregiver) can afford all ingredients, fuel, clean water, soap, etc. • Sustainable: Continuous, dependable supply of all ingredients can be ensured for as long as the infant needs. • Safe: Replacement feeds are accurately and hygienically prepared and stored.

15b) HIV exposed children aged 7-36 months When a child reaches 6 months, breast milk or replacement feeding alone is not enough to provide all the energy, protein, and micronutrients needed for a growing child’s nutritional needs. At six months, the child should begin to receive semi-solid and solid foods in addition to replacement milk.

During these months, children require supplemental foods with lots of nutrients. To ensure that the young child is getting enough nutrients, it is recommended to feed the child a wide variety of foods and to include a lot of fruits and vegetables. Feed mashed vegetables and fruits to the child. In the rice-porridge, add small portions of boneless fish, ground meat, cooked egg. For young children, if available and affordable for the family, complementary foods that are fortified with multiple-micronutrients may help deliver the calories and nutrients that a child needs.

It is very important to prevent the child from getting an infection as this may lead to malnutrition and prevent growth. To prevent infection, be sure that all persons preparing food for the child practice good hygiene and proper foods safety and handling (see section 4). An HIV exposed baby can have an HIV test any time up to 18 months depending on what test are available in your hospital. If the HIV-infected child becomes sick with any illness in the first few years of life â&#x20AC;&#x201C; refer them to the under 5 or the HIV clinic for assessment. If your child is quite sick with HIV and is loosing weight or not gaining weight they may need 50 -100% extra food to what they would usually eat (see question 3)

Are there any specific vitamin supplements for young children born to HIV-infected mothers? For all children whether they are HIV infected or not, it is recommended to:

Ensure infant has received all the vaccinations required in the National Vaccination Program The HIV OPC will provide your child with Iron-Folate supplements The Under 5 program at the commune or district health center will provide vitamin A supplement Always check with vitamin supplements a child should be on by asking the doctor at the HIV OPC Provide children with lots of foods from animal sources and lots of fruits and vegetables

Section 3 Management of HIV/AIDS related gastro-intestinal symptoms and weight loss

What can I do to prevent weight loss?

Weight loss is very common for PLHIV. There are many things that can cause weight loss, the most common being loss of appetite. Other causes include:

Infections or illnesses which make the body burn up more energy and nutrients HIV infection causing nutrients to not be properly absorbed by the body Diarrhea Side-effects of therapeutic medications Difficulties in buying or preparing food

Weight loss is dangerous and must be prevented because it can lead to increased risk for opportunistic infections and poor health. Loss of weight can be an important warning sign of the presence of an infection even there are no other symptoms. To prevent weight loss, it is important to try to eat larger portions at meal times and to eat several times a day. Try to take at least 2 snacks during the day and 3 major meals (breakfast, lunch and dinner).

Even small amounts of weight loss are important in people with HIV. It is very important to consistently monitor weight at the HIV outpatient clinic

Tips:

Try to vary the type of food at each snack-for example boiled egg, nuts, corn, banana Make sure the snacks are nutritiousâ&#x20AC;&#x201D;for example, fruits and nuts make great and easy snacks!

What can I do to prevent muscle loss?

The best thing to prevent muscle loss is to make sure that you get enough energy from food. When you donâ&#x20AC;&#x2122;t supply enough energy from food, your body takes energy by breaking down muscles. This can make you feel weak and make it difficult to be mobile. To prevent muscle loss:

Increase food intake by increasing quantity of food and frequency of consumption Make sure you eat at least 3 meals a day and 2 snacks. Increase protein in your diet from foods such as eggs, fish, tofu, beef, nuts, seafood, chicken, and milk. Remember, protein is important for growth and helps build muscle. Exercise is crucial to maintaining weight and strength. Try to do regular exercises to build your health status if your health allows you to.

Although protein is an important part of a daily meal, it is not MORE important than fruits and vegetables. Some people mistakenly believe that if they eat just rice and meat that they are getting a good quality diet because meats are more expensive than vegetables or fruits. To stay healthy you need to have a diet that has a lot of variety with in vegetables and fruits. Remember, strive for a meal that has plenty of color.

What should I do if I donâ&#x20AC;&#x2122;t have any appetite?

When you are not hungry, the best way to regain your appetite is to eat. With illness or medication you may lose your appetite or find the taste and texture of foods change; this happens often with illness. To build your appetite, try the following:

Try to stimulate appetite by eating favorite foods Eat small amounts of foods more often, eat frequent snacks Try different foods until you find one you like Exercise to stimulate the appetite. Take light exercise before meals, such as taking a walk outdoors or doing some housework.

What foods should I eat to if I have diarrhea?

Diarrhea is very common amongst PLHIV, particularly those with low CD4 counts and on anti-retroviral therapy. Diarrhea can be very uncomfortable and dangerous for PLHIV especially if it lasts for several days and results in weight loss and dehydration. You should go to the HIV OPC if you have diarrhea for more than 2 days or you are becoming weak. Your doctor at the OPC can give you some medication to treat diarrhea and help the symptoms If you are suffering from diarrhea, it is important to drink plenty of fluids and to continue to eat. Stopping eating and drinking does not help diarrhea â&#x20AC;&#x201C; in fact it can make it worse. If you have diarrhea it may be helped by the following:

Important! Go to health center if you have severe

Drink lots of fluids (soups, fruit symptoms: shakes, boiled water, and light low or no urine output herbal teas) to avoid dehydration high fever Mix up ORS and drink frequently bloody stools (your OPC and HBC team has ORS weight loss that they can give you) fainting Eat foods rich in soluble fiber such severe abdominal pain as bananas, apples, sweet potatoes to help retain fluids Eat easily digestible foods such as rice porridge, bread and crackers Eat eggs, fish and chicken for protein Boil or steam foods

Avoid or reduce intake of:

Strong citrus fruits (orange, lemon) because they may irritate the stomach Caffeine and alcohol Fatty and oily foods including fried foods Sugary food Gas-forming food such as cabbage, beans, onions, sodas

I often feel nauseous and vomit after eating. How can I manage this problem?

Nausea is worse if nothing is in the stomach. Avoid an empty stomach by eating small and frequent meals Eat bland low-fat foods such as rice soup, and fruits such as bananas and sweet potatoes Eat lightly salted and dry foods such as plain rice and rice porridge to calm the stomach Eat slowly Avoid spicy and fatty foods Avoid lying down Avoid caffeine and alcohol immediately after eating. Avoid foods such as: Wait at least 20 minutes to avoid vomiting

Fatty, greasy or fried foods Very sweet foods Foods with strong odors Hot temperature foods

I often feel tired. What foods should I eat to prevent fatigue? Fatigue is due to lack of energy, exhaustion, and prolonged tiredness. It is very common in PLHIV. Try these ways to manage the symptoms and improve your energy levels:

Eat every 1-2 hours to get enough food so you have more energy! You may find it helpful to set an alarm clock to remind yourself to eat something. Keep food beside you all day, so that you can snack. Try fruits, dried fruits and snacks Hard-boiled eggs are good energy source Limit caffeine as this can sometimes increase fatigue once the caffeine wears off Moderate exercise boosts energy level and also increases appetite. Try to get some exercise everyday. Try to walk, do some â&#x20AC;&#x153;tai chiâ&#x20AC;? or other stretching exercises Get enough sleep and relaxation.

Section 4 Prevention of Food-Borne Illness: Food Safety and Hygiene

Food and water can carry germs that cause illness. Germs in food and water may cause serious infections in people with HIV. You can protect yourself from many infections by preparing food and drinks properly. Germs in food and water (food poisoning) can make someone with HIV extremely ill as the immune system may not be strong enough to fight them off. These germs can cause an upset stomach, severe vomiting and diarrhea, stomach cramps, fever, headache, muscle pains and make you very sick indeed The diarrhea and nausea can be much worse and more difficult to treat in people with HIV. People with HIV also have a harder and longer time recovering fully from these illnesses.

How can I prevent food-borne illness?

In order to prevent opportunistic infections from food it is important to practice food safety and hygiene. Bacteria or viruses can be passed to you from food that is undercooked or handled improperly. Symptoms of food poisoning include fever, nausea, vomiting, cramping, and diarrhea. The following guidelines can help you protect yourself from food poisoning when you are choosing food in the market, preparing and storing food.

What foods should I buy and how should I shop to avoid food borne illness?

Choose foods with plenty of color, strive for variety in your meals: Select foods that give energy (rice, noodles, bread), growth (animal foods, nuts, tofu), and immunity (fruits and vegetables). When shopping, stay away from live animals in the market. Animals carry many diseases so it better not to be near them. When selecting meats, make sure that blood from uncooked meat is carefully contained in plastic bags. Check to make sure that there are no holes in the bag and that no blood drips out of the bags. Take care to ensure that no blood drips on other foods, especially fresh fruits and vegetables. Separate raw meats from fresh fruits and vegetables at all times. After shopping, put all raw meats and fish in the refrigerator as soon as possible. If you do not have a refrigerator, cook and eat the food immediately after returning home from the market. Make sure you wash your hands well after going to the market, or after handling meat.

Can I eat at street vendors or in restaurants?

Yes, it is fine but you must be very careful choosing and ordering foods.

Eat from stalls and restaurants with a good reputation for good hygiene Order all foods well done.

Only eat foods that are cooked and prepared hot. Do not eat foods that have been sitting around. If meat is served pink or bloody, send it back and ask for more cooking. Do not eat raw or uncooked foods in the market or by street vendors as the water that they use may not be safe and clean. Do not order any raw or slightly steamed fish or shellfish, such as oysters, clams, mussels. All fish should be cooked until well done. When eating on the streets or in restaurants, ask for “no ice” in drinks.

How should I prepare and cook food to minimize food borne infection?

Wash hands repeatedly with warm, soapy water before and after preparing and eating food! After handling raw meat, poultry, and fish wash your hands well with soap and water before you touch any other food. Cover any open wounds or sores when handling and preparing foods to prevent contamination. Clean any cutting surfaces, cutting boards and knives that touch chicken and meat with soap and HOT water before any other food touches them. Rinse all fresh fruits and vegetables with boiled, safe, clean water. Because of heavy pesticides in Vietnam, it is best to peel the skin off fruits and vegetables. Make sure that fresh fruit, vegetable and well-cooked food are kept separately from raw food such as un-cook meat, fish or seafood… Use seperate chopping-boards or different chopping surfaces for preparing cooked food and raw food Cook all meats, fish and especially chicken and pork well done. Do not eat raw or soft-boiled eggs. Boil all drinking water. Do not eat any raw meat, fish, or seafood.

Once food is cooked â&#x20AC;&#x201C; how should I store it safely?

Refrigerate any leftovers immediately. Do not leave food out in the kitchen or table. Make sure that uncooked food is kept separate from cooked food in the refrigerator. Use clean dishes and utensils to store food. Cover and store food in containers to avoid contamination. Do not eat leftovers that have been in the refrigerator for more than 2 days. Completely reheat leftovers before eating.

Common questions about food and HIV

Can I eat eggs if I have HIV? Yes. Eggs are safe and nutritious to eat if they are well cooked. Cook eggs until the yolk and white are solid, not runny. Even when making fried eggs, make sure to cook the eggs on both sides so that the yolk is completely cooked. Be careful of soups that have an egg cracked inside as the egg may not be cooked thoroughly.

Can I eat raw fruits and vegetables? Yes. Raw fruits and vegetables are safe and have plenty of vitamins and minerals to eat if you wash them carefully first. Wash then peel fruit that you will eat raw. Eating raw alfalfa sprouts and other herbs can cause illness, but washing them well can reduce your risk of illness.

Section 5 Food restrictions, interactions and gastro-intestinal side effects from ART

Should I take my anti-retroviral medications with food or without food? Some ARV drugs need to be taken with food as this helps the medication be absorbed into the stomach. Other ARV drugs need to be taken on an empty stomach. You should always ask your doctor about how to take ARV drugs – with or without food. In this section, we will list common ARV drugs taken by PLHIV in Vietnam, whether they should be taken with or without food, foods to avoid and possible gastrointestinal side effects from the ARV medications. See section 3 for management of these side effects.

Medication

Food restrictions

Possible gastro-intestinal side effects Usually well tolerated but occasionally can cause nausea and vomiting, diarrhea, loss of appetite.

Abacavir (ABC)