Background: South Sudan ranks among top 30 countries in the world which account for 89% of new HIV infections. Households of People living with HIV (PLHIV) are among those most affected by the persistent conflict, displacements, poverty, food insecurity and malnutrition in the country. The United Nations World Food Programme (WFP) supports a nationwide institutional feeding programme (IFP) for PLHIV but there was no reliable information on their food security and nutrition situation. The vulnerability assessment was conducted to provide reliable national data on food security and nutrition among households affected by HIV in order to inform appropriate responses.
Methods: Qualitative and quantitative data was collected from 933 households of PLHIV (aged 15 years and above) in 7 of the 10 former states of South Sudan, using a two stage cluster sampling method. The Consolidated Approach to Reporting Indicators for food security (CARI) was used to measure the degree of food insecurity. The nutrition status of 942 PLHIV was assessed using Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC).
Results: Majority of the household heads (77.2%) were PLHIV, 45% were headed by women and 41% households were food insecure. A significant proportion of households (60%) relied on unsustainable sources of food including remittances, begging and the sale of natural resources and alcoholic beverages. One in three PLHIV households consumed less than the recommended four food groups. The factors affecting food security included: nutrition and health status of PLHIV, ability to engage in agriculture, stigma and discrimination. The prevalence of acute malnutrition among PLHIV based on BMI was 26.2% and 19.7% based on MUAC. The risk of malnutrition was significantly higher among female headed households, those hosting an orphan or with a lower wealth index.
Conclusions: The food security and nutrition situation of PLHIV in South Sudan is alarming. PLHIV headed households had an increased risk of food insecurity. Special consideration should be made to provide food and nutrition support for PLHIV on ART and those with limited workability. The findings triggered a revision of the WFP HIV/AIDS nutrition strategy which is now aligned with national and global policies.

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