The number of women with HIV who were nutritionally assessed with anthropometry and those who received nutrition counseling at the same time during the reporting period can be tabulated by program staff reviewing individual client and/or clinic records. Data can be collected continuously at the facility/community level and information should be documented on program records each time a client is nutritionally assessed and/or counseled.  Tools for the measures mentioned above may include weight scales, MUAC measurement tapes, and stadiometers/height measuring devices. Data can be disaggregated by reproductive status (pregnant, postpartum up to six months, and non-pregnant, non-lactating), by treatment status for opportunistic infections and antiretroviral treatment, and by age groups, parity, and other relevant factors such as education, income, and urban/rural residence.

If targeting and/or linking to inequity, classify outlets where counseling is taking place by location (poor/not poor) and disaggregate by area served.  Exit interviews can be conducted with clients to determine client’s poverty status.

Program and site records that document women’s HIV status and whether clients who have received anthropometric assessment were provided nutrition counseling.

This indicator monitors the number and proportion of women with HIV who are nutritionally assessed and receive nutrition counseling within a facility or geographic area. It is important for women with HIV to be nutritionally assessed at regular intervals and nutritional counseling helps clients understand nutritional needs, identify constraints and options for improved diet, and plan feasible dietary actions to improve nutritional status. Ideally, nutrition counseling should be based on an assessment of nutritional status. This indicator is part of the linked set of ‘Harmonized Indicators for Nutrition and HIV Care’ (FANTA, 2009), which track and provide comparative and trend data on the number and proportion of undernourished individuals receiving various program services.

Women with HIV are a critical population for health and nutrition assessment and intervention.  According to UNAIDS data from 2009, women account for over 50 percent of global HIV infections and over 19.2 million women live with HIV. The nutritional status of HIV-infected women before or during pregnancy and during lactation influences both the women’s health and the health and survival of their infants. For women who are under- to normal weight pre-pregnancy, adequate weight gain during pregnancy reduces the risks for low birth weight, stillbirth and perinatal mortality.  In addition, sufficient energy and nutrient intakes are necessary postpartum to support the demands of breastfeeding and for women to replenish their nutrient stores.  HIV infection increases energy requirements due to higher resting energy expenditures and increased nutritional needs from HIV-related infections and illnesses, thereby placing pregnant and lactating women at greater nutritional risk than their HIV-uninfected counterparts (WHO, 2004; Papathakis and Rollins, 2005; FANTA, 2010). This indicator relates to four of the Millennium Development Goals: #1. Reduce poverty and hunger; #4. Reduce child mortality; #5. Improve maternal health; and #6. Combat HIV/AIDs.

The information provided by this indicator can be used at many levels and for a variety of purposes. At the global level, this indicator can be used by donors and international organizations to track the extent to which program nutrition interventions are reaching women with HIV and to identify countries or regions where more focused efforts may be required.  This information can be used similarly by national governments to track efforts, identify gaps in service delivery, and prioritize needs within countries.  Programs can use the information to assess the reach of their services, to inform resource allocation and program management, to plan resource needs (e.g., commodities and staff training), and to report data to donors.  Data collected by this indicator would likely be reviewed annually at the national and global level and could be reviewed more frequently at the program level as needed.

Many countries are integrating nutrition assessment using anthropometric measurements and nutrition counseling into national HIV programs. Acquiring tools for conducting anthropometric measures, training counseling staff, and developing systems for collecting, recording, and reporting data are becoming priorities for national governments as well as international donors making collection and utilization of this indicator increasingly feasible.

This indicator only measures the number of clients who received both nutrition assessment and nutrition counseling at the same time.  Therefore, the indicator should not be interpreted as measuring total coverage of assessment and counseling, rather as measuring coverage of assessed clients with counseling. The indicator does not provide information about the quality of the assessment and counseling, and accordingly quality assurance systems should be established and indicators of quality collected to assess how effectively these services are being implemented.

Accurate collection of data relies largely on flow of services at the clinic/program level and requires availability of standardized anthropometric measurement equipment, trained staff, and accurate record keeping within a program.  The indicator may underestimate the number of HIV-infected women in an area and should not be used for these purposes.  Not all women with HIV will be able access to services, especially in remote areas or where women’s mobility is limited by cultural norms.

Women’s ability to access HIV programs and services may be more limited than men’s in settings where women are particularly stigmatized for being HIV-positive or where cultural norms limit women’s ability to travel outside the home.