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“It is more than food; it is like an invisible family (my invisible family) who is taking care of me in tough times” What we do There are four major barriers that prevent People living with HIV in London from accessing good nutrition: •Ill health •Poverty •Isolation (a reduced motivation) and •Limited nutrition knowledge. Our new Personalised Nutrition Care Plans are designed by dietitians to provide tailored support that improves the health and/or quality of life of those most in need. What we do Our practical services are delivered by over 700 skilled community volunteers supported by a team of just eight staff. In 2011, The food Chain: •borrowed 4 kitchens to prepare and deliver over 30,000 tailored meals •sent over 2,000 food hampers containing a full week’s groceries to families in ill-health or poverty. •taught practical skills to over 300 people living with HIV, so they can better selfmanage their health •piloted Eating Together, a project aiming to address social isolation. Most people we support have complex needs, so require a combination of services Achievements In the last year we have also: •developed a clear new strategy to expand our work and restructure our services •been given a grant of £1m from Elton John AIDS Foundation to help deliver our strategy •embedded a new team of staff with the skills to deliver our strategy •developed a new service model that will increase and clearly show the impact of our work •piloted schemes to allow us to plan and procure food more efficiently •scoped and funded Eating Together – a new communal eating project that aims to address social isolation. Many central London boroughs experience high levels of deprivation and HIV infection Over 1,000 PLHIV accessing care Over 500 PLHIV accessing care Over 300 PLHIV accessing care Focus area for Food Chain Services Source: SOPHID 2006 How we help Barriers to good nutrition Poverty as a result of unemployment, inability to work, debt, asylum issues Ill-health as a result of late diagnosis, or other short / long term complications Intervention (Food Chain) An appropriate package of food (meals & groceries) provided to PLHIV and their children/ carers/ dependents Expected outcomes Improved nutrition, short term alleviation of poverty, improved health, exit strategy Improved nutrition, improved health, stronger immune system, exit strategy Isolation as a result of discrimination, mental health, cultural barriers Pilot ‘Eating Together’ service Regular contact opportunities to eat, learn, socialise and discuss problems Limited knowledge Lack of information / skills to make informed choices Information and skills taught at nutrition and cookery classes supported by appropriate fact sheets Ability to maximise benefits of nutrition to self manage health long term Poverty In 2009, 25% of those accessing our food services had a household food budget of less than £20pw We have seen a 550% surge in demand for our emergency hampers over the past four years 56% of people receiving our emergency hampers in 2010 had NO INCOME £0 For families living in poverty, the food budget is often the most flexible household expense. The average weekly income for applicants to the Crusaid hardship fund fell from £99pw in 1999 to £63pw in 2008 (£22.78pw for an applicant with residency issues) 18% of applicants to the CWAC hardship fund are unable to provide their children with 3 meals a day We estimate that 15% of PLHIV in London (4,400 people) and their families are living in extreme poverty, and aim to reach 3,200 of them within 3 years. Ill-Health 7,000 people in the UK are newly diagnosed with HIV each year - half of these in London. One in three are diagnosed late when they are already unwell. We expect 20% of our new referrals to come from HIV clinics and healthcare professionals, looking to support patients following immediate discharge from hospital. The assurance that appropriate nutrition will be available to patients at home frees up hospital beds, and saves the state thousands of pounds annually in avoidable care costs. We estimate 1,167 PLHIV receive a late diagnosis in London each year, and aim to reach 800 of the most vulnerable within 3 years. Isolation Eating Together will bring isolated PLHIV around a table to eat together and offer peer support. Living and eating alone diminishes appetite, food consumption and dietary quality. In many cases this isolation and deprivation can contribute towards worsening health. New arrivals in the UK can face additional barriers that contribute towards social isolation including language and cultural differences. The population of PLHIV is ageing and older people are more likely to be isolated. Nearly one in three people living with HIV in London has experienced discrimination as a result of HIV – often leading to social isolation where a persons condition is likely to deteriorate. Limited knowledge Eating Positively cookery and nutrition classes allow us to share over 20 years of nutrition expertise faceto-face with service users. The classes offer practical skills and advice in a kitchen setting where we can discuss topics including food labels, budgeting or understanding ingredients. Tailored classes are run to support people with specific knowledge needs e.g. adapting diets to help manage diabetes or heart health. This knowledge adds a longer term benefits to the immediate food we deliver and allows people living with HIV to make better food choices in the future. The classes aim to reach 400 people in 2012-12 and are complimented by factsheets, recipes and bespoke dietetic advice where appropriate. Responding to a growing need More people living with HIV : There are 3 x more PLHIV in the UK than in 2001 with over 7,000 newly diagnosed with HIV each year – half in London. Soaring food prices : Groceries cost 19% more than a year ago meaning more people struggle to access the food they need to stay well. To meet this increasing demand we need more resources, more capacity and to become more efficient. Contact Please do not hesitate to contact me if you have any questions: Andrew Davies, General Manager www.foodchain.org.uk [email protected] Direct line 020 7288 9000 Mobile 07949 559989 Registered charity No. 1003014 Barriers to healthy eating Access Plots • Foods prices • Gardens • Relative costs of • Allotment healthier food • Money for food • Shopping capacity: Availability time, transport, • Foods stocked in physical care National and local policies shops used • Agriculture range, quality • Trade Foods households can buy • Food storage capacity • Location of shops • Housing • Employment Institutional food • Retailing • School, canteen, day centre, hospital, home • Health • Planning • Welfare Information • Foods labelling • Advertising and marketing Food preparation Practices Foods households and individuals choose to buy • Leaflets, contact with health Choice • Cooking skills professionals, • Taste, preferences • Ability and schools • Family acceptability confidence to • Social/cultural norms prepare healthier • Nutritional knowledge foods • Motivation • Cooking facilities Intra-household distribution Frame work of the barriers to healthy eating - The Manual of Dietetic Practice (4th edition) Eating patterns • Family food hierarchy • Influence of promotions and advertising Eating/ meal patterns Food consumed by individual nutrients absorbed Our direct interventions (green) Interventions to help PLHIV Access Food packages home delivered for those in ill - health Availability National and local policies Foods households can buy Food packages provided for those in poverty Eating patterns Institutional food Evidence shared with advocacy organisations to influence policy Pilot meal programme at Mildmay Information Nutrition classes, fact sheets and pathways to other care services Foods households and individuals choose to buy Eating/ meal patterns Food preparation Practices Choice Tailored. culturally appropriate meals and groceries Practical cookery classes Intra-household distribution Sufficient food for entire family Food consumed by individual nutrients absorbed Where our work influences decisions (yellow)