by Edwin Krales, MS, CDN
Nutritionist/Outreach Coordinator, The Momentum Project
Adjunct Professor of Nutrition, Hunter College

There are many factors that can motivate people to change their eating habits. Moving into a new culture and wanting to become a part of it, looking better in a bathing suit, being sexier, improving athletic performance or trying to become healthier are just a few examples. People who get diabetes, heart conditions, high blood pressure or other illnesses are often motivated to make positive changes in their eating habits in order to improve their chances of gaining control over their illnesses. HIV disease can be such a motivator. Remember, there are always choices to make. Some will be better, others worse.

A strong desire to change is a great motivator, but a person needs other tools to make the changes. These tools include enough money for food, access to good cooking facilities every day, an adequate meal program that keeps one from isolation, and clear water. If you give someone a bunch of broccoli, a bag of rice, a bag of beans, a freshly killed, organic, free range chicken and he or she doesn't have a kitchen to cook in, these good foods have less nutritional value uneaten than eating a bag of chips and a soda. Along with kitchen facilities such as a stove, a sink with both hot and cold water, a refrigerator and freezer, and enough pats, pans, dishes and utensils, the person must also have good enough cooking skills to know what to do. Having good enough cooking skills means several things. One has to know various recipes or be able to read them in a cookbook. Are you literate? Do you have a cookbook? Does your kitchen have the supplies necessary to complete a recipe, for example, salt, sugar, spices, oil, vinegar, onions, garlic, hot sauce, soy sauce and butter?

If a person can't read or doesn't have the skills or equipment to begin the change, than he or she needs to be able to get help with both literacy and cooking skills. If one doesn't get help, frustration can kill the desire to change.

Low literacy, or illiteracy also interferes with a person's shopping ability. If you can't read labels you can't make the best choices. Watching T.V. enters the picture here, since the most recognizable products, though not necessarily the best ones, will be those most easily identified in the store. I am writing about shopping as if it were an activity, like breathing. We all do it about the same all the time. This is not the case. Some neighborhoods or areas are much better to shop in than others. In poorer neighborhoods in New York City it is difficult to find fresh vegetables. Last year I was at a health fair in the South Bronx. I needed broccoli for a demonstration and I hadn't brought one. My assumption was that I would buy one in the neighborhood so that I could tell visitors to my booth that I bought it locally. It was a good lesson for me. I went to 8 small stores before I found one that had fresh produce. The other 7 had no fresh or frozen vegetables. All they had were canned vegetables-peas, carrots, corn and beans. A good supermarket was a train ride away, a ride that would add three dollars to your grocery bill if you lived in that neighborhood and needed to shop elsewhere in order to change your diet.

We must also remember that gender plays a role here. In our society girls not boys are taught how to cook as a function of their growing into maturity. As a result many men don't know how to cook and they don't have a history of cooking to draw from. A woman may not know particular recipes, but she may remember how her mother prepared a certain dish. Men in homosexual or heterosexual relationships may be able to rely on their partners for help with shopping and cooking while working to change their eating habits, but gay or straight single men may have to go it alone. Women who were not taught cooking skills have similar problems to overcome.

The question we rarely ask when we talk about diet change is, "What do your friends and family eat?" What they eat exerts as much influence as what you eat when you want to change your eating habits. I say this because eating is not merely taking in nutrients. The definition of nutrition is "a source of nutrients culturally defined."

The culturally defined part is what is most difficult to change. If we could make fruits, vegetables and whole grains look and taste like Big Macs, french fries and a cake, and make sure they had all the vitamins, minerals, fibers, phytochemicals, protein and carbohydrates of the original produce, many of our nutrition education problems would be solved. It would be difficult if not impossible for most people to eat completely differently from the people they live with. This does not mean that you should eat alone rather than serve two kinds of meals when you eat with friends and family. It doesn't mean that you should give up on the idea of changing your eating habits. Except for the increase in calories and supplements, most of the dietary changes that a person with HIV who is asymptomatic should make would be beneficial. Everyone would benefit from an increase in green leaf and vegetables. Cutting down on junk food and not eating on the run would be better for everyone. Pure water is better for everyone and practicing food safety cuts down on the flulike symptoms that accompany food poisoning, especially during the warmer months. Even though people with HIV need additional protein, the amount of protein that Americans eat exceeds even those recommendations. Hopefully, following an HIV diet and increasing the amount of vegetables will result in an overall reduction in the amount of protein you eat, and perhaps happier healthier kidneys. Take your friends and family on this road to better health. It will help everyone.

To be realistic about these changes means that we have to face the fact that these things take time and often are not successful. Since it is critically important for HIV infected people to make positive dietary changes and be able to learn while eating well, you should find a support network as soon as possible. Going to congregate meal programs for people with HIV has many advantages. The meals are prepared especially for people with HIV. The participants exchange the latest information on many subjects, including HIV nutrition. Very often there are nutrition counselors present who can answer questions about your eating habits. Many of the participants have taken giant steps in how they care for themselves and as a result are good examples. Perhaps most important is sharing the sense of excitement and optimism about all the new information and therapies starting to develop. Finally, you will find that change is possible and that you have taken the right path to achieve that change.

See also, Breaking the Barriers to Good Eating