Kenya- Hunger threatens effective use of anti-AIDS drugs

By Johnstone Wanjala, Sima Community Based Organisation, Kenya

Dressed in a beautiful brown cloths a donation from well-wishers – Grace 8, recites a poem before guests at the Nzoia county social hall in Kitale.

In her thin long hair, the light skinned orphan smiles charmingly at Standard Group’s HIV/AIDS peer educators and speaks in a strong and hopeful voice.

Her poem is touching. Her voice suddenly becomes faint. She plods on softly till the last line.

"HIV/Aids
The mother of all killers
You are shameless;
Took my parents away.
HIV/Aids
You hurt individuals
Family and households
You have brought disaster
We dare you to stop now”

Her job done, she dizzily moves to the nearest bench, where she lays her head in her aunt’s laps.

As she recited the poem, a boy aged about four kicks around a football made of plastic bread
wrappers tied with rope. After two minutes, he sits on the floor and then lies down – tired. He sucks his thumb quietly before drifting to sleep.

As a group of HIV- positive “clients” entertains journalists, the boy wakes for a minute, tries to nod his head to the rhythm of drums but is soon overcome by sleep. His mother casually picks him up and continues dancing with the group.

These are some of the lucky 76 Kenyans who have free access to anti-retrovirals (ARVs) but lack basic meals. They belong to Wakibe’s HIV/Aids support group.

Medicens Sans Frontiers (MSF) Belgium, Mbagathi Hospital and Coptic Hope Centre supports them with free ARVs, counseling and follow-up. Some are monitored to see if they actually need the ARVs.

"Mimi ni Glady’s Nyongesa na niko na HIV. Kwa kusema kweli, madawa tunayo, lakini kizunguzungu imetuzidi (I’m Glady’s Nyongesa and I’m HIV positive. We have drugs but dizziness overwhelms us),” says one member.

They all introduce themselves as MSF clients and found a sheng name for their HIV/Aids status – Uzi (thread). “Mimi nina uzi (I have thread),” they say. The connotation is that they are as thin as thread, not because of the illness but for lack of food.

Glady’s, 36, a housewife and mother of six. Tested HIV- six –month old baby died of pneumonia. “I did not believe the results. I jumped from one Voluntary counseling Test centre (VCT) to another – Avenue, Mbagathi, Casino, Kenya Medical Research Institute (Kemri) but the results were all positive. My husband and I blamed each other and did not speak for a year although we lived in the same house”

With the couple now on an ARV regime, life has been a lot better. But with her husband retired from work on medical grounds and no source of income, Glady’s weight has dropped from 83kg to 38kg. “The ARVs have made me feel better when I started. But now they make me hungry and my head goes round and round. Sometimes I have no breath so I cannot even talk or get up.”

Beatrice Naliaka, 32, a former businesswoman, says she wanted to die when she tested HIV- positive. The married mother of five boys says she had a CD-4 count of four and her mouth kept bleeding. A where she joined the group in 2003.

“Initially, Simiyu had only six members. Then we would get nutritious foods, porridge and boosters every Friday and this took care of the ARVs. But suddenly there was an influx. Over 120 widows, jobless people and their children showed up and the meals were reduced to once a month,” says Naliaka.

Naliaka, who spent most of her money on herbal medicine and witchdoctors, says she is now jobless. But being at Simiyu has made a difference. From the group, the 135 members get moral support and food twice a month.

Simiyu started as a charitable outreach health services and home-based nursing care to the Huruma community with the Nursing Council of Kenya. Says Irine Nekesa Wesonga, the director and co-ordinator: “late 2002, one of our colleagues stopped coming to work for weeks.

A vegetable vendor told us she dive and hid herself for fear of stigmatization. When we visited her, she was too sick to recognize anyone or talk. She succumbed within the week”

Feeling guilty and ashamed, says Wesonga, they asked the vegetable vendor to inform any community member willing to disclose their status to come to Simiyu flats where they had a medical clinic. That is how clients started coming in large numbers.

When members get the time and energy, they weave woolen mats; spin kikoi, bed covers, shirts and shorts. They also pack liquid soap and beads.

Dr. William Kiarie of Crystal Hill, who offers voluntary services at Simiyu and has sponsored a youth member to driving school, says lack of food affects the administration of anti-retrovirals.

“When they stop taking drugs due to starvation, the whole cycle of treatment is affected and they have to start all over again. The side- effects can be devastating,” he says.

Prepared by:
Johnstone Sikulu Wanjala, Programme Coordinator/ Journalists.

Sima Community Based Organization
PO BOX 1691, Kitale
30200 Kenya.
Phone: +254- 733 453 339.
Email: sikuluj@yahoo.com

Africa-- Food Crisis: Worsened By Aids

By Thomas Kagera, The New Times (Kigali), October 14, 2005

KIGALI--The mighty and the powerful, the poor and the rich, intellectuals and peasants, all have a time when they only mind how to put food on the plates of their family members. The intermittent alternations of famine and abundance have for long been tied to weather failures, precipitated by droughts and floods.

But today a mere drought does not necessarily warrant famine, neither is it the only cause of famine in, especially, Sub-Saharan Africa. As we celebrate the World Food Day tomorrow, we need to reflect on the devastations visited upon Africa by famine and Aids

The depredations of war, the unpredictability of crop failure, the invasion of locusts in some countries and the ravages of Aids all do come into play to worsen the already deep food crisis. Aids, especially, has aggravated the food crisis in Sub-Saharan Africa.

Latest statistics show over half of those with HIV/AIDS live in rural areas, where stricken families struggle to produce enough food to survive.

Once a largely urban problem, AIDS has moved to rural areas in developing countries, devastating thousands of farming communities and leaving impoverished survivors scarcely able to feed themselves. The disease is no longer a health problem alone, but is having a measurable impact on food production, household food security and rural people's ability to make a living.

The latest statistical evidence issued by the Joint United Nations Programme on HIV/Aids (UNAIDS) on sub-Saharan Africa -- the worst-hit region -- confirms the scale of the epidemic's impact on the countryside.

UNAIDS estimates that over half of the 28 million people living with HIV/AIDS in sub-Saharan Africa live in rural areas. In order to estimate such figures, UNAIDS epidemiologists start with data taken from tests done on blood samples from pregnant women attending prenatal clinics.

They then extrapolate the figures to estimate infection rates in larger areas. Recent findings point to two of the hardest-hit countries:

Zimbabwe, where the 2000 prevalence survey showed that 31.4 percent of pregnant women living in rural areas were HIV positive. Women who listed their residence as "farm" registered a 43.7 per cent prevalence rate. Such figures mean that over 1 million people in rural areas have HIV/Aids in Zimbabwe.

Swaziland, whose 2000 survey showed that 25 per cent of the women who listed their occupation as "subsistence farming" were HIV positive, Overall prevalence among pregnant women in rural areas was 32.7 per cent. Such figures mean that over 100, 000 people in rural areas of this small southern African country, out of a total population of 938, 000, have the virus.

"This is a real wake-up call for governments," says Marcela Villarreal, FAO focal point on AIDS.

"Policy-makers are guided by evidence. Solid evidence is now coming in and will make governments understand how rural areas are actually more vulnerable to AIDS than urban areas."

Recent reports from other African countries show a similar pattern of rampant rural infection.
In FAO-supported study commissioned by Uganda's Ministry of Agriculture, Animal Industry and Fisheries, researchers surveyed 300 households in five rural districts in late 2001. The majority of the households (91 per cent) had lost a family member in the preceding 10 years, mostly in the 20-35 age-bracket. AIDS caused 56 percent of the deaths.

Study author Narathius Asingwire, of Makerere University in Kampala, says that the deaths of so many farmers in the prime of life has far-reaching implications for the country, since agriculture accounts for 43 percent of GDP, 85 per cent of export earnings and 80 per cent of employment. In addition, 85 per cent of Uganda's 22 million people live in rural areas and depend mainly on agriculture.

Asked to comment on the effects of HIV/AIDS in their households, two thirds of households replied that they now grow less food, over two thirds reported producing fewer cash crops and over half said they were eating less. The following statistic spells trouble for the many rural landless who depend on casual farm labour to survive: 85 per cent of respondents said they were using less farm labour.

Survey respondent Paulo, 80, supports five young grandchildren orphaned by AIDS. He has a banana plantation, but the biggest part is overgrown with weeds due to lack of labour. There has been a sharp reduction in food consumption among his family members -- they now only get one full meal a day, in the evening, eating just some porridge for lunch.

"Even now when I am still alive, we do not have enough to eat," says Paulo, who is ill and cannot work to augment the family income. Pointing to the youngest grandchild, he says, "You can see that young one is gloomy not because he is sick or has been punished, but because he has not eaten anything since morning."

In Kenya, the latest figures from the Ministry of Agriculture and Rural Development predict that the total number of lost wor kdays in the agricultural sector due to HIV/AIDS will reach 329,000 person years in 2020, if present trends continue. In 1990 the figure was 45,000 person years.

The district of Bondo in western Kenya has been particularly hard hit by the virus, with about 29 percent of the population infected, according to a 2000 survey, says Kenneth Ayuko, leader of an FAO community support team in Kenya. In some communities, as many as half of the adults are HIV positive.

"We have grandparents having to take care of up to 20 or even 30 orphans, and that takes a very big toll. Therefore, it is probably correct to say that food production under these circumstances of the HIV/AIDS pandemic is not possible," he says. "No wonder that the bulk of the population in Bondo is going hungry."

Poverty underlies the suffering and devastation behind these figures, says Ms Villarreal. "The HIV/AIDS epidemic cannot be addressed without doing something about rural livelihoods: how people make their living, how they get enough food, what strategies they follow in order to survive," she says.

FAO is currently formulating pilot projects that will test labour-saving techniques and low-input agriculture in African and Asian communities hard hit by the epidemic. Other priorities for the FAO HIV/Aids programme include putting up institutions that help rural communities, improving nutrition, addressing gender inequalities in access to productive resources (especially land) and helping decimated communities find a way to pass on farming knowledge to the young.

Consider the following facts;
--AIDS has killed around 7 million agricultural workers since 1985 in the 25 hardest-hit countries in Africa. It could kill 16 million more before 2020.
"
--The most-affected African countries could lose up to 26 per cent of their agricultural labour-force within two decades.

--Food consumption has been found to drop by 40 per cent in homes afflicted by HIV/Aids.

--Total spending on Aids in Africa, which goes largely to prevention, is just US$150 million a year. Barely one tenth of that sum comes from national budgets in the region.

--In 2000, close to 3 million people died of Aids and 5.3 million people became infected around the world.

--By 1999, there were 13.2 million Aids orphans, 95 percent of them in sub-Saharan Africa.

--HIV infection rates are three to five times higher in young women than in young men.

Source: pronut-hiv eForum

SAFAIDS- HIV/AIDS and Nutrition

From SAFAIDS Septmber 2005 newsletter. To read this article on HIV and nutrition go to: http://www.safaids.org.zw/publications/Sahaa%20issue%2057%20September.pdf

**
Food cannot cure AIDS, nor doest treat the virus, But it can certainly improve fitness and quality of life for People Living with HIV/AIDS (PWHAs). Eating well plays a central role in your overall health and well-being.

It is very important to eat foods that will help your immune system to grow stronger. A healthy and balanced diet provides foods in the right amounts and combinations that are safe and free from disease and harmful substances. This applies to everyone-whether they are HIV positive or not.

Good nutrition is essential for achieving and preserving health. Nutrition is the process by which your body provides materials for its structural and functional needs (Romeyn 1995: Nutrition and HIV pg385)).

To prevent malnutrition, the body has to have enough nutrients. These are mainly found in food. Infection with HIV damages the immune system (the immune system is your body's natural protection), which leads to other infections such as fever and diarrhea. These infections can lower food intake because they both reduce appetite and interfere with the body's ability to absorb food. As a result the person becomes malnourished, loses weight and is weakened.

Nutrition education gives a person a chance to build up healthy eating habits and to take action to improve food security in the home, particularly with regards the cultivation, storage and the cooking of foods

Why is nutrition important for people living with HIV/AIDS?
Preventing weight loss: one of the signs of the on set of clinical AIDS is a weight loss of about 6-7kg for an average adult. A healthy balanced diet, early treatment of infection and proper nutritional recovery after infection can reduce weight loss And lessen the impact of future infection.

Reinforcing treatment: a person may be receiving treatment for opportunistic infections or combination therapy for HIV. These treatments and medicines may influence eating and nutrition. Good nutrition will reinforce the effects of any medication, herbal intake or use of supplementary pills.

Maintaining good health: when nutritional needs are not met recovery from illness will take longer. During this period the family will have the burden of caring for the person, paying for health care and absorbing the loss of earnings while the person is unable to work. Good nutrition can help to extend the period when the person with HIV/AIDS is well and working.

Source: pronut-hiv eForum

HIV Patients : Balanced Diet Needed

by Brenda yofeh, Cameroon Tribune, September 30, 2005

HIV patients say their nutritional intake is vital to their health but the means at their disposal are limited.

Nutrition plays an important role for the human system to remain healthy. Good nutrition is therefore indispensable to the health of each individual.

Given that malnutrition weakens the body system, giving way for the HIV infection to propagates , it is necessary for HIV patients to receive a balanced diet. However, most HIV patients say they cannot provide the necessary diet required to maintain their depreciating health system.

Medically, it is noted that multiple nutritional abnormalities occur relatively early in the course of the HIV infection. Infected persons tend to have elevated protein and energy requirements; making it more likely for HIV patients to experience weight loss if early nutrition intervention is not available. Medical analysis indicates that such patients experience multi-system complications due to changes which result from the nutritional status and intake.

According to Catherine Djite, a dietician at the Yaounde Teaching Hospital, a healthy and balanced diet is essential for every human beings especially those living with HIV. This is so because good nutrition increases resistance to infection and disease, improves energy and makes a person feel generally stronger and more productive.

While good nutrition is important for everyone, Catherine Djite stress that it is more important for HIV patients because nutrition and HIV are strongly related to each other especially as the immune systems of HIV persons are weaker.

Noting that an HIV patient needs a special nutritional intake since he is at a risk of malnutrition, the dietician stressed the intake of all nutrients such as meals containing protein, carbohydrate, minerals, fat, energy, etc have to be doubled. Conversely, HIV patients say they can hardly provide the daily intake of the vital nutrients due to the lack of money.

In a chat with an HIV patient, she stressed that a balanced diet is important in the daily life of any HIV person. "When I do not take a balance quantity of all the necessary body nutrients needed, I feel more sick", the patient said. The patient noted that when she does not take fruits and vegetable, she feels very tired. In addition, when she consumes too much of red meat, she has digestion problem.

However, when the patient eats vegetable prepared in any manner, coupled with a glass of milk taken before bedtime, she feels very ok. Fruits, fish and chicken pose no problem to her. She concluded that an HIV patient who does not eat well has another problem besides the fact that he is HIV infected.

While other HIV patients know what to eat and are able to get what to eat, there are others who do not have money to eat what is necessary for their health. While there are those who do not even know the necessary nutrients they need. Thus, Catherine Djite says that the nutritional intake for HIV patients should be a priority.

Source: Health Gap eForum