Steady Progress As ARV Rollout Gathers Momentum

UN Integrated Regional Information Networks, January 4, 2006

MAPUTO- When Maria (last name withheld), 35 years old and HIV-positive, reflects on the past year she gives an answer that a growing number of Mozambicans living with HIV/AIDS would probably echo.

"The year 2005 has been good for my health. It has got so much better because this year I started taking ARVs (antiretroviral drugs)," she told PlusNews.

Maria is one of 17,000 people now accessing ARVs of a national target to treat 20,000 people by the end of 2005.

"This is a major milestone, considering we started to roll [out] ARVs so late because the necessary health infrastructure was not in place," said Ivo Correia, a UNAIDS project officer.

During 2005 the government cranked up its treatment programme to reach double the number of people receiving the life-prolonging medication - a year ago, in December 2004, only between 8,000 and 9,000 Mozambicans were getting the drugs.

Even better news was that "the quality of service and support the patients receive has improved, with more health workers trained this year," Correia noted.

Maria's biggest problem in 2005 was a lack of food. "I am meant to eat a nutritious diet now that I am on ARVs, but there is not enough food for me and my family," said the single parent of two.

Her family relies on food provided by the UN World Food Programme and 'Kindlimuka', Mozambique's first association of people living with HIV. She receives no support from her husband, a driving instructor, who left her four years ago when she told him she was HIV positive.

In a country where 54 percent of the 18 million population live below the poverty line, Maria's
situation is typical of many women.

Despite working as a counsellor to patients receiving ARVs at Maputo Central Hospital as well as at her local health post, Maria has not yet publicly disclosed her status. "Stigma is still a major problem for people living with HIV," Correia pointed out.

He admitted that despite the progress achieved during the year, "a more systematic approach" was needed to address the pandemic.

As the National Action Plan for 2005-2009 gathers momentum, Correia is optimistic about the country's HIV/AIDS efforts in 2006. "We're moving now from policy into action: indicators are in place to measure progress, there will be more coordination, less duplication and we shall see the gaps more clearly," he said.

Maria hopes that in 2006 she will be rewarded for her efforts. "I am counselling people, but it is all voluntary. I don't want to live off handouts - the government should give us something."

Despite the encouraging results of the ARV rollout in 2005, an estimated 200,000 adults are in need of ARV treatment, with children lagging far behind: around 62,000 need treatment, but by mid-2005 only 1,226 were receiving it; few children receive Cotrimoxazole, a low-cost antibiotic that can nearly halve child deaths from AIDS-related diseases for only US $0.03 a day.

The UN children's agency (UNICEF) representative in Mozambique, Leila Pakkala, stressed the need for people to become aware of the importance of diagnosing and treating HIV-positive youngsters. "Communities aren't aware that such treatment can be available for children, so a demand needs to be created," she noted.

Moreover, despite the fact that as many as 326,000 children have been orphaned by AIDS, and more than 500,000 are caring for sick family members, many children do not receive support enabling them to stay in school.

Another population group to be targeted in 2006 will be the 800,000 people in the drought-affected southern half of Mozambique. The communities in the region are reeling from the double whammy of economic hardship and HIV/AIDS, which has risen along the main transport route to South Africa.

Traditional male employment in the mines in neighbouring South Africa is also drying up, while agriculture has been affected by both drought and the loss of those who fall sick and die of AIDS-related illnesses.

HIV prevalence is generally higher in these areas, for example, 18 percent of people living in Gaza province are living with HIV/AIDS, while recent health ministry figures indicate that national HIV prevalence has increased from 14.9 percent to 16.2 percent over the past two years, and women like Maria and young girls are worst-affected.

The rise in prevalence meant that Mozambique could not afford to neglect its prevention activities this year, Correia warned.

"We need to have prevention activities [implemented] regularly in a consistent and systematic manner throughout the country. People need to hear the message constantly so they talk about these issues openly," he stressed. "This is the only way to convert messages into behavioural change."

[ This report does not necessarily reflect the views of the United Nations ]

Source: AllAfrica.com

Engineers design nutrition delivery system for Kenyan AIDS victims

WEST LAFAYETTE, Ind. – Purdue University engineering professors are building a nutritional supply chain to help fight AIDS in Africa.

Mark Lawley and Yuehwern Yih (YOU-wern YEE) say that without proper nutrition the drugs used to treat AIDS patients won't work. The two industrial engineering professors are putting together a system for food delivery that includes both flown-in dry food and locally grown produce. They are working with the Indiana University-Kenya Partnership and retired physician Dr. Joe Mamlin, who runs a dozen AIDS clinics treating 400 patients per month around Eldoret in western Kenya.

Lawley and Yih spent two weeks at the clinics in September and returned at the end of November. The two started the project as faculty fellows at the Regenstrief Center for Healthcare Engineering at Purdue's Discovery Park. The center's mission is to apply interdisciplinary principles to health-care delivery, and faculty fellows spend a semester working on solutions to large problems.

"We met Salina, Dr. Mamlin's first patient to whom he provided a nutrition supplement," Lawley says. "When he started treating her, she was so malnourished that the anti-retroviral drugs weren't working. So, Dr. Mamlin realized nutrition had to be part of successful treatment."

Lawley says Mamlin gave Salina money for food, the medicine began to work, and Salina is now healthy and robust. Mamlin then began acquiring farmland and growing fresh produce for his patients. There are now four operating farms and plans to expand.

The clinics are part of the Academic Model for the Prevention and Treatment of HIV, or AMPATH, which provides treatment for 14,000 HIV-infected Kenyan adults, as well as a program to prevent mother-to-child HIV transmission.

"The AMPATH program has farming expertise," Yih says. "What we're doing is solving operational issues to turn the flown-in dry food and produce from the food operation into a smooth system that delivers the correct amount and variety of food in an appropriate amount of time."

She estimates it will take two years to take the components and complexities of the delivery of nutrition to the AIDS patients and turn them into a smoothly running machine. When she and Lawley complete the project, she says there will be a brand new model that can be used to deliver food to other impoverished areas.

"We will eventually link the food distribution database with the patient medical record system so that nutritional researchers can study the effects of nutrition on AIDS treatment," Yih says. "To our knowledge, no one has done this before."

The program was receiving 19 metric tons of dry food, such as corn, beans and soybean powder, each month from the World Food Program to feed 2,200 people. The farms produce 800 eggs and 450 500-ml packets of milk product per day.

Lawley says there are many variables to evaluate, account for and ultimately coordinate: farm crops and production, yield and perishability; dry goods packing center operation and its weighing, packaging and tracking operations; the condition, reliability and mileage of delivery vehicles and how they are maintained; the generally bad road conditions; and distribution centers, supply chain and scheduling. The list goes on.

While the challenge sounds agricultural, Lawley and Yih say they look at the problems in terms of applying industrial engineering principles to the medical field in what's termed health-care engineering, which concerns itself with delivery of required treatments, medications and services to patients in as timely and efficient a manner as possible.

Yih was initially approached about becoming involved in the IU-Kenya Partnership by Dr. Thomas Inui, president and CEO of the Regenstrief (REE-gen-streef) Institute Inc., the Indianapolis informatics and health-care research organization located at the Indiana University medical campus.

The Regenstrief Foundation provided start-up funding for Purdue's Regenstrief Center for Healthcare Engineering in Discovery Park, the university's interdisciplinary research and enterprise hub. Lawley and Yih are both associated with Purdue's Regenstrief Center, which has supported their work with the IU-Kenya Partnership.

Yih says that while most people wouldn't initially think of applying industrial engineering methods to curing AIDS in an impoverished country, it is just what the doctor ordered.

"We can use the principles of industrial engineering to solve complex problems," she says. "This is important work that needs to be done. Purdue and the Regenstrief Center are making it possible for us to donate our time to this project."

Lawley says they learned from Mamlin that the project is even more complex than he and Yih had originally thought, and it is expanding rapidly.

"Dr. Mamlin realized that even feeding the patient properly wasn't enough. You have to feed the family, too, or the patient will share food with family members and not get sufficient nutrition for the medicine to be effective," he says. So the 400 patients represent 2,200 mouths to feed.

"And as the clinics have grown, there are questions of how to scale up the food operation and all the components that go into it."

On Jan. 1 the food program expanded to feed 3,000 patients and a total of 17,000 mouths per month, requiring 150 metric tons of food to be distributed. Also, there is more production from the farms due to an increased amount of farmland and the addition of a continuous-drip irrigation system.

Lawley says the final piece of the puzzle for the project's AIDS sufferers is the Family Preservation Initiative, which teaches former patients skills in agriculture and industry and offers "microloans" so they can start new businesses.

Kenya, located on the east coast of Africa, has a population of 34 million. According to U.S. government figures, 6.7 percent of the adult population is infected with AIDS. The population is desperately poor, with 50 percent living below the poverty line and 40 percent unemployed. Adult life expectancy averages less than 48 years.

"You don't see real suffering when you see scenes of Africa on television," Lawley says. "It has always been important to me to alleviate suffering, but I've appreciated that so much more deeply since we made the trip. We'll stay as long as they want us to."

Yih says that despite the country's impoverishment, "the Kenyan people are happy and welcoming."

And Yih and Lawley are already looking at the next phase.

Three of the professors' students are capturing all the numbers involved in systematizing food delivery and putting them in a database for future research work.

***
Source: Purdue News Service: (765) 494-2096; purduenews@purdue.edu
Writer: Mike Lillich, (765) 494-2077, mlillich@purdue.edu
Sources: Mark A. Lawley, (765) 494-5415, malawley@purdue.edu
Yuehwern Yih, (765) 494-0826, yih@purdue.edu

Kenya: Food On the Table Helps 'Keep the Promise'

by Joyce Mulama, Inter Press Service, November 30, 2005

Nairobi - With only a quarter of Kenyans who need anti-retroviral drugs (ARVs) receiving them from government, the race is on to ensure that many more people get treatment to fend off AIDS-related diseases.

But, is a similar enthusiasm being applied -- particularly by officials-- to ensuring that ARV recipients are also provided with enough good food, without which ARVs cannot work properly?

No, says the Network of African People Living With HIV/AIDS (NAP+).

"The government has not been supportive. There is no government initiative that focuses on the issue of nutrition," Michael Angaga, national coordinator of NAP+, told IPS. "Government efforts to address HIV/AIDS have focused mainly on provision of ARVs."

Medina Yahya would probably agree with this claim. A resident of Kibera, the largest slum in the Kenyan capital of Nairobi and possibly Africa, Yahya has developed various ailments, including ulcers, through having taken ARVs on a perpetually empty stomach.

"I was put on the medication at the beginning of last year, and for a long time I was taking it without having any food to eat," she told IPS.

The 30-year-old has since been advised to go off treatment until her strength improves. But, this depends on Yahya being able to find enough food for herself and her three children. At the moment, she is dependent on hand-outs from well-wishers and the Stara Rescue Centre: an informal school that feeds the children of HIV-positive people, and also provides once-weekly rations to adults living with HIV/AIDS.

Thirty-five-year old Susan Asiko, who provides home-based care to Yahya, tells a similar tale. She has been on ARVs since she was diagnosed with HIV last year.

"At first, the drugs affected me because it was difficult for me to get enough food to eat. I was bed-ridden for a while, but when I started getting food regularly, my health improved," she told IPS. "Getting food is the main challenge here, especially if one is not working."

Kibera houses approximately 700,000 people. More than half of all Kenyans get by on less than a dollar a day, according to government statistics.

Ultimately, the price of a meal rather than the cost of ARVs may stand in the way of people with HIV/AIDS staying alive.

"What we have experienced here is parents stopping their medication because of the side effects experienced when taking the strong ARVs on empty stomachs," Josephine Mumo, the headmistress of Stara Rescue Centre and one of its founders, said in an interview with IPS.

"They remain weak and bed-ridden in their houses and unable to fend for their children. They later die, leaving their children as orphans."

Stara's attempts to get food from government have been unsuccessful, added Mumo. The school presently receives supplies from aid agencies.

Non-governmental groups have also stepped into the breach elsewhere.

NAP-Plus has embarked on a pilot project to supply Nutropath, a supplement in powder form, to those living with HIV/AIDS. The project is being run in two centres in Nairobi and the western city of Kisumu, and has targeted 150 adults and 50 children.

"The product can be mixed with water, milk or juice, and those who are currently being tested with it have shown tremendous changes in their health," says Angaga. "Those who had lost weight have regained it. Most of them say they can skip a meal and still feel strong."

For its part, government insists that the picture concerning nutrition is not as bleak as NAP+ and others claim.

"The government has a budget for supporting nutrition through the Global Fund (the Global Fund to Fight Aids, Tuberculosis and Malaria),"says Patrick Orege, director of the National Aids Control Council -- an organisation charged with co-ordinating the fight against HIV in Kenya.

The fund was created in 2002 as an international partnership to finance efforts to curb HIV/AIDS, tuberculosis and malaria.

As welcome as money from the global fund is, the question that begs asking is whether government should also be committing Kenyan revenue to nutrition programmes for those with HIV -- especially in light of its 2001 adoption of the United Nations Declaration of Commitment on HIV/AIDS.

This document says countries should "Increase and prioritise national budgetary allocations for HIV/AIDS programmes as required and ensure that adequate allocations are made by all ministries and other relevant stakeholders..."

The theme for World AIDS Day (Dec. 1) this year is "Stop AIDS. Keep the Promise." -- adopted in a bid to get governments to uphold pledges made under the U.N. declaration and elsewhere.

While food programmes may not be receive much attention in the national budget, entertainment allowances for members of parliament (MPs) do -- not to mention car grants.

Each minister and MP is entitled to a car grant of 44,600 dollars, and a monthly entertainment allowance of not less than 1,000 dollars. This means that government spends over 200,000 dollars a month on entertainment allowances for legislators.

The same amount buys about 17,000 bags of maize, which would doubtless go some way to improving the nutrition of poverty-stricken HIV/AIDS patients. At present, 2.2 million of Kenya's 32.8 million people are infected with HIV/AIDS.

Namibia: Living Positively is a Challenge

by Wezi Tjaronda, New Era (Windhoek), December 2, 2005

NAMIBIA- As much as people living with HIV and AIDS are trying their best to live positively, lack of support remains a problem in their day to day lives.

While some get sick so frequently that they are retrenched from work, others, especially women, have the support they get from their spouses withdrawn once they discover they are HIV positive.

Many interventions on the epidemic focus on prevention and not on care and support, which has brought fears that without support, the infections may rise.

Several women from Windhoek's informal settlements that New Era spoke to on the issue had the same story to tell. Ebba Uzombala's husband left her in 2000, when he was informed about his wife's HIV status. They were married since 1990 and together they have two children, whose responsibility was left to Uzombala.

Kaalina Ekandjo also experienced the same when she was diagnosed HIV positive. "My husband left me but he came back when our child died,"said she, adding that it turned out that the husband was also positive.

The epidemic is still shrouded in secrecy to an extent that women are scared to share their status with their spouses. For Hernnea Rainhard, who was diagnosed positive in 1996, she only told her husband that she was HIV positive in 2004. "He was so upset he took a knife to kill me and himself," she told New Era, adding that she had to take refuge at a women's shelter to remain alive.

For those that cannot accept it, they take their lives.

Twenty-five-year- old Ndahafa Nghinyengulwa's boyfriend killed himself after he was diagnosed HIV positive.

"He called me to his place and started quarrelling with me that I am the one that gave him AIDS. Then he killed himself," said Nghinyengulwa.

She lives on her own in Ombili informal settlement, where she has to struggle to feed herself.

Being in an informal settlement, the young woman says she finds herself drinking sugar water most of the time to be able to take her medication.

"Sometimes I have food but I cannot cook it because I need paraffin to cook, and I have no money," she added.

This and many other problems such as stigma and discrimination face women who are living with the virus and are dependent on support from either their relatives or AIDS support organisations.

Penina Ita, the acting Director of the AIDS Care Trust, says food security is the main concern because over 90 percent of poor women that are positive do not have a source of income, which calls for individuals and private sector organisations to start supporting their own people.

"There are so many people including children on ARVs, but they have no food to eat. Although we give them food parcels, it is hardly enough for them to survive," Ita said.

The trust sometimes goes out of its way to care and support People Living With Aids (PLWHA) but, according to Ita, this can only happen when the donor funded trust has money.

For some women whose husbands have accepted their spouses' status, support in terms of giving them money for basic needs of the households has decreased tremendously. For instance, Rainhard said that after her husband learnt about her status, he stopped giving her money apparently because his salary was reduced.

"He never supported me properly again. He says his salary is now very low," she said. Rainhard has had to take up selling cosmetics to support the family, who along were supported by the husband.

Uzombala also sells beauty products, whose proceeds she uses for her daily needs and needs of her school-going children.

The ACT says people need a lot of awareness to change their mindset to start assisting people in need.

"Our population is so small such that we can support each other.

Instead of buying six cars each, we should adopt families whom they can help," added Ita.

Although many are laid off from their workplaces with the excuse that they are not fit for work, Ita said many PLWHA are fit and could work.

The trust has several women who at the moment are looking for work to be able to sustain themselves and their families.

The trust is also in need of clothes and food, which could be given to those that need them.