UGANDA: Hunger kills you faster, say HIV-positive northerners

by, IRIN PlusNews, October 26, 2006

Life-prolonging antiretroviral (ARV) medication is rare enough in war-damaged northern Uganda, but the lucky few able to access treatment have the additional problem of finding enough food to go with the powerful drugs.

With the support of Catholic Relief Services and the European Union, 670 people receive ARVs from St Joseph's Hospital in the northern district of Kitgum, the largest provider of drugs in the district, but this represents just 24 percent of the hospital's HIV-positive patients who need treatment.

"For the rest, we just have to treat their opportunistic infections as they get them," said Robert Ochola, coordinator of HIV/AIDS programmes at the hospital. "For children, we are only able to treat 30 percent of those who need the ARVs, and even then we do not have [paediatric] ARVs for them - they take the same drugs as the adults in different doses."

Kitgum is one of the districts most affected by two decades of war between the rebel Lord's Resistance Army and the government. About 90 percent of Kitgum's people live in camps for the internally displaced and are almost entirely dependent on relief aid, as insecurity has prevented them from farming.

It is even worse for the region's HIV-positive people, who need a healthy diet to maintain their immune systems to fight off the HI virus.

Some of the hospital's ARV patients receive nutritional support from the United Nation's World Food Programme and the Comboni Roman Catholic Mission, but qualification is not automatic: patients complete application forms and the organisations then decide who is eligible for the limited food aid.

The rations are enough to feed a family for a month. They make a real difference to the overall health of the patients, and increase the likelihood that they will adhere to the daily ritual of taking their ARVs, which can have unpleasant side effects even on a full stomach.

Sylvia Ocan and Christine Oyela have both been on treatment for two years, but only Oyela has qualified for nutritional support. Oyela looks healthy but Ocan is visibly undernourished and suffers from a condition that has left unsightly, dry patches on her face.

"I don't know why I did not qualify for the food, but I have no money to buy food and I get sick quite often," said Ocan, whose husband died from AIDS-related complications three years ago. "I make tablecloths and mats to sell, but my two children and I sometimes can spend the whole day without eating anything - I feel dizzy and weak if I do not eat when I take the drugs, and then I can't even work."

Despite these difficulties, Ocan has persevered with her medication, aware that if she does not she risks developing resistance to ARVs.

"The main reason for non-adherence among our patients is the lack of food. Of our 2,000 patients, just 819 are receiving food support," said Charles Odong, coordinator of Meeting Point, a local NGO helping HIV-positive people in Kitgum.

People who default on treatment often turn to traditional healers for remedies, which can make them even sicker, he said. With the support of relief agencies like the Italian NGO, Associazione Volontari per il Servizio Internazionale, Meeting Point provides home-care kits of soap and sugar to its members, and grants of school fees for their children.

"People are so desperate for food that many are willing to sell sex and risk contracting HIV because they say the disease will take some time to kill you, while the hunger will kill you immediately," said Odong. "Finding food for people in the region should be a priority for the government and aid agencies, because it helps those who are already sick and could also help prevent new infections."

Kr/oa/he


Source: http://www.plusnews.org/webspecials/ART/56020.asp

HIV/AIDS and Malnutrition Locked in "Vicious Cycle"

International community working to address hunger among people with HIV/AIDS

In many of the world’s poor regions, where HIV/AIDS has taken the worst toll, the virus and malnutrition are locked in a “vicious cycle” that worsens the impact of both.

“Insufficient intake [of calories] can enhance the progression of the virus,” said Suneetha Kadiyala, a scientist at the International Food Policy Research Institute (IFPRI) who participated in a panel on food security and HIV/AIDS at the Woodrow Wilson Center in Washington October 16.

The discussion was held in observance of World Food Day.

After six years of study, Kadiyala said, the damaging relationship between malnutrition and HIV/AIDS is becoming better understood. It can begin when a family member first begins to exhibit symptoms after HIV infection. His or her capacity to work – whether as a farmer or a wage earner – is diminished, possibly affecting household income and the availability of food for an entire family.

Already compromised by the presence of HIV, the immune system becomes even less effective at defending against infection when the body is malnourished.

As anti-retroviral drugs (ARV) become more widely available in poor regions where AIDS is taking the greatest toll, Kadiyala said, scientists also are discovering that malnutrition compromises the efficacy and increases the toxicity of medications.

“Improving the nutrition status of people is critical if ARV treatment is going to be successful,” she said.

Food insecurity also can increase individual risk for exposure to HIV, researchers have found. People who are hungry will leave their homes for food, expanding their social exposures and engaging in desperate behaviors that can make them more vulnerable to infection.

With this hard-won understanding, IFPRI is working to create expanded networks of policy-makers and health experts to raise awareness about the links among poverty, nutrition and disease in hopes of finding wider solutions.

Even though recent research is revealing more about the complexity of the interaction between HIV/AIDS and malnutrition, the need to include food assistance in a program to support those suffering from HIV/AIDS is well understood.

The U.N. World Food Programme, the sponsor of World Food Day, is feeding 9 million people infected with HIV/AIDS, according to Jordan Dey, director of the program’s U.S. relations office.

“Hunger is the greatest public health threat, and it undermines a nation’s development,” Dey said.

The United States is the largest donor of food assistance worldwide, investing more than $2.4 billion in that cause in 2005, according to a report presented to the U.S. Congress in early 2006.

The U.S. Agency for International Development and the U.S. Department of Agriculture are key players in delivering food assistance and supporting efforts under the President’s Emergency Program for AIDS Relief (PEPFAR) to reduce malnutrition among people living with HIV/AIDS and those affected by the disease.

Report on Food and Nutrition for People Living with HIV/AIDS (PLWHA), released by the Global AIDS Coordinator’s Office in May, outlines the specific objectives of PEPFAR nutrition programs:

• Improve the quantity and quality of diets among PLWHA,

• Build or replenish body stores of essential nutrients,

• Prevent or stabilize weight loss,

• Preserve and gain muscle mass,

• Prevent diarrhea and other infections that affect nutritional status, and

• Speed recuperation from HIV-related symptoms that affect food consumption and dietary intake.


Source: Charlene Porter, Washington File Staff Writer, USINFO.STATE.GOV, 16 October 2006