BURUNDI: Food cuts for HIV-positive people worry NGOs

By, Reuters Foundation, November 14, 2006

BUJUMBURA - AIDS advocacy groups in Burundi are worried that a decision by the United Nations World Food Programme (WFP) to cut special feeding programmes next year for HIV-positive people will harm their long-term health.

Drought, crop disease, endemic poverty and more than a decade of instability mean Burundi suffers from serious food insecurity. WFP is expected to feed an estimated 874,000 Burundians by the end of 2006, including particularly vulnerable groups such as internally displaced persons, school children and HIV-positive people.

However, the agency's new policy means that feeding programmes for people infected and affected by HIV/AIDS will come to an end in December 2005 and will not be renewed.

"We have previously considered people infected and affected by HIV as a separate category of beneficiaries," Guillaume Foliot, programme manager for WFP in Burundi, told IRIN/PlusNews. "But we found that we were diverting an important tranche of our monthly food distribution to HIV patients, when the fact of being HIV positive in itself does not make one vulnerable - many people can carry on working and can purchase food, whereas people in northern Burundi [who are worst-affected by food insecurity] sometimes have literally nothing to eat."

Burundi is struggling with a 500,000-tonne food deficit, but WFP is able to provide just 70,000 tonnes in aid. "People infected and affected by HIV/AIDS have been taking up between 10 and 15 percent of our monthly distributions," Foliot said.

Local AIDS organisations dependent on WFP assistance are worried that the end of the programme could have disastrous consequences for already vulnerable people.

"We have been feeding orphans, child-headed households and our most desperate patients with WFP food, but with the programme coming to an end, we do not know what is going to happen to them," said Jeanne Gapiya Niyonzima, a leading AIDS advocate and president of the National Association to Support HIV-positive People. Gapiya's organisation has 1,700 people on life-prolonging antiretroviral (ARV) drugs, hundreds of whom are currently receiving food aid from WFP.

Foliot said WFP would continue to provide food to people starting on ARVs for the first nine months of treatment, which Gapiya - herself HIV-positive for several years - said was insufficient.

"I have been on the drugs for years and I still need a very good diet to feel okay," she said. "We are negotiating with WFP to see if they can continue feeding the patients who really are in urgent need."

The Burundi chapter of the Society for Women Against AIDS in Africa (SWAA), which runs a programme for prisoners, said WFP's decision would also affect the health of the country's HIV-positive inmates.

"Conditions in prison are really difficult; the inmates do not get a balanced diet, which is especially dangerous for HIV-positive people," said Baselisse Ndayisaba, coordinator of SWAA Burundi.

Foliot said WFP's decision was made after consultations with the Burundian Ministry of Health and UNAIDS to allow the agency to focus on the "the worst of the worst". Apart from the programme for HIV-positive people, programmes for elderly people in institutions, street children and hospitals have also been cut.

"There are so many thousands of people in Burundi who desperately need food, and those HIV-positive people who are indeed vulnerable should still qualify for food aid under one of our other vulnerable categories," he added.

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MOZAMBIQUE: WFP halves rations for the hungry

By, IRIN PlusNews, November 10, 2006

MAPUTO, 10 November (PLUSNEWS) - A funding shortfall of more than 70 percent has forced the United Nations' World Food Programme (WFP) to halve its rations to hungry Mozambicans, ahead of the critical "lean season" between harvests, when food stocks generally run out. The cut has come at a critical time, when food is at its scarcest and most expensive.

The food aid agency urgently requires US$10 million to feed 460,000 people between now and March 2007, when the next harvest is due. WFP currently assists 292,000 vulnerable people, but a 77 percent shortfall in funding has deprived hundreds of thousands of half the ration of cereals and corn-soya blend they have been using to stave off starvation.

"We are very concerned, because we are not talking about small numbers: some 240,000 people have no food security; half of those people are living in arid areas where they cannot farm; they have nothing. And now we are about to enter into a period of emergencies, with possible cyclones and floods. We should have stockpiles of food in case of emergencies," said Paulo Zacula, Director of Mozambique's National Disaster agency (INGC).

Karin Manente, WFP Acting Country Director in Mozambique, told IRIN, "By this time, we have usually pre-positioned food stocks in areas that become inaccessible during such emergencies." She added that due to the huge shortfall, some WFP-supported activities might have to be discontinued or suspended during November unless new donations were received.

The reason for the shortfall in donor funds could be partly due to the fact that Mozambique has had a better harvest than in previous years. Preliminary results of the 2006 assessment indicate that food security and nutrition improved substantially. The country produced 2.3 million mt of cereals, including carryover stock, compared to a national requirement of 2.6 million mt.

"Although WFP scaled back its activities, we continue to focus on pockets of food insecurity. We are currently making appeals to the donor community both here and abroad," said Manente.

Teresa Antonio, 27, a resident of Beira, capital of the central province of Sofala, is among those directly affected by the cut in rations. She was close to tears as she tried to soothe the hungry baby cradled in her emaciated, rash-covered arms.

"I have no money to buy milk for my child," said Antonio, who is living with HIV and is on antiretrovirals. A representative of the local Association of People Living with HIV and AIDS, who are given WFP rations to distribute each month to members suffering food shortages, has promised to help her but warned that there are too many in her situation.

Beira has the highest HIV/AIDS prevalence rate in the country, with at least 26 percent of its adult population infected. Nationally, the prevalence rate is 16.2 percent and rising.

Christaine Rudert, Health and Nutrition officer with the United Nations Children's Fund (UNICEF), was also concerned about the impact that the cuts could have on her agency's programmes. "We could see an increase in the numbers of severely malnourished children, who will then need therapeutic feeding, which, although it is not in short supply, is much more expensive than food rations."

The disaster agency's Zacula said Mozambique had taken action to reduce its dependence on food aid. In March this year, the government approved a $40million disaster management plan covering the next 10 years, with the aim of reducing the number of people dependent on food aid by 10 percent per year. The initiatives include providing at least nine cu.m of water for drinking, and 500cu.m per family for irrigation.

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KENYA: HIV exacerbates malnutrition among infants in drought-prone Turkana

By, IRIN PlusNews, November 2, 2006

LODWAR - A high incidence of HIV has worsened the condition of hungry children in drought-prone Turkana region, in northern Kenya.

Over the past month, seven of the 10 children admitted to a nutritional rehabilitation centre at the hospital in Lodwar, Turkana's largest town, were found to be HIV positive. Turkana has a high HIV prevalence rate of 11.4 percent, almost double the national rate of 6.7 percent estimated by UNAIDS.

"HIV is an increasing problem in Turkana, the rate here is high," said Seife K-Yohannes, nutrition coordinator for Merlin, a UK-based healthcare NGO. "Most of the HIV-positive children have a poor appetite, nausea and vomiting and frequent uncontrolled diarrhea, so they become very dehydrated and lose a lot of nutrients."

The problems associated with HIV start early, according to Mary Anne Macharia, a nurse at the Merlin-run rehabilitation centre. "If the mother is infected, she gives birth to a child with a weak constitution and then she struggles to provide enough milk to the already weak child".

The pastoral and farming communities of Turkana have been especially vulnerable to the severe year-long drought afflicting the Horn of Africa. A recent survey by Unicef, the UN children's agency, found that acute malnutrition rates were dangerously elevated in all parts of Turkana. It recorded a global acute malnourished rate of 20 per cent, above the World Health Organization critical point, which is 15 percent.

Severely malnourished children admitted to the centre are given Plumpy'nut, a peanut-based therapeutic food paste. The meal requires no additional preparation and leads to rapid weight gain provided there are no other health complications.

But poverty and chronic food insecurity often forces the entire family to share the supplement. For HIV-positive children, even a sufficient quantity of the Plumpy'nut supplement is not always enough. Merlin refers these children to a local church-run programme that provides paediatric ARVs.

Besides the rehabilitation centre, Merlin operates an infant feeding outpatient service that visits 100 different villages every week.

Despite the availability of treatment, fear and stigma associated with HIV means that few people in Turkana volunteer for HIV testing. Only four out of 19 mothers who were offered testing during a seven-week period at the rehabilitation centre accepted it - three of them tested positive.

The few women who know they are infected, receive drugs to lower their chances of transmitting the virus during childbirth, but lack of access to formula milk means there is still a chance their babies will become infected: "Because of the drought here, there is no supplementary feeding [to replace breast milk] and no reliable sources to get food or even water," Macharia said.

Additionally, food insecurity makes HIV infected mothers particularly vulnerable to other health problems. "Often they survive on one meal a day, this is not satisfying or balanced," said Ewoi Bengunn, the supervising clinical officer at the rehabilitation centre. "When the immunity is low, there is nothing to fight the infections. We see many respiratory infections, kala-azar [also known as leishmaniasis, a tropical infection spread by sand flies] and recently severe skin infections, measles and, of course, lots of diarrhea and vomiting."

Yakish Eyapan, the district's HIV/AIDS and sexually transmitted infections coordinator, explained that the pandemic had to compete for attention with many other pressing issues.

According to Eyapan: "The problem with Turkana is that it has many neglected issues that are more important to people than HIV... like food insecurity, water, education and poverty. If people have no water and are hungry, how can you talk to them about HIV?"

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SAO TOME AND PRINCIPE: HIV-positive mothers reject formula feeding

By, IRIN PlusNews, November 1, 2006

SAO TOME - Poverty and a cultural preference for breastfeeding are driving the spread of HIV from mothers to their babies in Sao Tome and Principe.

The HIV rate among pregnant women on the tiny West African islands tripled from 0.5 percent to 1.5 percent between 2001 and 2005.

"The number of cases is growing every year," said Luis Bonfim, the UN children's fund health project officer. "We were hoping that with increased support, the rate would either stagnate or reduce. So it's clear that something isn't working."

HIV testing in Sao Tome and Principe is free and health workers say they have no problem persuading pregnant women to test for the virus, adding that most of them who discover they are HIV positive agree to take antiretroviral drugs to prevent transmission of the virus to their unborn child. Others, however, prefer to visit traditional doctors or avoid treatment altogether.

Health workers point out that at present, many women risk post-natal transmission by opting to breastfeed because they cannot afford formula milk. "We recommend that HIV positive mothers feed their babies formula milk, but in most cases this doesn't happen because of the financial difficulties they face," said Antonio Amado Vaz, medical doctor and executive director of the Sao Tome Association for Family Promotion (ASPF).

"A small tin of formula milk costs around 80,000 dobras (US$ 6) and it doesn't even last two weeks. There is no aid programme to help HIV-positive women pay for the milk and they can't afford it. This is a big problem, it is not sustainable," he said.

Sao Tome is currently trying to access financing from the Global Fund to Fight AIDS, Tuberculosis and Malaria to help support HIV-positive mothers.

Next to the financial constraints, many HIV-positive mothers decide not to feed their babies formula milk because they fear it will attract suspicion from family and friends.

"When the baby comes it is hard to convince people to use formula milk, even if they have been doing the [antiretroviral] prevention during pregnancy," said Alzira do Rosario, a medical doctor and coordinator of Sao Tome's national AIDS programme.

"The grandmother will put pressure on the mother to feed the baby breast milk and the mother doesn't want to explain why she is using formula milk," she added.

Filomena (not her real name) knows the risks of breastfeeding only too well. She believes her son contracted HIV from her breast milk, which she fed him from birth.

"I don't think he was born HIV positive. He was a fat baby; he weighed four kilos when he was born. At that time I didn't know I had HIV and so I breastfed him. Here in Sao Tome we are taught that this is the best thing you can do for your child. It was only after about six months that he stopped putting on weight and I realised something was wrong," she said.

Filomena's son is one of only a few Sao Tomean children who are known to be living with HIV, but health workers fear these figures are likely to continue rising. They say that the stigma attached to HIV/AIDS in Sao Tome is promoting behaviour that is likely to increase the incidence of mother-to-child transmission.

While most of the 170,000 people living in the twin-island nation are poor there are high hopes that crude oil exploration may lead to a brighter economic future. Sao Tome and Principe currently relies on small agricultural exports and substantial donor funding. Its external debt stands at around US$300 million.

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