SUDAN: People with HIV demand safe drinking water

By, IRIN PlusNews, May 12, 2008

For years, Lole Laila Lole had to drink, cook with, and bathe in the dirty, contaminated water he fetched from the River Nile. "There was no other way," he told IRIN/PlusNews.

Lole, chairperson of an association for people living with HIV/AIDS in southern Sudan, discovered he was HIV-positive after falling ill in 2002 and travelling to the Sudanese capital, Khartoum, where the country's only HIV testing facility at the time was located.

Due to their weakened immune systems, people living with HIV are particularly susceptible to infections and diseases that can be present in untreated water. But after testing positive, Lole was forced to return to the virtually non-existent water system of Juba, the southern capital, which had been at war for close to two decades.

The conflict ended in 2005, but government leaders in the south say they lack adequate resources to redevelop the war-ravaged region and deliver services such as providing safe water.

Since the end of the war, treatment tablets have become available in the shops, and HIV-positive people who can afford them are now able to protect themselves from the outbreaks of cholera and other diarrhoeal diseases that are common in this region.

This year, non-profit organisation, Population Services International (PSI), with funding from the United States Centres for Disease Control, began including water treatment tablets in the basic care packets they distribute to people with HIV every three months.

Water Guard, the brand name of the tablets being distributed, is helping to keep people healthy in areas of the south where antiretroviral treatment is unavailable. Each care packet contains 90 tablets, and each tablet treats 25 litres of water. The packet also includes a jerry can with a tap at the bottom, water containers, condoms, two mosquito nets and educational materials on malaria and how to prevent HIV infection.

"The health indicators [in southern Sudan] are very low," said Erin Stuckey, HIV/AIDS technical advisor to PSI in southern Sudan. "If you have a high incidence of watery diarrhoea and a high incidence of malaria, the HIV-positive people would be affected the most."

The decision to include Water Guard in PSI's care packets was partly in response to pressure from people living with HIV. The fruits of this effort were visible last month, when hundreds of HIV-positive people swarmed the office of the Sudan Council of Churches in Juba. Five hundred people received packets, but more than two hundred had to be turned away.

Women in Sudan also face very high maternal health risks, which are exacerbated by the unavailability of clean water. According to the United Nations Population Fund, a Sudanese woman's lifetime risk of dying from pregnancy-related causes is estimated at 1 in 30. The risks are significantly higher for HIV-positive mothers and babies, particularly if they are unable to access safe drinking water.

"It's a major concern for us; we feel that they must have access to clean water," said Dr Angok Kuol, executive director of the Southern Sudan AIDS Commission. "If they don't have safe water, they are always prone to infections such as watery diarrhoea."

PSI's Stuckey said the programme to distribute care packets to people living with HIV would be expanded into other areas of southern Sudan in the near future. Meanwhile, several organisations, including the UN Children's Fund (UNICEF) and Solidarités, a French non-governmental organisation, are raising awareness about hygiene and sanitation, drilling boreholes and repairing existing water points across the south.

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Source: http://www.plusnews.org/Report.aspx?ReportId=78148

WHO To Launch Campaign Aimed at Improving Nutrition Among HIV-Positive People in South, Southeast Asia

By, Kaisernetwork, October 17, 2007

The World Health Organization soon will launch a campaign in South and Southeast Asia aimed at making nutrition programs a central part of HIV/AIDS treatment in the region, Randa Saadeh, a scientist in WHO's Nutrition for Health and Development Department, said recently, Inter Press Service reports. Saadeh was speaking at the end of a weeklong meeting in Bangkok aimed at increasing support for the campaign and ensuring that governments in the region have measures to implement program in place by 2009.

According to Saadeh, this is the first time the region has been targeted to improve nutrition as part of its effort to fight HIV/AIDS. "We want governments to adopt strong positions on this link" between HIV/AIDS and nutrition "as a solution," she said. The campaign follows a similar WHO initiative in sub-Saharan Africa that was launched after the approval of a resolution that formally recognized the link between nutrition and HIV/AIDS at the 2006 World Health Assembly in Geneva, Switzerland, Inter Press Service reports. The resolution called on governments to "make nutrition an integral part of their response to HIV/AIDS."

According to WHO, HIV-positive adults and children need 10% more energy than HIV-negative people to maintain their weight. People who have progressed to advanced stages of the disease require 20% to 30% more energy, and HIV-positive children who are losing weight need 50% to 100% more energy to maintain their weight, WHO said. In addition, the growth of HIV-positive children who do not have access to proper nutrition is hindered and can lead to opportunistic infections that "place an additional demand" on children's energy and nutrient needs, according to WHO. HIV-positive people who are malnourished also are at an increased risk of malaria and other diseases, Nigel Rollins, a professor of maternal and child health at the University of KwaZulu-Natal in South Africa, said.

Studies conducted among the estimated four million people living with HIV/AIDS in South and Southeast Asia in 2006 found that many people had difficulty accessing proper nutrition. "High malnutrition rates persist in the region, and food is often identified as the most immediate and critical need by people living with HIV and others affected by the epidemic," WHO said.

Prasada Rao, head of the Asia-Pacific division of UNAIDS, said that HIV-positive people taking antiretroviral drugs might be unable to handle the medication without proper nutrition. He added that low-income populations without proper nutrition also might sell antiretrovirals for money to purchase food. Current "nutrition policies of governments" in the region "do not address the HIV/AIDS concerns," Rao said, adding that HIV/AIDS and nutrition "have to be addressed together, as one" (Macan-Markar, Inter Press Service, 10/14).

KENYA: Food shortages complicating ARV programme in the north

By, IRIN PlusNews, September 6, 2007

Food shortages in arid, remote northern Kenya are making it impossible for HIV-positive people in the region to adhere to their antiretroviral (ARV) medication regime, relief workers say.

The life-prolonging ARV drugs have been labelled "death drugs" because of the effect they have on patients who take them without adequate food, according to Ahmed Mohamed Patel, a volunteer with the Kenya Red Cross in Isiolo, in Kenya's Eastern Province, which borders Ethiopia in the far north of the country.

"The safety and effectiveness of the drugs depends on the food intake ... unfortunately, most of the victims are poor and cannot afford a simple bite of food," he told IRIN/PlusNews. "The expected relief and intended assistance will never be achieved unless the problem is addressed."

Health workers said many HIV-positive people were opting to stay off the drugs rather than suffer the side effects of taking them on an empty stomach. The government has initiated a free food programme to assist families of people infected and affected by HIV in Isiolo but, so far, only 30 families have been benefiting.

"The food assistance programme is a big relief to the poor and their families; we know there are many deserving cases, but cannot assist all of them," said Isiolo district commissioner Evans Ogonkwo. "We are planning to expand and help more people."

Galma Aliof, of Isiolo Youth against AIDS and Poverty, a non-governmental support group, alleged that corrupt officials affiliated to the organisations providing free food have been selling the food supplements rather than giving them to needy families.

"Some of the officials heading these organisations are using this sad situation to make money ... they sell food openly," he said. "The other day an HIV-positive person died at Kulamawe village [near Isiolo], and yet a food store next to his house was filled with food."

Health workers have also complained that ARVs have not been reaching all those who need them. Although the government has been distributing free ARVs nationally for more than a year, many areas in the north, other than the main towns, are not served by a road network and have no access to the life-prolonging drugs.

Need to decentralise HIV services

"Infected persons have to travel to the district headquarters in case they need the drugs; it is expensive and many would rather not make the trip," said Sofia Shano, an HIV/AIDS counsellor in Isiolo.

Even where health facilities existed in remote areas, there was no electricity to store drugs that needed refrigeration. "Health centres in remote areas must be equipped with solar panels [to generate electricity for refrigeration] to help store the drugs," Shano said.

Margaret Leshore, patron of the Samburu East Women's Empowerment Programme, a non-governmental organisation advocating women's rights, told IRIN/PlusNews that all HIV programming, including testing, advocacy and treatment, needed to be taken to "the grazing fields, livestock market and watering points", where the region's mainly pastoralist communities could easily be found.

Although northern Kenya has some of the country's lowest HIV-prevalence rates, the region also has very low levels of awareness, and the nomadic lifestyle of its inhabitants means HIV service providers must find innovative ways of reaching all the area's resident with their messages.

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Source: http://www.plusnews.org/Report.aspx?ReportId=74162

South African experts say food no substitute for medical drugs in AIDS and TB

By, News-Medical.Net, August 22, 2007

A report by the Academy of Science of South Africa has stated that there is no evidence to support the theory that a healthy diet is a substitute for medical drugs when it comes to treating HIV/AIDS and tuberculosis (TB).

The scientists conducted a comprehensive study on the links between nutrition and treatment and found that no food has been identified as an effective alternative to appropriate medication in fighting HIV/AIDS and TB.

The South African government currently stresses that nutrition as well as drugs is important in the fight against these devastating diseases despite the fact that the country's health minister has earned herself international ridicule and the nickname "Dr Beetroot" for her views.

Dr. Tshabalala-Msimang has been criticised in the past for stressing the benefits of beetroot, garlic and potatoes in fighting HIV and under-playing the role of anti-retroviral (ARVs) drugs.

South Africa has one of the world's highest HIV infection rates and the country's researchers say that scientific evidence about conditions in South Africa was urgently needed.

The report by the country's top scientific advisory panel concludes that though nutrition is important for general health, is not sufficient to contain either the HIV/AIDS or the TB epidemic and says a well-fed population on its own will not resist HIV/AIDS without anti-retroviral (ARV) drugs.

A more comprehensive approach on the part of the government now means about 280,000 people were on ARV treatment at the end of March this year but that falls well below the estimated 800,000 who are thought to need ARVs in South Africa.

South Africa has one of the world's highest HIV infection rates with an estimated 12% of the country's 47-million population infected with the deadly virus.

South Africa's healthcare system struggles to cope because of a lack of doctors and nurses, many of whom have left the country for better pay abroad; the fight against AIDS has also been confused and hampered by the conflicting messages sent by senior government officials such as Health Minister Manto Tshabalala-Msimang.

Deputy health minister Nozizwe Madlala-Routledge was sacked this month for insubordination, provoking an outcry from AIDS activists who strongly backed her policies and critics who say she was fired for political reasons.


Source: http://www.news-medical.net/?id=28994

South Africa: New report confirms nutrition no substitute for treatment

By, IRIN PlusNews, August 22, 2007

There is no evidence that better nutrition can substitute for antiretroviral (ARV) treatment, a new report has found. These findings might seem unremarkable anywhere else in the world, but not in South Africa, where the issue of nutrition has been tainted by a damaging debate that has tended to frame it as an alternative to ARVs.

Statements by Health Minister Manto Tshabalala-Msimang, suggesting that eating garlic, beetroot and olive oil, could delay the need to take ARVs, have created widespread confusion in the country with the world's highest HIV caseload.

A multidisciplinary panel of 15 members of the Academy of Science of South Africa (ASSAf), an independent statutory body considered to be the national academy of science for the country, spent nearly two years reviewing an estimated 2,000 studies on the role of nutrition in the HIV and TB pandemics.

Drawing on literature as well as years of field experience, the panel formed a consensus on the role of nutrition and reviewed guidelines from the World Health Organisation (WHO), the South African Department of Health and the Southern African HIV/AIDS Clinicians Society to see how the guidelines matched the science.

The report concluded that no evidence exists to back claims that better nutrition alone can treat HIV or TB - let alone curb these pandemics. Such assertions have led many South Africans to question high-level commitment to ARV promotion and the national rollout.

"Neither poverty nor malnutrition is the cause of HIV/AIDS or tuberculosis," said Prof Este Vorster, director of the Africa Unit for Transdisciplinary Health Research at Northwest University and panel member. "If you've been tested for HIV and you know your status, you need to know that dietary supplements cannot compensate for healthy eating; in the same way, eating healthily cannot compensate for antiretroviral drugs."

Many studies indicated improved outcomes for patients practising better nutrition in addition to drug treatments. For instance, the intake of macronutrients, such as carbohydrates, fats and proteins, was a strong indicator as to how fast people living with HIV and on treatment would progress to AIDS, said Jimmy Volmink, a clinical researcher at the University of Stellenbosch, but such studies on the role of nutrition in HIV and TB were rare.

He noted that among the small number of studies available, most had been conducted in high-income countries, where populations tend to be better nourished and treated. Questions remained as to the applicability of these studies in lower-income settings or even more socio-economically complex settings such as South Africa.

"We might be one country, but we are not one nation yet," he said. "We need to be aware of disparities between the haves and the have-nots; we need to see what works in specific situations."

Besides identifying a lack of research on nutrition in South Africa, the report noted confusion about the role of nutrition in HIV, which was being exacerbated by a dual system of medicine regulation that subjected "Western" medicine to much more rigorous controls than complementary medicines, such as immune boosters and nutritional supplements.

"If you simply put together something, put it in a bottle and sell it for R300, it's never checked," said Wieland Gevers, ASSAf's executive officer and panel member.

Consequently, HIV-positive people, family members, caregivers and the community were not only confused about the validity of medicines and nutrition, and what roles they played, but also distrustful of medical doctors and prescription treatments, according to the report.

The duality in regulatory practice arises from the contrast between Western scientific tradition, with its enormous emphasis on rigorous testing, and traditional medicine and the politics related to tradition in South Africa, he said.

"In traditional medicine, we have a different approach: it is seen as wisdom passed on. It's simply, in a sense, experience in practice," he said. "Traditional medical practitioners say that part of the remedy is the patient's belief in the remedy itself, and it's very hard to test that in a controlled study."

"Also, there are the special conditions of the historical transitions," he said. "Nobody wants to be very heavy handed with the traditions of the majority - about 80 percent of South Africans would go to a traditional healer first; it's very hard to regulate a tradition that the majority of the population thinks is okay," Gevers said.

Although the report did not focus on the debate about the regulation of traditional versus "Western" medicines, it noted the need for better regulation of "traditional" or "alternative" medicines, and to educate the population about their uses. According to Gevers, the health department and the Medical Research Council were moving in that direction.

The report has been released at a tumultuous time for the health minister and her department. Earlier this week, claims surfaced in the South African media that Tshabalala-Msimang's heavy drinking may have prompted her liver problems and subsequent transplant, and that her position and influence had pushed her to the top of the recipient list.

Deputy Health Minister Nozizwe Madlala-Routledge, who was fired less than two weeks ago, has also been at loggerheads with the health minister over her stance on nutrition, ARVs and other health issues.

"I want to stress that this not part of any political issue; the project had a dynamic of its own," Gevers said, pointing out that the timing of ASSAf's report on nutrition was coincidental. "We saw a need for this study; in these highly controversial areas of nutrition everybody's an expert, and you have to be sure of your ground."

The WHO, the South African Health Department and the Southern African HIV/AIDS Clinicians Society, whose guidelines were reviewed, have not yet commented on the study but ASSAf said it was too soon to expect a response. Tshabalala-Msimang received an advanced copy of the report.

"The health department is likely to be preoccupied with other matters right now, but we expect to give a detailed presentation to explore how we can link our research with current interventions," Gevers said.

To read the report's findings and recommendations in full, go to http://search.sabinet.co.za/images/ejour/assaf/Study%20%20pdf%20final%20ASSAf%20HIV%20TB%20and%20Nutrition%20doc.pdf

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South Africa: Chewing Over the Research On HIV/Aids And Food

By, Barry Mendelow, Business Day (Johannesburg), August 22, 2007

There is an astonishing abundance of over-the-counter products, extracts made from food and food supplements, which claim somehow to modulate the human immune system to prevent or treat deadly infections such as HIV and tuberculosis. Such mixed messages about nutrition have been harmful from an individual level all the way up to the level of government policy and implementation. An unambiguous message has emerged from a 16-month analysis of all the relevant research, which we did, with many colleagues, under the auspices of the Academy of Science of SA: there is no evidence that better nutrition is an alternative to the correct medications at the correct times.

We are not saying nutrition is insignificant. Healthy eating habits still have a hugely important role to play in managing these infections. Eating a variety of food, including fruit and vegetables, daily is especially important in developing countries, where nutritional deficiencies are rife.

Nutritional support is helpful. But nutritional support cannot substitute for the specific combinations of drugs required to cure the TB infection or reduce the amount of HIV to undetectable levels.

Much of the previous coverage of the intersection of nutrition, HIV and tuberculosis has focused on politics and personalities. We suggest that some of the factors contributing to the uncertainty are scientific in nature.

One is the desire for a solution without the evidence to back up the claims. The academy panel has noted the startling lack of welldesigned, relevant studies in the field of nutritional intervention for people with HIV and/or TB. This absence of thorough research, before or after specific medical treatment is started, is a sad reflection in a country and continent in which hunger and micronutrient deficiencies are common.

Another factor that may be contributing to the confusion in the debate about nutrition and infections is simply the astonishing complexity of food. Plants have evolved to contain thousands of chemicals. Some affect humans. Few are well understood.

Another issue is the need for common guidelines. We need to agree on the best ways to test how malnourished a person is. We need reliable, appropriate, affordable tests. We need more sensitive ways to measure the depletion of vitamins and minerals. We need intensive research on vitamins, now known to be far more active in parts of the body that play a critical role during HIV infection.

We need much more research into whether specific kinds of nutritional support can assist in staving off the day when antiretroviral drugs are absolutely required.

And recent research showing how the gastrointestinal tract (the gut) plays a pivotal role in the speed and severity of HIV replication suggests that the intestine will be a major site of new advances against AIDS.

We have recommended to the science and technology and health departments that this absence of sound scientific research should be tackled as a priority.

We need to make it clear that we did not conduct new research ourselves. That is not the role of an academy. It is not meant to replace a university or a research council. What we can do is bring our particular skills to analyse and assess the existing research.

In this case, given the controversies, we thought it was essential that all the evidence, international and local, was thoroughly reviewed by an independent, impartial, multidisciplinary and authoritative panel.

So in 2005 the Academy of Science appointed a panel of 15 researchers with a wide variety of experience and expertise, including nutritionists, immunologists, biochemists, infectious disease physicians and paediatricians, policy experts and epidemiologists.

Many of these fields have been isolated from each other. This consensus panel was beneficial as it forced people to confront the latest news in areas outside their own specialisations. Since then, these researchers have systematically picked away at the myths, marketing hype and salesmanship that have thrived like weeds around two of the most serious diseases facing humanity.

For 16 months, we have carefully reviewed a vast amount of research. We are probably pioneers in bringing together separate medical fields that have seldom met, in what has been a very creative process. Many promising new avenues of research have opened up.

It is possible that in future, some types of foods may be confirmed in exhaustive and reputable scientific analyses as having some beneficial power to reduce the onslaught of HIV, especially if they dampen the early inflammation caused by the virus in the gut.

But there is enough evidence currently to suggest caution in any case in which exaggerated claims are made on behalf of any food, nutritional supplement or plant chemical. And under no circumstances should people be going off medically prescribed drugs in favour of a particular diet or vitamin.

Mendelow, a professor emeritus based at Wits University and the National Health Laboratory Service, chaired the panel investigation. Dr Ncayiyana, editor of the South African Medical Journal, Dr Dhansay of the Medical Research Council, and Vorster, a nutrition professor from the University of the North West, helped assess the research.

Source: http://allafrica.com/stories/200708220209.html

HIV/AIDS and food insecurity: Double jeopardy

By, Kate Harper, The International Development Research Centre

In 1989, while working at the Food and Agriculture Organization of the United Nations, Stuart Gillespie spent six months examining the connection between HIV/AIDS and food security. It quickly became clear to him that the epidemic’s long-term impacts could have a devastating effect on hunger throughout the developing world.
Seventeen years later, he continues to emphasize this connection as a senior research fellow with the International Food Policy Research Institute (IFPRI) and cofounder of the Regional Network on HIV/AIDS, Rural Livelihoods and Food Security (RENEWAL), partly funded by Canada’s International Development Research Centre (IDRC).

Reaching the MDG targets

Gillespie says that responding to the connection between HIV/AIDS and food security is now more important than ever, particularly in the context of the UN Millennium Development Goals (MDGs), drafted in 2000 and subscribed to by all 191 UN member countries. Halting or reversing the spread of HIV/AIDS, and halving the proportion of the world’s population living in extreme hunger are two of the eight MDGs to be achieved by 2015.

“There’s no way that Africa will reach the Millennium Development Goals by 2015 without addressing HIV/AIDS and food security together,” Gillespie says. “Both challenges are now so intertwined that they cannot be compartmentalized.”

To help tackle these issues, RENEWAL was launched in 2001 at a conference on HIV/AIDS, rural livelihoods and food security in Malawi as a joint project between IFPRI and the International Service for Agricultural Research (ISNAR). Currently active in Ethiopia, Kenya, Malawi, South Africa, Uganda, and Zambia, RENEWAL’s goal is to increase the “HIV-responsiveness” of agriculture, food, and nutrition policies and programs and to identify actions that could help reduce people’s exposure to HIV and lessen the impact of AIDS.

For example, research has shown that those affected by HIV and AIDS may be less likely to access a diverse mixture of crops needed for adequate nutrition, as the disease weakens their productivity. Dietary quantity and quality deteriorates, creating further health problems. RENEWAL researchers say this can be solved through more HIV-aware development policies and practices linked to improving access to information on the disease and the importance of nutritional support within prevention, care, and treatment.

After the 2001 Malawi conference, researchers began to see the advantages of working together in a network to strengthen their capacity, sharing information to inform policy.

In its first phase, launched in 2002, RENEWAL expanded into a “network of networks,” linking local researchers across sub-Saharan Africa through a series of eight studies examining HIV/AIDS and food security.

“We thought, ‘Why should we just limit this to one or two countries? Why not try and maximize that kind of interaction by going regionally as well?’” Gillespie says.

Maximizing results on a national level

In the project’s second phase, the results of these studies were compiled, and a further nine were initiated. The original studies continue to be used to inform national policies and programs. For example, in Malawi, the government met with RENEWAL researchers to draft an AIDS and agriculture strategy. Piloted in 2004 near the capital, Lilongwe, and officially launched in 2005, the strategy aims to integrate food and nutrition security interventions with HIV and AIDS prevention programs.

In the future, RENEWAL aims to encourage studies that focus on more local and regional issues. This is part of an effort to expand its influence beyond the food and nutrition community by targeting international organizations, including many that deal with health or HIV policy.

A study in Malawi, for example, found that the risk of sexually transmitted diseases increased during the “hungry season.” As local residents faced a decreasing food supply, some had little choice but to resort to high-risk transactional sex, to support themselves and their families.

Renaud De Plaen of IDRC’s EcoHealth program says that the research results from Malawi illustrate the need to examine HIV/AIDS not just from a health standpoint, but from a food and nutrition perspective as well.

“The more people are affected, the harder it becomes for them to produce enough food, and the more vulnerable they become,” De Plaen says. “As the most vulnerable are often the most at risk, it becomes a vicious spiral.”

Gillespie agrees. “People who are extremely poor or food insecure are more likely to be at risk of being exposed to the virus, and being infected,” he says. “Then later, their households are at greater risk of becoming irreversibly poorer because of this infection”

Involving key stakeholders

At the regional level, RENEWAL is supported by National Advisory Panels (NAPs) of about 10 members, which include representatives from the local agriculture and health sectors, nongovernmental organizations, and AIDS-related groups within each country of operation. Involving those closest to the issue is key to solving problems, and is an important part of the RENEWAL research process, Gillespie says.

“To have a real and sustained impact, certainly at a national level, all key stakeholders grappling with this crisis have to be fundamentally involved,” he says.

A third phase of RENEWAL, set to launch in 2007, will end in 2010, the year the UN aims to have achieved several benchmark goals for HIV/AIDS, as outlined in its 2001 Declaration of Commitment. This next phase will involve more activity throughout sub-Saharan Africa as well as in India and will increase connections with international AIDS organizations. Another goal is to eventually make the networks self-reliant, Gillespie says.

“We need to keep our focus on the bigger picture,” he says. “Our ultimate goal is to have demonstrable impact on the food and nutrition sectors, as well as the health and HIV sectors, with regard to the interaction between the two.”

Though there’s still work to be done, more people are beginning to recognize the connection between HIV/AIDS and food security, says De Plaen.

“Four years after the initial phase, there is a general recognition among the scientific community that food security and HIV/AIDS cannot be looked at separately,” he says. “It’s very clear the only way to handle the AIDS crisis is through better collaboration between the health, food production, agricultural, and education sectors.”

Kate Harper is an Ottawa-based writer.

Source: http://www.idrc.ca/en/ev-100661-201-1-DO_TOPIC.html

Lesotho: Hungry for assistance

By, IRIN Plus News, July 18, 2007

In the wake of the most severe drought in 30 years, the kingdom of Lesotho has declared a state of emergency and appealed for international assistance for over 400,000 people in need of urgent food aid.

"Food assessments conducted by local and international institutions and organisations, including the [government's] Disaster Management Authority, the [UN] Food and Agriculture Organisation (FAO) and the World Food Programme (WFP), ... all confirm a food crisis," Prime Minister Pakalitha Mosisili said in a recent statement.

According to the FAO and WFP reports, the cereal harvest, of which the largest part is maize, Lesotho's staple food, has been slashed by over 40 percent, from 126,200 metric tonnes (mt) of cereals in 2006 to 72,000mt this year. Approximately 328,000mt of cereals are required to feed the country.

The rainy season in Lesotho usually lasts from October to April. Farmers at Thuathe, a farming area near the capital, Maseru, welcomed the prime minister's call for assistance, saying that without help they would have nothing to feed their families.

In normal circumstances, Malakabane Mokoatsi, a sharecropper and mother of six, produced 40 bags of maize from the eight hectares she tends. This year the yield was a mere 12 bags, six of which went to the other shareholder.

"This means that I am literally without food, as these six bags ... at the very most, will be able to feed my family until the end of September, and from then onwards I will be forced to buy."

Food prices soar

The significant drop in cereal harvests, such as maize and sorghum, has increased prices beyond the reach of many households. Reduced harvests in South Africa, the main regional supplier, have also contributed to the price hikes.

Mokoatsi said feeding her family would be a struggle, because the family's only cash income was $130 a month, which her son earned as a taxi driver.

"Field reports indicate that the price of 12.5kg of maize meal has nearly doubled since 2006, from $3.50 in March 2006 to $5.40 in March 2007. More than half the country lives on less than US$2 a day," said the latest Southern Africa Humanitarian Update by the Regional Inter-Agency Standing Committee, a group of UN agencies and humanitarian non-governmental agencies.

The crop failure has also reduced casual labour opportunities, especially in agriculture, making it even harder for the nation's poor to survive.

A chronic problem

"These assessments point to the vicious cycle of food insecurity brought on by erratic weather, prolonged drought, poverty and the impact of HIV/AIDS in the region," the update said, warning that although immediate food and agricultural assistance was required, it would not significantly change the long-term situation of the affected people.

Mapoloko Halieo, who also farms at Thuathe, said this was the worst harvest in years of investing in field and food production, and she had only managed to reap three bags of maize from her three hectares. She said her maize cobs were short and small, with underdeveloped grains.

"There were years when I did bad, but at least I could feed my family. This maize has not returned even my planting expenses, and I do not know what I am going to do," she said. "I might have to sell my cows, though I cannot expect to get much from them either, as they are thin and will not sell for much."

Mosisili said Lesotho produced about 30 percent of its total food requirement. "Furthermore, our people are going through untold hardships because of the unrelenting impact of HIV/AIDS [official estimates put prevalence at 23.2 percent] and the number of orphans is increasing each day.

Our people are going through untold hardships because of the unrelenting impact of HIV/AIDS and the number of orphans is increasing each day
His statement noted that "analysis of prices of basic food commodities indicate a drastic upward trend ... compounded by very low purchasing power - quite a vicious circle by all accounts."

Quoting a Basotho saying, loosely translated as "help is given to those who make an effort to help themselves", Mosisili said the government viewed the declaration "of food crisis and appeal for assistance as a short-term measure to alleviate famine", and appealed "for adequate resources to eliminate our dependency on food aid in the long term".

He said the government had devised strategies to ensure national food security in the future, which included identifying agriculture as the key factor in the poverty-reduction strategy; improving agricultural productivity and food security through maximum use of arable land, with subsidised inputs; promoting drought-resistant crops, and scaling up homestead farming/gardening.

Besides food shortages, there was also a critical shortage of water for human as well as livestock consumption, and the statement pointed out that "major streams and rivers are either dry or running low".

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Source: http://www.irinnews.org/Report.aspx?ReportId=73291

BURUNDI: Food cuts for HIV-positive people worry NGOs

By, IRIN PlusNews, August 15, 2007

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 2006 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, many 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.

Source: http://www.irinnews.org/report.aspx?reportid=61557