“We have a large number of patients with a BMI [body mass index, a measure of nutritional status] below the healthy cut-off of 18.5,” Fransiscah Yula, a nutritionist at the hospital, told IRIN/PlusNews.

An estimated 10 million Kenyans are battling a food crisis as a result of crop failure due to poor rains and drought, high food prices, and the effects of post-election violence in early 2008 that disrupted farming activities in Rift Valley Province, the country’s breadbasket.

Yula said she counselled HIV-positive patients to eat a healthy, balanced diet, but the advice was somewhat ironic under the circumstances. “Most of the patients we see tell us they have one meal per day; some take drugs on empty stomachs,” she said.

“It would help if the distribution of relief food was accompanied by the distribution of nutritious complements like tinned meat, vegetables and fruit to help provide these people with a nutritional balance – the food they eat at home is not nutrient-dense at all.”

Poor nutrition weakens the body’s defences against the virus, hastens progress from HIV to AIDS, and makes it difficult to take antiretroviral (ARV) drugs, which can increase appetite. Enough food can help reduce some side effects of ARVs and promote adherence to drug regimens.

The food shortages in Makueni are evidenced by farmland lying fallow, long queues of people patiently waiting for maize-meal donations at a local political party’s headquarters, and river beds so dry that people have to dig a hole to find water.

Health workers say local residents have begun to resort to dangerous practices to put food on the table. “In December we got reports that men were sending their wives out to sleep with other men in exchange for food,” said Albanus Mutiso, the district HIV/AIDS and sexually transmitted infections coordinator for Makueni district. “You know the situation is desperate if people are going to that extent to find food.”

He said rations for HIV-positive people were often insufficient because they were intended for one person but were used to feed entire families. “A mother will almost always feed her children before herself, so she remains undernourished,” he noted. “Recently we saw a pregnant HIV-positive woman who weighed just 35 kilos – unless the government moves in swiftly, people will die.”

Makueni has an HIV prevalence of seven percent in a population of about 290,000, slightly lower than the national prevalence of 7.4 percent; 73 percent of the people live below the poverty line, and just 26 percent earn a wage, leaving the rest to depend mainly on subsistence farming to make a living.

Harder to adhere

“I weigh 48 kilos now – I sometimes go one month without drinking milk and three months without eating meat,” said Mbula Waema, an HIV-positive widow who is caring for a family of ten.
Her obvious malnutrition deeply concerns Millicent Ondigo, who coordinates ‘Zingatia Maisha’, a HIV drug-adherence support programme run by the African Medical and Research Foundation (AMREF), which has its headquarters in Nairobi, the Kenyan capital. “I have never seen Mbula like this; I’m very worried about what would happen if she got sick now.”

Despite the fact that Waema eats one meal a day – usually a cup of porridge – she has continued to take her life-prolonging ARV medication because she knows that interrupting her regimen could mean death, but taking the drugs on an empty stomach is hard.

“I feel weak, nauseous and dizzy – my stomach burns when I don’t eat well and take the medicine,” she said. “It’s difficult to farm when I’m this weak, but I have to … When I feel too dizzy I sit under a tree and rest.” Waema farms sisal plants, from which she weaves ropes for sale in the local market, otherwise her family will starve.

Marietta Nzula, 38, is more fortunate; she lives at her family’s homestead near the town of Kathonzweni in Makueni. “My family makes sure I get treatment when I’m sick, and even now, when times are tough, at least I get some of the children’s uji [porridge] so I can have something in my stomach to take my medication,” she said. “My brother’s wife reminds me to take my drugs every morning – they are very good to me.”

Nzula says she wishes she was able to do her part to keep the family afloat; she feels that especially in hard times such as these, she is a burden her family could do without.

Support networks under pressure

Although the traditional community support systems still exist, they are stretched to breaking point said Onesmus Mutungi, who heads two local HIV support groups.

“I eat two or three meals a day, which makes me better off than most, so I share with those who have less,” he told IRIN/PlusNews. “But now, even in my home, things are tight, and sharing my food means that I eat less, so I feel weak when I take my medication.”

Mutungi said it was getting harder to persuade support group members to stay on their medication when they did not have enough food. “None of them have stopped taking their ARVs, but many are tempted to do so,” he said.

“We can’t hold additional support meetings because transport costs are too high – many people aren’t even coming to the meetings because they can’t afford the matatu [minibus-taxi] fare.”

AMREF’s Ondigo said Zingatia Maisha was working with local NGOs and the government to try to provide the HIV support groups with food supplements so they would be less likely to interrupt their treatment regimens.

President Mwai Kibaki has declared Kenya’s food crisis a national disaster and the government has appealed for 37 billion Kenya Shillings (US$400 million) to meet the needs of the food-insecure.

This feature is used with permission from IRIN/PlusNewswww.plusnews.org

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