Food and work for those living with HIV

The first six years of Elsa's life have not looked promising. "She was born sick," said the girl's aunt, Elena Ze. Elsa's head seemed heavy for her small, frail frame. She had difficulty breathing and her body, including her face, were covered in rashes and sores. Elsa has AIDS-related illnesses, including stomach problems and persistent headaches. Her mother died of AIDS last May after many years of being sick. Now Elsa and her two older siblings live with her aunt, a single parent, in a small cramped almost bare one-roomed cane home. Her aunt has four other young children of her own to take care of single-handedly. But the aunt, putting her arm around Elsa, did not complain. "I treat all the children the same, and they all play well together." Besides having three extra mouths to feed, Ze's crops all failed this year. "I used to grow maize, peanuts and cassava - now I have to carry goods across the border for other people in return for food or money, but it is not enough." Often the family have had to go to bed with no food and, despite Elsa's poor health, Ze has often only been able to give her sickly niece maize meal to eat. She was clearly malnourished, further jeopardizing her chances of a longer life. Ze's family is becoming increasingly representative of the current humanitarian crisis in Mozambique, one of the worst-affected countries in the region. Poor harvests, high levels of poverty and the devastating impact of HIV/AIDS have pushed people in the south of the country to the brink of survival. An estimated 659,000 people in 40 districts have been identified as "extremely food insecure". They will need assistance until the next harvest in 2004, said Katerina Gola, the WFP information officer. A recent survey also identified a further 255,000 people in those districts who are at risk of declining food insecurity from this month onwards. However, Tom Shortley, WFP emergency coordinator, said although there had been a plan to increase WFP support to take into consideration the deteriorating situation, a lack of funds and severe commodity shortfalls in the country had meant that support would have to remain at its current levels. "Difficult decisions will have to be made about who is going to get food and who is not," he told IRIN. An increasing number of people now in need of food are also living with, or feeling the impact of, HIV/AIDS. Some 13 percent of the adult population is HIV positive, with an estimated 500 new infections every day. Over 300,000 children have been orphaned by AIDS. Despite the gradual fall in the costs of antiretroviral (ARV) drugs, they are unaffordable for most people in Mozambique, who live on less than one dollar a day. However, with or without the drugs, a good diet is essential for fighting opportunistic infections and prolonging life. "One of the most important things you need if you are HIV-positive is good nutrition," said Gola. To try to move into a new phase of assistance, WFP launched a pilot project in July with its partners, to provide food to those in desperate need because their crops have failed and they are infected, or directly affected, by the HIV/AIDS epidemic. So far 1,250 people have benefited from the scheme in Namaacha, in Maputo Province, which is being implemented by the NGO, Medicos do Mundo (Doctors of the World). With the assistance of the community and the local hospital, they identify vulnerable households, most of whom are headed by women, the elderly or children. Medicos do Mundo also provides other assistance, including testing and counselling services, health care and educational material. They support street theatre that transmits prevention messages and tries to boost the morale of those living with the virus. People living with HIV and are well enough, are encouraged to take part in food-for-work programmes, such as clearing roads and drains. For example, Tiane (meaning "gain strength"), a newly formed association of people living with HIV, is engaged in making mud ovens that use firewood economically. Isaura Simone, a single mother of six children, although looking emaciated and weak, showed off with pride the fuel-conserving ovens that she and a group of 34 others living with HIV had made to sell in the community for about 100,000 meticais each (less than US $5). Even though she still cannot afford sugar, salt and soap, "it has helped me provide food for my children." Elsa's family began to benefit from the project in September. Ze participated in a food-for-work project, clearing drains, and in return received a monthly ration of 7.5 kilos of beans, 7.5 kilos of maize and almost four litres of oil. "It has made a big difference," she said. The support has been especially important to Elsa, who may also have the chance of benefiting from ARVs. Peter Butage of Medicos do Mundo said he would soon take Elsa to a clinic in Maputo for tests, to see whether she could start taking the drugs to prolong her life. The food and drugs could turn Elsa's life around. She dreams of one day being able to go school. "I have never been, but I want to," she said in a timid voice, still leaning on her aunt.