Hungry for help - HIV-positive people struggle to survive in drought-hit east

As the unrelenting sun sears the hard, red earth of eastern Kenya's Makueni district, dust devils carry balls of dry grass across the land where some 3.5 million Kenyans face severe food shortages after several consecutive failed rainy seasons. Communities in eastern Kenya, which traditionally depend on agriculture and livestock to make a living, have watched crop after crop fail, while their animals die as pasture and water dry up. "There has been no rain for three to four years now, so nobody can grow anything," said Dr Richard Onkware, head of medical services at the Sub-District Hospital in Makindu, a small truck-stop town on the main highway between the capital, Nairobi, and the port city of Mombasa. Here the carcasses of cows and goats lie strewn along the road, skinned and left behind because there is not enough meat on the bones to make a meal. The trucks are helping to keep the town's economy alive, but they have also contributed to its relatively high HIV prevalence rate of 11 percent, compared to six percent in the rest of Makueni district, where people doggedly eke out a living by trading in homemade crafts, honey and charcoal. Although the provincial administration provides maize flour, the drought has hit the area's HIV-positive population much harder. "I am too weak to work for food. The [provincial] chief gives us food, and I eat about one meal per day," said David, a gaunt young man awaiting treatment at the hospital. "It is taking very long for me to recover because I do not have enough food." He was diagnosed with tuberculosis and HIV in 2005 and receives antiretroviral therapy (ART) at Makindu Hospital but cannot complement the drugs with a healthy diet. The hospital has a comprehensive care clinic, providing HIV-positive patients with ART and treatment for opportunistic infections, a tuberculosis clinic, and a maternal and child health centre that will start offering ART to children this month. Around 750 people are being treated, of whom 280 receive ART at a cost of 100 Kenya shillings (US $1.40) per month, which can be waived for those who cannot afford it. But the facility does not provide nutritional supplements - it merely educates patients about the importance of a good diet. Onkware said the food distributed by the provincial administration was often "unpalatable" and not nutritious enough to support the needs of HIV-positive people on treatment. "We have not developed to the point where we have a nutritional programme, but we occasionally provide Unimix [fortified flour] to our patients," he added. VICIOUS CYCLE OF HUNGER AND ILLNESS "Nutrition is a core factor in management of HIV/AIDS," Onkware pointed out. "In the recent past, the drought has worsened and although we are advising our patients to feed well, the food shortages mean they are not adhering to the treatment as well as they should, and their health does not pick up very fast." According to a 2005 report by the Kenyan Ministry of Health, 'AIDS in Kenya: Trends, Interventions and Impact', "The relationship between malnutrition and HIV/AIDS is synergistic and creates a vicious cycle that additively weakens the immune system ... Poor nutrition increases susceptibility to opportunistic infections and in so doing accelerates the progression of HIV to AIDS." SPECIAL HELP FOR HIV-POSITIVE PEOPLE? Some help has been forthcoming, with the UN World Food Programme and the International Federation of Red Cross and Red Crescent Societies channelling food distributions to the most vulnerable people, including children and those affected by HIV/AIDS. Nongovernmental organisations have been concerned about singling out HIV-positive people for special food distribution while severe shortages are widespread. "We are torn about helping HIV-positive people when the general population is also starving," said Iris Krebber, regional co-coordinator for German Agro Action (GAA), an NGO running food and water projects in eastern Kenya. "In Ethiopia, which is also badly affected by the regional drought, I met a woman who regretted she was not HIV-positive, because those who were received food from the NGOs," she recalled. According to GAA, more than 60 percent of Makueni's population live below the poverty line and at least 45 percent of the children are undernourished. "The government needs to have a strategy to feed the most vulnerable people," said Krebber. "It is not enough to provide ART without the proper nutrition."