MOZAMBIQUE: Living with HIV and an empty stomach
MAPUTO, 11 August 2008 (IRIN) - Antiretroviral (ARV) drugs are free in Mozambique, and access to them is relatively easy, but for many HIV-positive Mozambicans the real challenge is a far more basic problem of finding enough food.
ARVs are powerful drugs that need to be taken with nourishment. Regular and nutritious meals are also needed to help the body's own defences fight the opportunistic infections associated with AIDS.
Ana Costa*, 55, decided to abandon her ARV treatment earlier this year after two years of suffering from constant nausea and weakness as a result of taking the medicine on an empty stomach.
"The pills I was being given at the hospital are very strong. I couldn't take them if I was hungry. That's why I decided to stop," she told IRIN/PlusNews.
Costa, who has been living with HIV since the 1980s, is trapped in a vicious cycle: her health is too poor to allow her to work, so she cannot afford to buy food.
She was an only child and although she was married, she had no children and is divorced, so her only resource is the sporadic help she receives from a few of her neighbours. Costa knows that her health may deteriorate even further without the ARVs, but feels she has no choice.
Food insecurity threatens treatment programmes
According to the medical humanitarian organisation, Medecins Sans Frontieres (MSF), which provides ARVs to over 11,000 Mozambicans, large numbers of people are dropping out of the treatment programme and staff suspect one of the main reasons is lack of food.
"It's hard to know the specific reasons why people abandon treatment, but there are lots of patients with low weight and nutrition problems," said Clarice Nheleti, a psychologist and supervisor at MSF's psycho-social unit.
Like Costa, many HIV-positive patients lose their jobs when their health declines, and without a source of income they cannot afford to eat regularly, making it difficult to continue treatment.
MSF has responded by starting a food support programme in Maputo for patients whose economic situation is precarious. "It's impossible for us to assist everybody," Nheleti said. "We only support those who are visibly weak, those who come from families with no possessions, and those who are too feeble to work."
Food support is given for a six-month period, which is usually long enough for most patients to regain their strength and return to work.
Generalised problem
Rising oil prices, the impact of climate change and the loss of agricultural land to biofuel production have all contributed to the current global food crisis - and the challenge facing governments as anger grows. In February six people died in Maputo in protests over the cost of living, and the government was forced to rescind a hike in diesel prices.
Mozambique is one of the poorest countries in the world, placed at 172 among the 177 countries evaluated by the United Nations Human Development Index. More than 300,000 people are estimated to be experiencing extreme food insecurity, and 16 percent of the population of 21 million are HIV positive.
According to the national health department, of the 88,000 adults and 6,000 children who were on ARV treatment by the end of 2007, only 9.7 percent were receiving food aid.
"Talking about nutrition in Mozambique is extremely complex, because the question of lack of food does not only affect HIV-positive patients," said Amós Sibambo, an activist from the National Network of Associations of People Living with HIV/AIDS (Rensida).
He stressed the need for government and civil society to understand the importance of nutrition for patients infected with HIV, and to take action to address the issue.
Rensida is taking the first steps in this direction by organising a series of activities to commemorate World Food Day on October 16, where one of the highlights will be lectures by nutritionists and the presentation of specific diets for people living with HIV.
*Not her real name
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