LESOTHO: "We need food"
MOHALE'S HOEK, 3 February 2009 (PlusNews) - Moroke Moletsane has been trying to coax some vegetables from the small garden in front of his home in Mohale's Hoek, a rain-starved district in southern Lesotho.
Moletsane, 50, and his wife are both living with HIV. They need a nutritious diet to stay healthy and slow the progress of the disease, but they mainly get by on pap [maize-meal porridge]. Their only source of vegetables is the garden, but the current crop is likely to be meagre - most of the plants have withered and died.
Food production in Lesotho has been shrinking for years due to erratic weather and soil erosion, while HIV has weakened subsistence farming communities. The country now imports 70 percent of its food, mostly from neighbouring South Africa, making it particularly vulnerable to food and fuel price hikes in that country.
Chronically high rates of unemployment mean that many families rely on relatives working in South Africa to send money home, but retrenchments in the mining and other sectors are on the rise.
The migrant labour system, which separates husbands and wives for long periods, has almost certainly contributed to Lesotho's adult HIV prevalence rate of 23 percent, the third highest in the world.
Moletsane worked as a miner in South Africa until 10 years ago. After returning to Lesotho, he occasionally worked as a casual labourer until he was hospitalised in 2007 and tested positive for HIV. Antiretroviral (ARV) treatment helped him recover, but he is still unsteady on his feet.
"I feel like a child who's just starting to walk," he told IRIN/PlusNews. "It's a big challenge to get food because I can't do piece jobs [casual labour]."
Limited food assistance
A food support programme for people living with HIV, run by the World Food Programme (WFP), used to provide Moletsane and his family with monthly food parcels, but the programme was only funded for four years and the parcels stopped in April 2008.
A subsequent WFP project, run in partnership with the Ministry of Health, is providing food support to around 8,500 HIV-positive people on ARV drugs and their families in six of Lesotho's 10 districts.
"We had limited resources, so we had a dilemma whether to spread resources to 10 districts or concentrate on the most vulnerable," said Prabhakar Addala, head of programme and logistics for the WFP in Lesotho.
It was decided to roll out the programme in the three districts with the highest HIV prevalence and in the three most remote rural districts. Mohale's Hoek is among the four districts not covered. "We're trying to get additional funds to cover those districts," said Addala, "but we haven't been able to so far."
In the districts covered by the programme, only the poorest households qualify and the assistance is temporary. After nine months, the food parcels stop coming and are supposed to be replaced by Livelihood Recovery Projects that will help patients and their families generate an income. But these projects, which are the responsibility of partner organisations like the Lesotho Red Cross and World Vision, are not yet fully functioning.
"There are a lot of complaints about what happens after the nine months when the food aid ends, because that household will still be food insecure," commented Dr Esther Aceng, country HIV officer for the World Health Organisation (WHO) in Lesotho.
HIV adds to food woes
There are some days when Moletsane, and others like him in Mohale's Hoek, are forced to take their ARVs on an empty stomach. "It makes me dizzy," he said.
Not only does taking ARVs without food make patients feel sick, it also reduces the effectiveness of the drugs.
Matsepiso Lemphane, a nurse clinician at Liphiring Health Centre, the remote, mountainside clinic where Moletsane is a patient, estimated that 80 percent of the centre's HIV-positive patients did not have enough food.
"Even today, a patient said: 'You just give us these drugs that make us hungry - we need food'. They'll go to a neighbour and ask for food, or some make local brew and sell it for peanuts."
"It's been too dry to grow food," she added. "The old people say the weather used to be good 10 years ago, but now it's very unpredictable."
A WFP survey of Lesotho's urban areas in 2008 found that 30.2 percent of urban households in Mohale's Hoek - the largest proportion in the country - were highly food insecure.
The survey also noted that HIV adversely affected a household's food security: caring for a chronically ill family member or orphans could put a huge financial strain on a household that might already be struggling to cope with the loss of a breadwinner.
Mamoipone Sekoboto, 75, has been caring for her four grandchildren since her son died while working as a miner in South Africa five years ago - "He came home a corpse," she told IRIN/PlusNews. Her daughter-in-law died soon after and the children came to live in Sekoboto's small mud-walled home, built with her own hands.
A tiny sprightly woman, Sekoboto supports herself and the children on a pension of 200 maloti (US$20) a month. After making her monthly funeral society payment, she is left with 150 maloti ($15) to buy paraffin and maize-meal. "There's nothing left for other things," she said.
Her garden is also failing because of late rains - the only plants thriving are chillies. The children receive a free midday meal at school, but after her pension runs out Sekoboto only eats in the mornings and evenings.
Mothers most vulnerable
For people living with HIV, who need to consume 10 to 30 percent more calories than those without the virus, the consequences of skipping meals can be serious.
 People end up as defaulters because they're not getting enough food |
Lemphane, the nurse at Liphiring Health Centre, said her biggest concern was HIV-positive mothers. "We want them to breastfeed exclusively for six months and then wean [the baby], but there's no formula or food to give them, so the mother carries on trying to breastfeed."
Mixed feeding, or breastfeeding beyond six months, is thought to increase the chances of transmitting the virus from mother to child, but mothers who are not getting enough to eat may struggle to produce enough milk to breastfeed exclusively.
Maneo Matsoele*, 26, tested HIV-positive during an antenatal visit, but doesn't remember being told to exclusively breastfeed for six months and doubts she is eating enough to do so. Instead, she is following the advice of older relatives and feeding her five-month-old son porridge as well as breast-milk.
Matsoele subsists on a diet of pap, occasionally supplemented by spinach and soup when her husband earns money from piece jobs. Now that he has gone to South Africa to look for work, she is alone.
Mojalefa Lee, 59, another former miner who has been on ARVs since testing positive in 2004, said his CD4 count [a test of immune system strength] had been coming down since he could no longer afford to vary his diet with fruits and vegetables. "Food, water, electricity – everything has gone up," he said. "Everything is condemning us."
"People end up as [treatment] defaulters because they're not getting enough food," he added. "Positive people need support, but there's no such thing here."
*Not her real name
ks/he
See also: The Triple Threat
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