In-depth: ART on the frontline
UGANDA: Hunger kills you faster, say HIV-positive northerners
Food shortages are endemic in war-torn northern Uganda
KITGUM, 20 October 2006 (IRIN) - Life-prolonging antiretroviral (ARV) medication is rare enough in war-damaged northern Uganda, but the lucky few able to access treatment have the additional problem of finding enough food to go with the powerful drugs.
With the support of Catholic Relief Services and the European Union, 670 people receive ARVs from St Joseph's Hospital in the northern district of Kitgum, the largest provider of drugs in the district, but this represents just 24 percent of the hospital's HIV-positive patients who need treatment.
"For the rest, we just have to treat their opportunistic infections as they get them," said Robert Ochola, coordinator of HIV/AIDS programmes at the hospital. "For children, we are only able to treat 30 percent of those who need the ARVs, and even then we do not have [paediatric] ARVs for them - they take the same drugs as the adults in different doses."
Kitgum is one of the districts most affected by two decades of war between the rebel Lord's Resistance Army and the government. About 90 percent of Kitgum's people live in camps for the internally displaced and are almost entirely dependent on relief aid, as insecurity has prevented them from farming.
It is even worse for the region's HIV-positive people, who need a healthy diet to maintain their immune systems to fight off the HI virus.
Some of the hospital's ARV patients receive nutritional support from the United Nation's World Food Programme and the Comboni Roman Catholic Mission, but qualification is not automatic: patients complete application forms and the organisations then decide who is eligible for the limited food aid.
The rations are enough to feed a family for a month. They make a real difference to the overall health of the patients, and increase the likelihood that they will adhere to the daily ritual of taking their ARVs, which can have unpleasant side effects even on a full stomach.
Sylvia Ocan and Christine Oyela have both been on treatment for two years, but only Oyela has qualified for nutritional support. Oyela looks healthy but Ocan is visibly undernourished and suffers from a condition that has left unsightly, dry patches on her face.
"I don't know why I did not qualify for the food, but I have no money to buy food and I get sick quite often," said Ocan, whose husband died from AIDS-related complications three years ago. "I make tablecloths and mats to sell, but my two children and I sometimes can spend the whole day without eating anything - I feel dizzy and weak if I do not eat when I take the drugs, and then I can't even work."
Despite these difficulties, Ocan has persevered with her medication, aware that if she does not she risks developing resistance to ARVs.
"The main reason for non-adherence among our patients is the lack of food. Of our 2,000 patients, just 819 are receiving food support," said Charles Odong, coordinator of Meeting Point, a local NGO helping HIV-positive people in Kitgum.
People who default on treatment often turn to traditional healers for remedies, which can make them even sicker, he said. With the support of relief agencies like the Italian NGO, Associazione Volontari per il Servizio Internazionale, Meeting Point provides home-care kits of soap and sugar to its members, and grants of school fees for their children.
"People are so desperate for food that many are willing to sell sex and risk contracting HIV because they say the disease will take some time to kill you, while the hunger will kill you immediately," said Odong. "Finding food for people in the region should be a priority for the government and aid agencies, because it helps those who are already sick and could also help prevent new infections."