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Фото автораНика Давыдова

Kenya HIV families torn between health or food

A young boy touches mangos for sale as his mother negotiates with the street-trader in the Mathare slum of Nairobi, Kenya.


Rosalia  Adhiambo won’t take the free anti-HIV drugs that would prolong her life. The  spiraling price of food in Kenya means she can’t afford to feed both her  grandniece and herself.

So she feeds 5-year-old Emily and doesn’t take her own medicine, fearing  that the nausea she would get from taking the drugs without adequate food will  make her too weak to look for work.

Prices for staple foods this year are almost twice as high as in 2009, the  U.N.’s Food and Agriculture Organization says. The rising prices and a dwindling  of funds for HIV programs mean countless poor families must decide whether to  focus on the health of an HIV-positive adult or on a child’s hunger.

Valerian  Kamito, a nurse at the clinic that gives Adhiambo her food, says some  patients are refusing to start treatment for HIV and around a quarter of his  1,555 patients on anti-HIV drugs are now skipping their medication.

“They say they cannot take them on an empty stomach,” Kamito said. Before  prices rose, he said, “it was very rare.”

HIV-positive adults need 10 percent more calories than other people just to  maintain their body weight. Children with HIV need between 30 percent to 50  percent more calories than other children. They will lose weight and be  vulnerable to infections without those calories, said nutritionist Kate Greenaway from  the aid agency Catholic Relief Services.

Annual inflation in Kenya is around 20 percent, but wages haven’t kept pace.  Around half of Kenyans live on less than $2 a day, including 52-year-old  Adhiambo, who makes $1 each day she does housework.

“When there is nothing to eat, we go to bed hungry. I tell Emily it is  because God did not send us food today,” said Adhiambo, motioning to a cardboard  picture of Jesus on the wall of their corrugated iron shack.

“Emily stands before that picture and prays, ‘God, please remember to send  us food tomorrow,'” said Adhiambo.

She had work for two weeks last month, but the younger women get most of the  jobs. Adhiambo relies on her daily free meal of rice, beans and vegetables from  a clinic run by Catholic Relief Services in the Mathare slum, though she  sometimes misses that if she is searching for work. The staff there are trying  to persuade her to take her anti-HIV drugs.

But Adhiambo carries the food home and gives most of it to Emily, who isn’t  signed up for the CRS program, though workers there are trying to get her into  it. The bright-eyed little girl in the torn blue dress is almost all that’s left  of Adhiambo’s family. Adhiambo’s brother, two sisters and husband are all dead.  Emily’s mother is alive, but ill. She refuses to be tested. Emily has been  tested and is HIV positive.

Adhiambo needs to take drugs called anti-retrovirals, or ARVs, and so will  Emily. Taken regularly, the medicine can prolong life by years, possibly  decades. But if taken sporadically, the medicine will lose its  effectiveness.

Patients say the medicine can cause nausea, fatigue, and diarrhea at first,  especially if there is no food to go with it, said Greenaway. The drugs also  cause a ravenous hunger as the body starts to recover. Adhiambo, afraid that the  side effects will prevent her from working, refuses to take the pills.

The clinic gives 400 of its patients, Adhiambo among them, “prescribed food”  to eat with their medicines so they’ll continue the treatment. But most take the  meals home to share with their families, said Kamito. The program has a long  waiting list. The financial crisis means there is no money to expand it.

Globally, there has been around a 10 percent decline in HIV/AIDS funding,  said Michel  Sidibe, the UNAIDS executive director. The world’s top funder of public  health programs – the Global Fund to Fight AIDS, Tuberculosis and Malaria – has  disbursed $15 billion since 2002, but it cannot afford to pay for any new or  expanded programs until 2014.

Poverty, meanwhile, continues to eat at the gains made by modern medicine in  fighting HIV, the virus that causes AIDS.

Twenty to 30 percent of HIV-positive patients in the developing world drop  out in the first two years of treatment, said Nils  Grede, the deputy chief of the World Food Program’s nutrition and HIV/AIDS  unit.

“Barriers to continue the treatment … are often related to poverty. You  don’t have the money to pay for the bus, you don’t have enough food, so you  spend your time on trying to make sure that your family eats,” Grede told The  Associated Press in Addis Ababa, Ethiopia.

“People adhere much better to drug regimens when there is food,” said  Greenaway. “But in poor families, that might mean mothers who want to stay  strong have to decide whether to take something from their children’s  plates.”

Adhiambo’s neighbor Ishmael  Abongo, a 35-year-old father of four, must do just that. He and his wife  Mary are both HIV positive, as is one of their sons. The whole family shares the  clinic’s food. When he has found work, Abongo takes a bit of porridge from  dinner and saves it for the morning so he isn’t too dizzy for a two-hour bus  journey.

“I know it is important to take the drugs,” he said.

He recounted knowing four people who did not take the pills because they had  no food. They are now all dead, Abongo said.

A clinic social worker visited Adhiambo in her tiny shack in December,  trying to persuade her to take her medication or risk dying, and leaving Emily  with no family to care for her. But Adhiambo was more worried about their  present situation.

“What will happen to her if I take these drugs and I get sick?” Adhiambo  asked, adding that if she can’t work or even walk because of side effects from  the medicine they won’t have any food.

Eventually, Adhiambo stood up. She needed to find some clothes or a floor  that needed washing. She was two months behind with the rent – $15 a month – and  could be evicted.

The white-winged Jesus that Emily prays to was shown in the picture walking  through a garden, nothing like the smelly alley outside the shack.

Words below picture said: “May my prayers come before you, that you heal me  according to your will.”

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