Wednesday, December 07, 2005

War against Aids must start with poverty

By James T. Morris
Being poor in the developing world is hard, but being poor, HIV positive and a parent of young children in a slum is living hell. This is the miserable lot of millions of people, especially in Africa, even if they do get some aid or manage to receive anti-retroviral drugs (ARVs).
On World Aids Day, for the first time in decades my colleagues at UNAids can point to some successes in the fight against this global pandemic, including reductions in HIV prevalence rates in a handful of countries and the increased availability of anti-retroviral therapy.
But I want to take this opportunity to focus on someone who is yet to taste these successes and who is fast running out of time, and food: Monica Mwikali.
Monica, 36, struggles every day to survive with her 10 children in the squalid Nairobi slum of Kibera, one of the biggest slums in sub-Saharan Africa.

Four of Monica’s children attend Stara Primary School, largely because they receive a free lunch and mid-morning porridge each school day from the United Nations World Food Programme.
BUT THIS remains a tale of our collective failure in the war against hunger and HIV/Aids, because Monica and her children in their one-room home still don’t have enough to eat.
"If I were given a wish I would want enough food and medicine to raise my 10 children," says Monica, who is HIV-positive and whose husband died of Aids five years ago. Five of her own eight children are HIV positive. She adopted two orphans after her sister died of Aids.
"My son Paul fell sick and I spent all my money on medicine and he still died one month ago. Now my 2-year-old son is very sick. The people giving us medicine have no food," says Monica, who blames her 2-year-old’s paralysis and blindness on anti-retroviral drugs provided without food.
After ARVs, good nutrition is the first line of defence in warding off the detrimental effects of HIV. Nutritious food can help people infected with HIV stay healthier longer. Without proper nutrition, the disease progresses faster and with greater severity. And adequate nutrition is vital to optimise the benefits of ARVs.
Shockingly, Monica’s story is nowhere near the worst case I have heard: similar tales are echoed across Africa.
Monica is one of 40 mothers in Kibera lucky enough to receive two kilogrammes of rice once a week provided by private donors to help her and her children.
WFP desperately wants to help Monica and her kids through the week. But the organisation cannot raise enough funds to give her children bags of food to take home for their families. This is a blight upon WFP, the international community and every one of us who can afford to give something.
The price of our failure is being paid by children like those that attend Stara School. Many resort to smuggling their lunch home to share with their brothers, sisters and sick parents. Quite a few handfuls of cooked beans and maize leave Stara stuffed in school bags and pockets. This means in turn that even those lucky children enrolled in schools with feeding programmes don’t get enough.
Let’s look at another mother in Kibera who is suffering from Aids. "I am so scared of dying before my children," says 30-year-old Medina Yahaya, who is bedridden, emaciated and very frail. Yahaya stopped taking her ARVs a month ago because she says they upset her stomach. She has barely left her mud-walled room for the past six months.
YAHAYA HAS four children she cannot care for. "The eldest is eight years old and the baby is just 16 months. Nobody will be there to look after them. I so want to live for them," she says. Two of them are old enough to receive WFP food at Stara School. The other two spend much of the day on the streets.
This brings me on to one of the hidden problems of living with HIV – the stress. Destitute and infected, parents in the slums find it hard to muster enough strength to keep themselves alive, let alone their kids. It is widely accepted that stress inhibits the immune function so the daily worry only worsens their health.
Slum poverty is particularly unforgiving. Every day, children play in ankle-deep human waste dumped in the narrow alleyways between the houses because the lack of toilets forces people to defecate in shopping bags, tie a knot and throw it into an alley.
And amid so much suffering, crime is rampant. Young children roam the alleys looking for any means to make money to buy a little food – often finding themselves dragged into crime or the victims of rape and sexual abuse.
"When the parent is sick, the children are sent onto the streets to look for food," says Josephine Mumo, the founder of Stara School. "Many end up being raped in the process. And the parents know that. They know they are risking their children’s lives."
"They suffer every time they send their children out.
But what can they do? If they could get food, they could recover, live longer, and look after and protect their children."
ARVs alone will not put an end to the scourge of HIV/Aids. There is still an urgent need for an integrated approach for all those who are HIV positive. Food must be part of it.
James T. Morris is the executive-director of the United Nations World Food Programme

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