Cambodia: Chea, Hom and Nob Nem
Chea, 36, worked as a construction labourer in Phnom Penh. “I don’t know when I became HIV-positive but we were both tested in 2005 during Hom’s pregnancy.”
“I am on antiretroviral therapy but now I have TB. At the moment I am too ill to work, though I am slowly improving and want to work again,” said Chea.
Normally he earns roughly $US7.50 per month.
Making ends meet
Hom brings in a small income by recycling rice bags into ropes for leading cattle.
It is labour intensive work and she manages to make 100 to 200 ropes per month, which sell for $US1.50 per hundred.
“Both our families sold their land and cattle in order to pay for treatment and food for us,” she explained.
After giving birth to their daughter, Hom required blood transfusions which finished the money completely.
Reflecting on the future
“We have nothing except our healthy baby,” she added. The baby’s grandmother, Nob Nem, is visibly upset as she contemplates the family’s future.
The baby is her first grandchild and she has spent much time with her while Hom was ill.
“We are accepted in the village. Whenever anyone needs anything we are there,” Nob Nem says.
The family relies on Partners in Compassion, a local non-governmental organisation for assistance.
The package of care they receive includes a food ration from WFP, which helps ensure that the TB and antiretroviral treatment that Chea and Hom receive is as effective as possible.
Ethiopia: Tsehai Tesfaye
My name is Tsehai Tesfaye. I’m 37 years old and come from a very poor family.
I have never worked other than being a sex worker. Any guy who would pay me for love was welcome. This was how I earned a living.
As I was going out with different men, I was often sick with sexually transmitted infections.
I have a feeling I got the virus from the one man I fell in love with. The guy was handsome, had a good job that paid him well.
When I don’t eat well, the illness becomes worse; all my body becomes full of rashes
We had a decent life for some time. But I started getting sick, so we separated.
Three years ago, I was tested and told that I am HIV-positive. Now my health is sporadic. I have an aching chest, a sore throat and a cough.
In this clinic where you found me, there were some 30 of us who were taking treatments for HIV.
Most have died and the few of us still alive survive thanks to the Community Based Integrated Sustainable Development Organization.
I’m also receiving food. Thanks to the organisation, I’m receiving 30 kilogrammes of wheat and some cooking oil.
I’m actually well fed and am not induced to go the other way to earn a living.
I head a family of nine, seven of whom are my children. Three in the family – my youngest daughter, my brother and myself – are living with the HIV virus.
My youngest daughter was almost always sick and losing weight. So I took her to the health centre where they told me the reality. I think she got it from me.
I’m doing my part for my 20-year-old daughter to prevent her from falling into the miserable life I led.
Young as she is, I’m advising her to be careful in her life. I don’t know to what extent I’ll be successful.
Good nutrition vital
Now I see one big problem. If I fall ill for a longer period of time, that may force my three young kids to look after me, which will eventually affect their schooling.
I openly tell to all I have the virus in my body and advise them they should be watchful not to be infected.
I even warn those who have the virus that they should eat nutritious food as much as possible so they live longer.
When I don’t eat well, the illness becomes worse; all my body becomes full of rashes. Had it not been for the food I am still getting, you wouldn’t have seen me talking to you now.
Swaziland: Sithembile Dlamini
Sithembile Dlamini is a 15-year-old schoolgirl from Sithobelweni in Swaziland.
Recently, she was promoted three grades ahead of her classmates. She wants to train as a nurse someday.
“My parents passed away when I was nine years old,” she says, glancing at her Grandmother Gogo.
Gogo relies on a cane to get around. When she became too frail to care for her granddaughters the responsibility for the younger girls fell on Sithembile’s shoulders.
Bed on an empty stomach
Sithembile recalls how, for days on end, they would eat only marula fruit. The children often went to sleep on empty stomachs until they started receiving food assistance from WFP.
I’m willing to study as long as there is money to pay for my school fees, because I know that if I get a good education, there is hope for my future
Close to one in six Swazi households are headed by children. Many, like Sithembile and her sisters, live in communities affected by constant drought, poverty and HIV/AIDS.
Communities have formed neighbourhood care points where children at risk can be brought together to receive meals, rudimentary lessons and psychosocial support.
Sithembile attended a neighbourhood care point soon after her parents died. She says the centre will always remain close to her heart.
Home from home
“Going to the NCP helped me a lot because I learnt many important skills from the caregivers,” she said.
In the past, many pupils fainted from hunger during morning assembly
She still considers it her second home. “I used to enjoy the food and being with the other children. We felt at home there because the caregivers were like mothers to us.”
Thanks to a government bursary, her sisters enrolled in school directly.
Under the same scheme, Sithembile enrolled this year – and began to shine. She started in Grade One – two years behind her sisters – but in just two months she was promoted to Grade Four.
Hot WFP meals
While Sithembile’s school days are different from those passed at the neighbourhood care point, one thing is similar: she is still receiving free hot meals, provided by WFP.
Sithembile’s English teacher, Mrs Motsa has observed that school meals help many children like Sithembile, who travel long distances every morning on an empty stomach.
In the past, many pupils fainted from hunger during morning assembly.
Dreaming of a better life
But this has stopped since the school started providing breakfast and a hot lunch of maize porridge and beans.
Today Sithembile dreams of a better life, saying: “I’m willing to study as long as there is money to pay for my school fees, because I know that if I get a good education, there is hope for my future.”
“I also pray that my sisters complete their schooling, so that we can end our family’s poverty together.”
Kenya: Dr Joseph Mamlin
Dr Joseph Mamlin, field director for AMPATH, sees the insidious impact of HIV and hunger in his Kenyan clinic every day.
He says that half of his programme’s 20,000 HIV-positive patients suffer from food insecurity. Hunger and malnutrition were interfering with patients’ recovery despite the availability antiretrovirals.
We provide the drugs, feed the family, and then they can get meat on their bones and get back to the work they were doing before they got sick
Dr Joseph Mamlin
AMPATH (Academic Model for the Prevention and Treatment of HIV/AIDS), is a partnership between Indiana University School of Medicine and the Moi University Faculty of Health Sciences.
The number of HIV-infected Kenyans with access to anti-retroviral drugs has doubled in just the past three years.
But unlike in the West, where the anti-retroviral medications alone are famed for their “Lazarus effect” reversing even severe cases of AIDS, the treatment for many of AMPATH’s patients does not stop with prescriptions.
Anne Boit is 40 years old, recently widowed, and is too weak from her disease to work and care for her nine children.
So Rachel Ototo, a clinical medical officer also orders a nutrition supplement for Anne and her family.
Maize, beans and cooking oil from WFP will be combined with vegetables, milk and eggs from nearby farms staffed by AMPATH patients.
Effects of malnutrition
Dr Mamlin found that malnutrition blunted the effect of antiretroviral treatment, and the side effects of taking the medicine while hungry was causing patients to drop out of treatment.
“I visited WFP’s operation in Busia near here, and I saw they were feeding 36,000 people,” Mamlin says.
“But after some short-term health gains from being fed, HIV-infected people were getting weaker because no one was treating their disease.
"Here, we were doing the opposite - giving the drugs but no food - and I saw the exact same problem with our patients. It was obvious what was missing.”
WFP and AMPATH now work together to provide six months of food supplements to HIV patients.
Back on their feet
Like Anne, most patients are supporting other family members, so the food given is also enough to feed their dependents as well.
“We provide the drugs, feed the family, and then they can get meat on their bones and get back to the work they were doing before they got sick,” Dr Mamlin says.
The six-month food regimen is usually long enough for the patients to benefit from the reconstitution of their immune system, with training programmes available for patients who can not return to their previous livelihood.
“We need to take hunger out of the equation in dealing with this pandemic,” Mamlin says. “You better be providing something beyond drugs, or you are just playing on the periphery of the problem.”