Nairobi, Kenya – Recent studies show that food insecurity is a barrier to the optimal treatment of HIV because some people forego crucial medication for fear of the side effects they experience when taking the drugs on an empty stomach. The problem is especially acute among people living in poverty – like the residents of Kibera, Kenya's biggest slum.
On the southern outskirts of Nairobi, Kibera is the largest informal settlement in East Africa and has an estimated HIV prevalence of 12 percent.
Poverty and unemployment are considered key factors contributing to transmission and in some cases the two have been cited as the main reason why HIV patients stop taking antiretroviral drugs (ARVs).
In a makeshift allotment, Mama Rita is harvesting kale and spinach she has planted in plastic containers. She is about to deliver a fresh stock of vitamin A to a single-parent family here in Kibera, which has two people living with HIV and cannot afford to buy food.
This is Rita’s only way of supporting them, and she has been doing it for more than five years now. Living with the virus for the last 23 years has taught her many things – key among them, that poor families within her community need food to be able to take their drugs.
"The drugs are very strong," she says as she picks the fresh green leaves. "I started taking them in 2005. It is very difficult to take them on an empty stomach. I used to miss taking them way back, but after learning it is the drugs that keep me going, I have no option but to take them."
Not far from Rita's garden lives Zipporah Achieng, a 22-year-old mother of one who also has HIV. She too almost gave up taking her medication at one point for lack of food.
"I have met some people who don’t take their medicine, I was once there," she says now. "I don’t blame them because circumstances at times force us to abstain from drugs. Taking ARVs without food is really a challenge."
Today Achieng is an HIV warrior. For the past three years, she has been sending messages to her peers reminding them of the importance of taking their medication and maintaining a healthy diet, as well as carrying out door-to-door visits to check up on people living with HIV in her community.
Funding gap
Austerity measures and funding cuts for HIV programmes and NGOs are slowing global efforts to eradicate the virus in Africa, which accounts for two-thirds of the world's total population living with HIV.
International donors fund most HIV treatment and prevention programmes in Kenya, with the largest such backer, the United States President's Emergency Plan for Aids Relief (Pepfar), investing more than 8 billion dollars in the country over the past 20 years.
The future of Pepfar is now uncertain after the US Congress last month failed to reauthorise its funding for the next five years.
"When I was diagnosed with the disease in 2000, I knew I was going to die soon. Thank god NGOs came from America, France, Europe and many Western countries: they started supplying us with food and medicine and in 2005 I religiously started taking my medicine," says Rita.
"It was good then, but I am worried about those people who cannot afford food now. Economic times are hard, NGOs are shutting down – living with HIV to some families has started to be a big burden, like the one I shouldered between 2000 and 2005."
Achieng agrees that aid seems to be tailing off. "When I was young, we used to get food and basic needs from donors. I didn’t know it was part of the support for persons living with HIV/Aids because then I did not even know about HIV," she says.
"Right now I am a grown-up, a mother – I need such support but I can’t see it anymore. Kibera used to have so many NGOs. They are still there, but they don’t support us as they used to do. Maybe it is because of economics, I just don’t know."
Treatment by injection?
Charities working with HIV-positive people in Kenya's slums acknowledge that they are struggling to meet needs.
Lenah Wangui, communications director for Christian Best Camps of Kenya (CBCK), a faith-based organisation supporting families in informal settlements, told RFI that getting enough to eat has always been a challenge for people living in slums – and it's even harder if they are living with HIV.
"We used to feed around 300 people in Mathare and Kibera slums. This is not sustainable anymore," she said.
"As a community-based organisation, we are feeding children under the age of 18 years. For those above 18 years we support them to set up businesses such as making soap and from those businesses they get something to keep them afloat."
Achieng and Rita believe that the introduction of injectable ARVs will go a long way towards improving medication adherence.
Kenya is one of several countries in Africa, including South Africa and Uganda, that is trialling injectable HIV drugs that can be given just once every two months.
President William Ruto recently assured that the Kenyan government was also in the process of setting aside more funds for HIV/Aids programmes.
"Kenya has joined 12 other African countries in the fight to eradicate HIV by 2027. In the last two years, the government has allocated 1 billion Kenyan shillings to curb disruption of supply of antiretroviral drugs and other essential commodities in the fight against HIV caused by a decline in donor support that has created a funding gap," Ruto said at an event to mark 20 years of Pepfar.
