ZAMBIA: Poor nutrition nullifies benefit of ARV treatment

Photo: IRIN

Medication for HIV positive people helps little in the absence of good nutrition

LUSAKA, 18 December 2006 (IRIN) - The poor nutrition often experienced by HIV-positive Zambians on antiretroviral [ARV] drug treatment is nullifying the benefits of the medicine, health experts are warning.

"Whenever I take my ARVs without eating anything, I begin to feel dizzy and sometimes I even vomit - I generally feel very weak in my body; I have to be in bed for some time unless I took the drugs after eating," Elizabeth Mukwendi, a resident in the capital, Lusaka, one of thousands on ARVs, told IRIN.

"We sold all our assets, including the only car we had while my late husband was sick, to pay for his medication, and this is why I am unable to buy food at the moment. Doctors have often advised me not to be taking ARVs without food but then, there is also the problem of drugs becoming resistant if I keep skipping because of not having food," Mukwendi said.

ARVs slow down the reproduction rate of the HI virus and delays progression to AIDS, but in the absence of good nutrition, experts warn that taking the drugs becomes just as bad as not taking them.

According to Nkandu Luo, Zambia's first woman professor and a former health minister, "It is like having two evils acting together in your body. Taking ARVs where there is no food only compounds the problem, because some of these drugs are toxic and, hence, they affect the body unless they are taken with the recommended food values."

President Levy Mwanawasa's administration is rolling out ARVs as part of its commitment to the global target of promoting universal access to treatment by 2010. Of the estimated 1.6 million Zambians living with HIV/AIDS - 17 percent of the sexually active adult population - only about 75,000 have access to ARV medication.

Justine Mwinga, spokesperson for the government National AIDS Council, said the treatment programme faced an uphill battle, in that "we have continued losing a lot of skilled medical staff to other countries, and we are seriously lacking the required equipment, such as the CD4 count machines, in most government institutions." The number of CD4 cells present in an individual's blood indicates the strength of their immune system.

Government scrapped the US$10 monthly user fee for HIV/AIDS treatment in 2005, and in April 2006 lifted all medical fees at government-run hospitals and clinics in rural areas, where food insecurity and poverty go hand in hand. Medical facilities in urban areas still charge individuals in monthly medical schemes up to $2.

Luo, now an HIV/AIDS consultant, said "Lack of food has become more critical and prevalent in Zambia than it was in the past. Some families are alternating when eating, especially in rural areas. In certain homes, each family member has to skip a day before taking the next meal, regardless of whether or not they are HIV positive and on medication."

In the past few years Zambia has managed to harvest a surplus of maize, the staple food, but the World Food Programme (WFP) has been providing food aid to about 555,000 people since July 2006.

Government departments and UN agencies have yet to establish the number of people living with HIV/AIDS and going hungry, but according to the Central Statistical Office, 68 percent of the 11.7 million population live $1 or less day.

Jo Woods, public information officer at the UN's WFP in Zambia, said food shortages among households with HIV-positive people was a complex issue.

"Certainly, [food] production levels do vary from region to region, but we are now also approaching the lean season in Zambia, where people are running out of food that they have stored from the last harvest. For people living in the cities, they may not have access to land for growing food and may not have ... [jobs], so poverty is the issue - they cannot afford to buy sufficient food," Woods said.

Humanitarian agencies, including the WFP and the International Federation of Red Cross and Red Crescent Societies [IFRC], are collaborating with the health ministry to set up an intervention programme for people who are on ARV treatment but have no access to food.

The WFP is providing food packs of high-energy proteins as well as farming inputs to some 9,610 people on ARV treatment in certain parts of the country, while the Zambia Red Cross Society is supporting about 1,000 HIV/AIDS patients on treatment with a monthly food supplement and a number of income-generating ventures, like livestock rearing and fish farming.

Mukesh Kapila, a Geneva-based IFRC director of policy and planning, said during a recent two-day visit to Zambia, "What we are doing, as humanitarian agencies, is not enough in itself, because the HIV epidemic in Zambia, and Southern Africa as a whole, is a matter of life and death. We need to do much more, but we are constrained by limited funding. The best way to deal with HIV is not just treatment; treatment brings hope, but it is not the solution. People should have ready access to food and basic information on health if treatment is to be effective."

The WFP's Woods said the agency faced a serious pipeline break in the food-pack support project and needed up to $7.8 million to provide food for the programme in 2007.

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