Three years ago, Munit* was hungry, lonely and HIV-positive; her husband refused to be tested and she felt burdened by her secret status, unable to share her daily struggles with friends and family.
When she joined other women in the Breedlove Project, she was grateful for the nutritional support she received, and even more so for the opportunity to meet other HIV-positive women with similar experiences.
"My secrets are here and they are safe. Nobody else knows my status, even my husband refuses to get tested so it is me and the people you see here," said Munit, bouncing her child on her lap at Addis's Gandhi Hospital.
The Breedlove Project - named after a lentil and potato blended soup package given to its beneficiaries - aims to integrate HIV, food and nutrition programming. It targets women living with HIV, pregnant or lactating, and those caring for children and on antiretroviral (ARV) drugs.
"My predecessor at one hospital saw HIV-positive people discussing in a group when they came for their treatment; it was very fruitful and that is how she came up with the coffee ceremony idea," said Wasihun Eshetu, the project coordinator. "It is very helpful for them to deal with stigma and discrimination as they each become a support to one another."
The project has been implemented in five hospitals, 12 health centres and two orphanages in Addis Ababa in cooperation with the city and federal authorities. Ethiopia has an HIV prevalence rate of 2.4 percent, with an estimated 1.2 million people living with HIV. In Addis Ababa, the HIV prevalence is 9.2 percent, representing more than 200,000 people living with HIV.
"When you are pregnant, hearing the news of having HIV in your blood can be very troubling especially if you don't have a person you can share the burden with," said one counsellor, who preferred anonymity. "What we hope to do here for the beneficiaries is be their confidante... we went through the same thing and are trained to counsel so we can offer them advice and direct them how to seek medical help."
The counsellors often have to advise women not to listen to their families and friends about motherhood and breastfeeding. "It is likely that family members or neighbours who suggest these things are unaware of the mother's HIV status," the counsellor added. "It is us against them to win hearts of the mothers which is very difficult on many occasions; [for example] if the mother wants to breastfeed her child, that requires taking various precautions."
For the women who attend the coffee ceremonies, the flexibility and discretion the project offers are its main benefits. "It is much easier to seek advice here; I can call them or drop by to get advice on everything," said Lelena. "I cannot call the hospital doctors; meeting them by appointment is hard by itself."
Breedlove is implemented by Project Concern International (PCI), which says the combination of nutritional support and a trusting environment in which to share experiences has improved the levels of ARV adherence among the women and their children.
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Improving food security
"We used to hear complaints from many people on ART who said the treatment was weakening them and that it was killing them by the day; this was mainly because they didn't have... sufficient food to eat," said Walleligne Alemaw, PCI Ethiopia country director.
Food insecurity is a major problem in Ethiopia; an estimated 4.2 million Ethiopians are threatened with starvation as the Horn of Africa experiences what has been described as its worst drought in 60 years. Lack of food is a widely acknowledged barrier to successful ARV therapy, and can increase the side-effects, including headaches, stomach pain, dizziness, shivers, loss of energy and fainting.
Funded by the US Agency for International Development, Breedlove receives 75MT of the lentil blend and the "Harvest Pro" vegetable blend annually; since it started in 2007, the project has supported 5,275 women and children.
"It has been three years since I [started] on the project; I am taking my drugs and get counselling and other support... I have been doing fine. I am well," said Munit.
Breedlove also offers urban gardening and poultry farming training.
"The nutrition the project provides is a very modest support and the food is a supplementary diet, so the beneficiaries need other food; these components help them secure that," said Wasihun. "It is also an exit strategy for the project's eventual completion."
Participants carry out either direct soil gardening or container gardening and are offered seeds, including kale, Swiss chard, lettuce, cabbage, tomato, green pepper, carrot, and beet. They also receive farming tools. For poultry farming, each participant receives two roosters, six laying hens, 50kg of chicken feed and a cage.
While many participants have reported improved access to fresh, nutritious food for their families and income from excess food and eggs, the project has not been without its problems.
"Only a few of us followed through after the training to benefit from urban gardening and poultry; only a few of us - maybe one in 10 - have our own house that has a backyard or space to do that," said one beneficiary, who preferred anonymity. "I was on the programme but road expansion led to my house demolition and the house I got in exchange doesn't have space. Most of the beneficiaries live in a rented small house that doesn't have such a space and your landlord also may not be willing. In most cases I have seen it is difficult to benefit from the programme after the training.
|Through urban farming, the women have improved their families' diets|
"The overall idea is wonderful; I, for example, make around 400 Birr [US$23.30] in a month washing clothes," she added. "Now, I have to take care of my child and it is increasingly very difficult and tiresome to do what I used to do so income generating or a food source is very nice to have but I don't think urban gardening is working for most of us."
While reiterating the importance of an exit strategy for the project, PCI officials admit it would be ideal outside Addis Ababa where there is more space for such initiatives.
They said alternatives were being discussed but they needed funding partners. Planned trainings include: how to identify and establish business opportunities, basic financial and budget skills to calculate expenses/profits, creating and managing a budget and facilitating links to local markets to sell products. It also plans to link women to networks of other female entrepreneurs.
Some of the other challenges include the long distances for the women to travel; overburdened staff, leading to insufficient communication about the proper use of the soup; inadequate promotion of the urban gardening component and insufficient rations, as most women share with their families rather than consuming it themselves.
Stigma also remains high, with many participants attending hospitals far away from home for fear of being spotted by neighbours, and others hiding the Breedlove visits from their husbands.
*One name used to protect her identity