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“People know that HIV will kill them within months, but hunger might kill them by the end of the week,” said Dr John Mundi Amolo as he makes his tour of the HIV and AIDS patients admitted to Mutomo Hospital in Kenya. “If someone has only 50 bob [35 pence], then they would rather buy food than get drugs for their HIV. They have no choice.”
Mutomo Hospital is in the Kitui district, which has been hit hard by years of drought. Rivers have dried up, crops destroyed, and the people worn down by hunger. Among the most affected have been those with HIV and AIDS. Although life-saving drugs are cheap and available, the small food and medical costs necessary to be able to take them are often too much.
“The anti-AIDS drugs don’t work well without good nutrition,” said the doctor. “People have not been eating day after day. Taking the drugs on an empty stomach makes them feel sick so they stop. If you don’t keep the same level of the drugs in your blood, HIV very quickly attacks the immune system. We are seeing very ill people being carried in all the time.”
When nurses from the hospital found Paul Kwaluma, he weighed just 34 kilogrammes. “I thought I was going to die,” he said. “I could not get out of bed. I was very weak.” He started taking the antiretroviral drugs last year, but went off them after his small vegetable plot withered away and he was left without food. “I stopped taking the medicine because when you have nothing in your stomach it makes you feel very ill. But as soon as I stopped, I rapidly became unwell. I had lost half my body weight in a couple of weeks.”
Mr Kwaluma is nearly back to health after being admitted to Mutomo Hospital, where he was fed and could return to his anti-Aids drug therapy again. The hospital is part of the Catholic diocese of Kitui HIV and Aids programme. It’s a long-established programme that works out of four hospitals, helping 5,000 people with home-based care, testing, education, counselling, income-generating projects and supporting orphans and vulnerable children.
Counselling stresses the importance of eating properly and always sticking to taking the drugs. Missing doses allows the virus to become resistant to the medicine. If less than 95 percent of the drugs are taken on time, resistance develops quickly, the medicine becomes less effective and the patient becomes very ill. Although a second generation of HIV drugs can then be used, they are prohibitively expensive.
Paul Kwaluma’s case is all too common for Fr Paul Healy, the administrator of Kitui diocese. “You are getting people in Kitui who don’t have any food,” he said. “When starvation comes, you don’t have many choices. If you don’t have money for food, you can’t eat. And you can’t take the drugs if you can’t eat. With HIV and drought, you are constantly ill with infections. People are getting sicker and doing more damage to their bodies.”
Paul Kwaluma is optimistic, after short rains in May, that there will be enough food for his immediate needs. But with the river beds already starting to dry up, all he can offer is a shrug as to what he’ll do if the main rains fail to deliver in the winter. “The world cannot pretend to ignore the severity of the problem,” said Fr Healy. “Unless we get long-term solutions, people will be more impoverished. People with HIV and Aids will not stand a chance.”
This extract is from the article Aids: when the drugs don’t work first published in The Tablet in 10 June 2006