MAKUENI, 23 January 2009 (PlusNews) - "We have a large number of patients with a BMI [body mass index, a measure of nutritional status] below the healthy cut-off of 18.5," Fransiscah Yula, a nutritionist at the hospital, told IRIN/PlusNews.
An estimated 10 million Kenyans are battling a food crisis as a result of crop failure due to poor rains and drought, high food prices, and the effects of post-election violence in early 2008 that disrupted farming activities in Rift Valley Province, the country's breadbasket.
Yula said she counselled HIV-positive patients to eat a healthy, balanced diet, but the advice was somewhat ironic under the circumstances. "Most of the patients we see tell us they have one meal per day; some take drugs on empty stomachs," she said.
"It would help if the distribution of relief food was accompanied by the distribution of nutritious complements like tinned meat, vegetables and fruit to help provide these people with a nutritional balance - the food they eat at home is not nutrient-dense at all."
Poor nutrition weakens the body's defences against the virus, hastens progress from HIV to AIDS, and makes it difficult to take antiretroviral (ARV) drugs, which can increase appetite. Enough food can help reduce some side effects of ARVs and promote adherence to drug regimens.
The food shortages in Makueni are evidenced by farmland lying fallow, long queues of people patiently waiting for maize-meal donations at a local political party's headquarters, and river beds so dry that people have to dig a hole to find water.
Health workers say local residents have begun to resort to dangerous practices to put food on the table. "In December we got reports that men were sending their wives out to sleep with other men in exchange for food," said Albanus Mutiso, the district HIV/AIDS and sexually transmitted infections coordinator for Makueni district. "You know the situation is desperate if people are going to that extent to find food."
He said rations for HIV-positive people were often insufficient because they were intended for one person but were used to feed entire families. "A mother will almost always feed her children before herself, so she remains undernourished," he noted. "Recently we saw a pregnant HIV-positive woman who weighed just 35 kilos - unless the government moves in swiftly, people will die."
Makueni has an HIV prevalence of seven percent in a population of about 290,000, slightly lower than the national prevalence of 7.4 percent; 73 percent of the people live below the poverty line, and just 26 percent earn a wage, leaving the rest to depend mainly on subsistence farming to make a living.
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