Hungry Africans' stark Aids dilemma

By Karen Allen
BBC News, Nairobi

Delegates at the UN summit on Aids have been hammering out the finer details of a declaration to combat HIV/Aids.

If you don't have any breakfast you can't take these drugs because when you swallow them you feel in your stomach pain Paul Kwaluma

Meanwhile, 40 million people worldwide are living with the disease.

In countries like Kenya, the prospect of getting anti-retroviral drugs is improving - there has been a six-fold increase in the numbers getting treatment in the past two years.

But there is a terrible irony.

Severe drought across Kenya and the Horn of Africa has meant that patients on anti-retrovirals who don't get enough to eat have been unable to tolerate their medicines.

So they have stopped taking them.

Debilitating side-effects

That is the situation that faced Paul Kwaluma, a 40-year-old father of four from Kitui in eastern Kenya.

He went onto anti-retroviral treatment in 2004. But last year, after four failed harvests, the food ran out at home.

They know HIV will not kill them immediately, but famine might kill you in one week Dr John Omondi Kenya offers free Aids drugs Have Your Say

Without regular meals, he became unable to cope with the potent medicines needed to keep him alive.

"If you don't have any breakfast you can't take these drugs because when you swallow them you feel in your stomach pain... and awful dizziness."

The side-effects are so debilitating that Mr Kwaluma had had to be hospitalised.

Only now that he receives a food ration of 6kg of maize meal and beans a month can he have any chance of sticking to the drugs.

Look around him and you see why food is in such short supply in eastern Kenya.

The river beds are dried up, the maize crops have failed and there are children all around with empty stomachs.

Blunt choices

Doctors at Mutomo hospital, where Paul receives treatment, say the links between food and Aids can't be overlooked.

Failure to adhere to treatment brings the prospect of drug resistance. If a patient no longer benefits from their drugs, then the option to move onto more expensive "second line" treatment is limited.

Famine can exacerbate Africa's Aids crisis

There is also the possibility of passing the resistant strain onto others, making the battle against HIV/Aids that much harder to fight.

Lack of food is preventing people from getting onto anti-retrovirals in the first place.

Dr John Omondi, the only doctor at Mutomo hospital, in charge of 350 patients, sets out the blunt choices that his hungry Aids patients face.

"If somebody has 50 bob [shillings] ($0.75; £0.40) he or she would rather buy food to eat than take pills. They know HIV will not kill them immediately, but famine might kill you in one week."

Hidden issue

As a stop-gap measure, Father Paul Healy a Catholic Priest at Mutomo hospital ensures patients get a hot meal when they come in for their monthly Aids tests.

But it's not sustainable and without outside help he fears many offered the hope of anti-retroviral treatment will die.

"There has been a constant famine in existence in Kitui. I think if we don't pay attention and find long term answers to a place like this, people living with HIV won't stand a chance."

The Kenyan government is expected to set out its policy on nutrition and Aids in the coming month.

There are no clear figures of how many Aids patients are struggling to get enough to eat - up until now it has remained a hidden issue.