Release date
November 28, 2008
Michael Hill
Communications Officer, Sub-Saharan Africa
Baltimore, MD

Zambia Project Faces Dual Crisis: HIV and Food Supply

November 28, 2008, —

By Michael Hill

The statistics on the charts can tell many stories. At the CRS-supported St. Francis Community Home-Based Care Project in Livingstone, Zambia, the most impressive chart is the one that records deaths.

Almost everyone in the program suffers from the effects of HIV. In 2003, 396 of them died. In 2004, it was 362. In 2005, the figure was 307. Then—look at 2006—the number dropped to 171. It went down further in 2007, to 124.

Sister Kafwinbi

Sister Kafwinbi fears the rising price of food might cause patients to stop taking their antiretroviral medications, which require a healthy diet high in protein. Photo by Michael Hill/CRS

What happened? In 2006, clinics began distributing the antiretroviral medicines that have proved so effective at keeping the effects of HIV under control.

People in Africa who are HIV-positive are now able to lead reasonably healthy lives, supporting their families, taking care of their children. An HIV-positive diagnosis is no longer a death sentence.

But that brings new challenges to places like St. Francis. HIV and AIDS care programs run out of such centers used to have one main mission—to care for those who were dying. There is still plenty of that work to do, unfortunately. But more and more, the challenge is to take care of the living, making sure they take their medications, helping them deal with—and reduce—the stigma of living with the virus, trying to see that they do not pass the virus on to others.

And now a new challenge looms: the rising price of food is making it difficult for many to stay on their regimen of antiretroviral medication.

Nutrition Crisis

"It is a very big problem," says Sister Kafwinbi of the rising food prices. The sister, a nurse, directs the Mwandi Mission Hospital, which is supported by Catholic Relief Services. "You cannot take this drug without food. It is a powerful drug and gives you bad reactions."

The Mwandi Mission Hospital sits about 70 miles from Livingstone, on the banks of the mighty Zambezi River. The hospital serves a broad rural area that has a devastating HIV prevalence of over 30 percent. The main roads in this area are busy trade routes between Zambia and Botswana, Namibia and Angola. Many studies show that HIV infection is always high in such areas.

That this area is so far-flung and lacking in infrastructure adds another problem—it is difficult to reach people with education programs that would help them avoid the disease. Nearly 1,000 people get their antiretroviral treatment from the hospital in Mwandi. Many more, most of whom arrive when their condition has advanced too far to benefit from the drugs, get palliative care.

Just to maintain basic health, users of antiretrovirals need more food than they normally would. Their diet also must be high in protein, the most expensive food.

Compounding the problem in this area, heavy floods in February and March washed away a season's crops. Ironically, the floods were followed by a lack of rain that has made it hard for agriculture to recover.

"Some of our patients just have no way of finding food to eat," Sister Kafwinbi says. "Some have stopped taking their drugs because of a lack of food."

Food Supply Down, Prices Up

She recited one more statistic that illustrates the problem. A 55-pound bag of corn, the staple in Zambia, cost 38,000 Kwacha—about $11 —in July. Now it is 58,000 Kwacha—a little more than $15.

The Mwandi hospital serves a far-flung area. Many travel scores of miles to get their drugs.

"I know of some who come [more than 100 miles] by ox cart," Sister Kafwinbi says.

In the hospital's HIV clinic on a recent afternoon, several people were waiting for drugs. Others were there for the first time, to be evaluated. One man, who did not want to be identified, said he had bicycled all morning to get there, traveling over 30 miles to get his supply of antiretroviral medications. His village was only partially affected by the floods and still had food, but the supply would run out in a few weeks.

"I don't know what I will do then," he says. "I am just a beggar."

Loveness Lubinda, 24, first came to the clinic a year ago for her evaluation, feeling very, very sick. She now takes antiretrovirals twice a day.

"I feel fine," she says, testifying to their effectiveness. "Now it feels as if the sickness never happened."

Loveness lives with her aunt, grandmother and a 6-year-old daughter who is in school. "Year one," Loveness says with some pride, and you wonder where the girl would be if her mother did not get these antiretroviral medicines.

Loveness's village faces the same problem as the man's—food running out in a few weeks. Again, she does not know what she will do then.

CRS supports many food programs in this area of Zambia. But it is enough of a challenge to see that healthy people get enough to avoid malnutrition. Trying to get those on antiretroviral treatment the right amount of nutrition is yet another task. And it is clear that no one will beat this disease without sufficient food.

More Outreach Needed

As much as the Mwandi clinic is doing, those who work there know it could do more. The area it serves has a population of 22,000, meaning probably 7,000 are HIV-positive. The clinic may be reaching a third of those, at most.

"We need to do more outreach," says Walusiko Muyunda, who keeps the clinic's computers running.

The staff in places like the Mwandi clinic is on the frontline, fighting of one of the greatest pandemics man has ever faced with relatively primitive weapons.

Back in Livingston, Sister Mary Courtney describes what it is like to switch the work of the St. Francis Community Home-Based Care Project she directs from helping people die from AIDS to helping them live with HIV.

"We have income-generating groups," she says, describing people who get together to work on handcrafts they can sell. They use the money to support themselves, particularly with the rising cost of food.

But there is a more important reason for the groups.

"They get to talk to each other," Sister Mary says. "While they work, they can share their life experiences of living with HIV, helping to eradicate the stigma of living with this disease."

Michael Hill is CRS' communications officer for sub-Saharan Africa. He is based at the agency's headquarters in Baltimore.