In the bleached shantytowns of southern Africa they call them the ”ugly sisters” — a twin force of such devastation that from the wreckage it is seldom possible to distinguish one sibling’s impact from the other: Aids and hunger have become inseparable.
Relief agencies and governments will meet in South Africa next week to call for a new approach to a humanitarian crisis on a scale no one has quite seen before. Plague and famine have intertwined into a self-perpetuating phenomenon which could last for decades.
The Johannesburg meeting will bring together UN agencies, the 14-member Southern African Development Community (SADC) and non-governmental organisations to discuss new ways of tackling the economic, social and cultural nexus that is the result of the ugly sisters.
A shack dustier than most in Lwangwe, a sprawling shantytown in northern Zambia, illustrated the challenge facing policymakers. Not so long ago it was a prosperous household. Although Derek Mubanga lost his job when the copper mines closed he found another with a relief agency and his wife, Agnes, sold vegetables in the market. Providing for the six children was not a problem.
Derek, however, was HIV positive and he became too sick to work. Nursing him for 16 months prevented Agnes from growing vegetables so they sold their possessions until there was nothing left to sell. Two weeks ago Derek died and the last of the food was used up at his wake.
Stretched on a mat cradling her youngest son, a three-year-old also called Derek, it was obvious from her wan, skeletal figure that Agnes (38) had full-blown Aids. The family had not eaten that day, there was no food in the house and the next monthly ration of relief food — a 1kg pack of fortified maize — would not arrive for two weeks.
”Derek cries from the hunger but I tell him God will provide and eventually he falls asleep,” said Agnes. Sheepishly, she admitted not consuming vitamin tablets. ”I know they are good for the health but the tablets make me hungry.”
The tablets stimulate appetite, making doctors despair that a vicious circle spins ever faster. People with HIV/Aids are supposed to eat 50% more protein than usual, supplemented by foods rich in micronutrients, otherwise the immune system collapses and vulnerability to opportunistic infections such as tuberculosis and meningitis rises.
”Forget antiretrovirals, the medicine these people need is food. Food, food, food,” said Sister Joan Walsh, an Irish nun who runs a home-based care organisation in Lwangwe.
Her colleague Eileen Keane, a doctor, was frustrated by governments and aid groups which focused on antiretrovirals. ”They end up in the hands of the elite and those who can afford bribes. For the poor the priority is nourishment.”
The traditional reliance on wild berries and nuts in lean times was not an option for those with enfeebled digestion, she added. Between 13% and 33% of the adult populations of Zambia, Lesotho, Swaziland, Malawi, Mozambique and Zimbabwe are HIV positive. Up to 28 million people are infected in sub-Saharan Africa, which is too poor to distribute antiretroviral drugs effectively.
According to the UN’s World Food Programme (WFP), 14,4 million people in those countries also face starvation because drought and mismanagement have shrivelled their crops. The region had a food crisis in 1992 but this one is different.
”The crisis within the crisis — the HIV/Aids crisis — is enormous,” said James Morris, the head of the WFP. ”This is a catastrophe in the world that in some respects is unprecedented.”
That the countries worst hit by famine are among those worst hit by Aids is no coincidence. Hunger breeds HIV and HIV breeds hunger. According to the Food and Agriculture Organisation the disease is ravaging farmers.
Mozambique, for example, lost 2,3% of its farmers in 2000 and can expect to lose 20% by 2020. No one can estimate the impact that will have on output.
Scarcity inflates prices but families exhaust savings caring for sick members — often the breadwinners — and abandon work in order to be by their bedsides. Penury deepens with funeral costs.
Justina Nalungwe (31) would earn about R7 every day selling fritters — enough to feed her two children — but since entering an Aids hospice near the Zambian town of Ndola the children have stayed with their impoverished grandmother. ”They have nothing to eat,” said Justina.
Admissions to the hospice have almost doubled in the past three months because hunger was accelerating the onset of full-blown Aids, said Sophie Chifokola, an administrator. It was also accelerating its spread.
Less than two miles from Justina’s bed a beer hall geared up for another night. Wearing short skirts and wide smiles, the widows and abandoned wives lined a bench, waiting in turn to pick up men.
Full sex cost around R20, double that if the man did not want to use a condom, said Richard Kasonde, a medical officer who dealt with the consequences.
”These ladies have children and with $2 [about R20] you can feed three mouths for one day. They are educated about the virus but say they would rather die of Aids than hunger.”
As pregnancies have soared so have the deaths of babies infected with HIV. The drug nevirapine can greatly reduce mother-to-child transmission if formula rather than breast milk is used. In the absence of formula milk some doctors tell mothers to breastfeed, calculating that malnutrition is a bigger risk than HIV. – Guardian Unlimited (c) Guardian Newspapers Limited 2002