Two sisters from Napasha Village in southern Malawi wake up before the sun rises and start walking to the maize fields a few kilometres away.
Along the way they stop to eat a slice of bread with the anti-retroviral medicine given them by the Malawian government.
Once they get to the fields they join other women and for the next few hours work under the baking sun.
The sisters, Christina Simikwa and Miritina Nyapigoti, are both in their fifties, and like many other HIV-positive women in Malawi, are having to raise a family on their own at a time of a massive food shortage.
Malawi was hit by a food crisis after a drought last season caused its staple maize crop to fail. The maize price has shot up to 50 kwacha a kilogramme (R2.50) in some areas, but for those with money it is possible to buy cheaper rationed amounts from the government.
Many in the poverty-stricken country earn just a few kwacha a day and cannot afford maize. The government estimates that about 4,5-million out of 12-million Malawians are in need of food aid.
The situation has become so dire that earlier this year President Binga wa Mutharika declared a national emergency and pleaded for aid from the rest of the world.
The hunger crisis has worsened the HIV/Aids pandemic in Malawi where about 1,7-million people (14,4% of the population) are said to be HIV positive.
The government has rolled out a treatment programme, but to be effective ARVs have to be taken with a balanced diet.
Napasha Village, a two-hour drive south of Blantyre, is in the Nsanje District. It is one of the areas hardest hit by the drought — and it also has a massive HIV infection rate.
The aid agency Goal, which works with the United Nations, estimates that about a third of the people in Nsanje are HIV-positive. There are about 15 000 Aids orphans in the area. With a life expectancy of just 40, not many Malawians live to old age.
The bones on Simikwa’s chest protrude as she sits on a log and stretches out her legs, on which the skin is dried and cracked.
”Once a month an aid agency gives out food, but it is not enough to feed my children,” she says through a translator.
”I have four children and my husband is dead. There is no one else to bring in money. For now we have to rely on the aid, which is no good because the aid can stop at any time.”
Simikwa and Nyapigoti were registered for the government’s anti-retroviral campaign after they were confirmed as being HIV-positive.
They and their children receive food from agencies such as Goal.
Simikwa says other people are jealous of the aid she and her family receive.
”People talk and make comments, but I do not think it is has reached the level where we have to start worrying. It is normal that not everyone will be happy.”
She says HIV/Aids has become so much part of life in the village that even the village headman talks openly about it.
”Before people never used to talk about sex. Now it is no longer a secret. Aids has made us talk about it openly.”
Nyapigoti’s eyes are bloodshot and her shoulders hunch forward as she speaks. Flies swarm around her but she does not bother to brush them away.
Her husband died in 1998 and she is the sole supporter of her two children.
She says she is grateful for the aid, but what people really want is a way of earning an income of their own.
”In this place people will always be hungry and poor. What we need is to have businesses so that we can trade with each other. Maybe next year donors will be tired of giving us aid.
”Maybe the government and the donors could find a way to help us start small businesses. They could teach us skills. Some of us know how to make biscuits. We could make money that way.”
Rain suddenly starts pelting down on the dry earth and for a moment there is a feeling of optimism. But it stops almost immediately and the sun comes out again.
”It always comes for a few seconds like that,” Simikwa says.
In Trinity Hospital near Napasha, six mothers are sitting on beds holding their babies. The ward is hot. There are no blankets, just plastic-covered mattresses and tied up mosquito nets, ready to be draped over the beds.
Two of the babies are so thin that their bones are visible. Sister Anna Bande, co-ordinator of the maternity ward, says in the past few months far more undernourished babies have been admitted than usual.
”Maybe about 30% more children and babies with symptoms of malnutrition are coming in than in previous years,” she says.
”We are treating about 100 children a week and 20 of those are severely malnourished. Most are HIV-positive.”
Once a week Bande travels through the surrounding villages scouting for chronically ill babies.
”When we go to the houses we find there is very little food.
”There are many hungry children in these villages. The sickest are brought back here.”
One of the women in the ward is Esnie Nyasangudza (29) who is breast feeding her 11-month-old daughter, Gertrude.
Nyasangudza’s husband left her when she was three months pregnant with Gertrude.
”I feed her porridge in the morning, but she will not eat,” she says.
”She has diarrhoea and she vomits up her food.”
Another mother, Mary Costa, looks after her baby, Hilda. She walked for three hours to get to the hospital to have her infant treated.
Hilda has also been vomiting and has diarrhoea. Most of the babies in the ward have similar symptoms.
Bande says these symptoms are typical of malnourished babies with HIV. She says some could also have contracted malaria.
Outside of the ward a Canadian missionary, Will Phillips, has come to have a child treated. He and his wife run an orphanage in a nearby town.
”The hunger situation is bad this year,” Phillips says. ”Much worse than usual.”
In Napasha Village it is late afternoon and a group of boys have started a soccer game. Women sit outside their homes chatting and those with food are cooking dinner. Children splash in a small stream.
”Yes, we suffer,” Simikwa says. ”But life carries on.” – Sapa