[pronut-hiv] Kenya: Using ARVs to Fill Empty Stomachs

["ProNut-HIV" <pronut-hiv@healthnet.org>]

Kenya: Using ARVs to Fill Empty Stomachs
Inter Press Service (Johannesburg)

June 2, 2006
Joyce Mulama
Nairobi

"ARVs can change things, but they do not change my socio-economic
status. Yes, I get the ARVs; but I cannot afford to put a simple meal on
the table," says a man who insists on being identified only as wa
Kimani.

"This is why I had to register at two treatment sites, so that I could
get ARVs (anti-retroviral drugs) twice: utilise one set from one site,
then sell the other batch from the second site, so that I can get
something small to put in my stomach."

Wa Kimani spoke to IPS outside one of the centres where he obtains
treatment, his face perspiring in the hot sun as he sat on a stone,
awaiting the client who buys medication from him. The stigma that
continues to surround AIDS in Kenya has apparently made the client wary
of obtaining ARVs through official channels -- something he fears may
lead to his HIV-positive status being made public.

Wa Kimani, who is unemployed, began selling the drugs last year. He
charges his client just under seven dollars for a month's worth of
medication.

"This is not much, but at least it helps me purchase some basic food so
that I do not take the medicine on an empty stomach. It can be
dangerous, you know," wa Kimani says.

"I remember once, before I thought of the trade, I would take the
medicine without any food -- just porridge alone. I nearly died. I got
so weak, I developed ulcers which have not healed well until now."

Until the beginning of this month, government facilities had been
charging about 1.4 dollars for the same amount of ARVs; however, the fee
was waived from Jun. 1. About two million people are living with
HIV/AIDS in Kenya -- more than 200,000 of whom require ARVs.

Wa Kimani's case does not seem to be unique.

Patricia Asero, a member of the Kenya Treatment Access Movement, heard
of six other people receiving ARVs from more than one centre last year.

"I got interested and investigated the matter further because these
people belong to the same support group as me. I found out that they had
registered in more than one treatment centre so that they could get
extra drugs to sell and buy food to take with medication," she told IPS.

In some cases, patients who only have one source of drugs will also sell
their ARVs to buy food, added Asero. However, they present a different
tale to staff at their treatment centres.

"They will tell you that their medication got lost; others claim that
their bags were snatched by thieves. But when you interrogate them
keenly, you get to know the truth," she noted. Asero is also an HIV/AIDS
counselor at a government hospital.

Other patients who live long distances from ARV sites and who are too
weak to walk to there -- also too poor to afford transport -- simply
skip treatment, using what money they have to buy food.

With official figures indicating that about 56 percent of the population
lives below the poverty line, the temptation that certain HIV-positive
Kenyans face to sell their medication is unlikely to diminish in the
near future.

"The fight against HIV/AIDS must be coupled with the fight against
poverty. If not, we are wasting our time," says Omu Anzala, a senior
lecturer in the Department of Medical Microbiology at Nairobi
University's School of Medicine. Nairobi is the Kenyan capital.

The government claims to have steadily increased the number of persons
who are receiving ARV medication in recent years: 39,000 patients were
treated in 2005, up from 24,000 in 2004. The aim was to have 95,000
people on the drugs by the start of 2006.

But, says Anzala, "The government should get away from giving us
numbers. It should be concerned about the quality and sustainability of
the service. These numbers mean nothing when the majority of the
patients are skipping or selling drugs."

The alleged sale of ARVs by some patients, and the erratic way in which
others are said to take the medicine, has raised fears of drug-resistant
strains of HIV in Kenya.

At present, there are only about 24 ARVs on the market -- and at any one
time, a patient must be on three. If present trends continue, says
Anzala, "we may not have any ARVs to talk about, since people will be
resistant on all of them."

There is a need to monitor people and to see if they are taking their
medication as required, as well as monitor resistant strains of the
disease."

Others claim that these problems would be circumvented if more attention
was given to the matter of nutrition.

"When we talk about comprehensive care in HIV/AIDS, nutrition is part of
it. But the government has neglected it; it only provides nutritional
counseling and that is it," notes Asero.