AFRO-NETS> Cheap AIDS drugs yes, but food as well

[A Odutola <chpss_abo@yahoo.com>]

Cheap AIDS drugs yes, but food as well
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In an in-depth commentary in the Daily Nation of Friday October 
31, 2003, titled: "Cheap Aids drugs yes, but food as well", 
Dorothy Kweyu uses a recent speech made by Mrs Graca Machel to 
explore the complex inter-play between HIV/AIDS, Food security, 
Nutrition, Wealth creation and Poverty alleviation. The commen-
tary calls into question, the current and well-orchestrated Af-
rica-wide policy pre-occupation with ARV treatment access in na-
tion states where nearly 60% of the people (living with and 
without HIV/AIDS) subsist below poverty line and barely have ac-
cess to one (decent) meal a day. The commentary is well worth 
reading and is reproduced below in full as "fair use".
 
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Cheap Aids drugs yes, but food as well
 
Daily Nation (Nairobi, Kenya)
Dorothy Kweyu
October 31, 2003
 
During her brief visit to Nairobi, Mrs Graca Machel veered off 
the African Women?s Network meeting whose business had brought 
her here to comment on pertinent issues relating to HIV/Aids. 
 
Noting that significant strides had been made in the access to 
treatment campaign since the 14th International Aids Conference 
in Barcelona, Spain (July, 2002), Mrs Machel introduced a little 
discussed issue in relation to HIV/Aids ­food. 
 
"Without food," she said, "treatment cannot work." 
 
Kenya is currently experimenting with different initiatives in-
cluding donations from pharmaceutical companies to spread access 
to anti-retrovirals (ARVs).
 
 Last week in the "Horizon" magazine, it was reported that 
Pfizer Pharmaceuticals had donated Diflucan, a drug that costs 
more than KSh 1,200 a tablet in most pharmacies, to the National 
Aids and STD Control Programme (Nascop) for nation-wide distri-
bution. 
 
According to the report, Kenya joins 15 other African countries 
including Uganda, Botswana, Swaziland, Namibia, Lesotho and Tan-
zania, already benefiting from the Diflucan programme. 
 
In the interview with Mrs Machel, she acknowledged the major 
strides that had been made since Barcelona. While treatment was 
spoken about strongly, it was not actually in place. It is now 
firmly on the agenda, she said. 
 
In Barcelona, "no one was seriously expected to provide treat-
ment to people living with Aids," Mrs Machel said. Since then, 
however, pharmaceuticals had moved from great reluctance to cut 
down the cost of ARVs to a point where the question was now fo-
cused on patents to allow developing countries to produce ge-
neric drugs to treat the suffering millions. 
 
She described the announcement by the World Trade Organisation 
(WTO) that by the year 2005 at least three million people would 
be on treatment as another "big move." 
 
For majority poor, however, access to ARVs is not enough. Mrs 
Machel appealed to those with money to avail it to the poorest 
families so that they are not only able to buy medicine but also 
food. She adds her voice to growing concern that the availabil-
ity of ARVs in the absence of food is not the answer to 
HIV/Aids. 
 
Ahead of the Barcelona parley last year, the Food and Agricul-
ture Organisation of the United Nations (FAO) declared that no 
country with more than one per cent of its population suffering 
from HIV/Aids could base its strategy for combating the disease 
purely on medical measures. 
 
>From the Indian Ocean to Lake Victoria and from Mount Kenya to 
Kakamega, the situation is bleak, with HIV/Aids prevalence well 
above the one percent figure that FAO is proposing as a basis 
for additional intervention. 
 
In Malindi, the Ministry of Health puts HIV/Aids prevalence at 
between 15 and 17 percent, while in Siaya, the percentage is 
38.4 percent. In Meru Central, the figure is just slightly less 
than Siaya?s; it is 38 percent compared with Kakamega?s 31 per-
cent. 
 
The tragedy of HIV/Aids is that it tends to walk hand in hand 
with poverty. Thus, the high prevalence areas mentioned above 
also suffer from chronic poverty. In Siaya, for instance, 58 
percent of the district?s population lives below the poverty 
line, loosely defined as less than one dollar a day (about KSh 
75). 
 
The double jeopardy of HIV/Aids and poverty calls for a serious 
rethink of the entire approach to the management of HIV/Aids 
with an eye on the best good for the majority. An average 57 
percent of Kenya?s 30 million people lives below the poverty 
line. In districts like Busia, the percentage living below the 
poverty line exceeds 70 percent. As Mrs Machel observes, it is 
not enough to say that ARVs are now cheaper because the poorest 
of the poor still cannot buy them. 
 
Specialists in HIV/Aids in Kenya, share Mrs Machel?s view. They 
assert that preoccupation with access to ARVs diverts attention 
from more pressing concerns like good nutrition ­ a prerequisite 
for immuno-compromised people living with HIV and Aids. And not 
only that, over-emphasis on ARVs also exposes patients to the 
dire side effects of ARVs which poor patients lack the capacity 
to address. 
 
Dr Sobbie Mulindi of the University of Nairobi?s School of Medi-
cine, believes that in the war against HIV/Aids, poverty alle-
viation must go hand in hand with food security. "Strengthening 
the agricultural sector is critical to ensuring that there is 
food security," he said, adding that provision of ARVs alone was 
not a solution to HIV/Aids. 
 
Kenyans need to come to grips with the reality that most people 
cannot afford one decent meal a day. Having ARVs is all right, 
Mulindi says, "but nutrition is also very important." 
 
This brings in the issue of poverty alleviation, which cannot be 
tackled without wealth creation. The dilemma of HIV/Aids is that 
while its tackling is linked with poverty reduction, it is not 
enough to have a poverty reduction strategy in place. Wealth 
creation that such a strategy presumes must go hand in hand with 
an enabling environment to tackle the pandemic. Sadly, the dis-
ease targets the most productive age bracket (24 - 35 years) and 
is so debilitating as to undermine all hope of their contribut-
ing to economic growth. 
 
With continuous revelations that Kenya?s economic situation is 
dire, and that Kenyans are becoming poorer, there is need to re-
think the high profile ARV strategy. Kenyans are currently too 
poor to afford a single dose of malaria that costs about 80 
shillings. It is unrealistic to expect them to raise Ksh 1,500 
for a monthly dose of ARVs. Ways must therefore be found to en-
able the majority poor to access ARVs. 
 
 Health minister, Charity Ngilu has spoken about an evolving na-
tional health insurance policy. But it remains to be seen how 
exactly this will work. The bottom line is that ways have to be 
found to subsidise ARVs to realistic levels and to factor food 
and nutrition into their use. 
 
According to Mrs Machel, every nation facing the HIV/Aids crisis 
has to design and find a strategy of getting food to each fam-
ily. 
 
She points to the World Food Programme?s inclusion in the war 
against Aids in situations where internal resources are insuffi-
cient, a root that Kenyans are adopting, according to Dr Mu-
lindi. Stressing home-grown strategies ­ "I am not saying go 
abroad and ask for food" ­ Mrs Machel proposes movement of food 
from surplus to deficit areas. 
 
Describing South Africa as a country that is doing better than 
other countries in this area, she talks about a system of grants 
that targets vulnerable families. 
 
The South African model is based on organising with local gov-
ernments to identify families to receive a monthly allowance (or 
grant) that enables them to buy the minimum of food and other 
necessities. The grant system is backed by a nutritious meal of 
enriched milk and a sandwich for school going children. 
 
The Kenyan experiment with the Constituency Aids fund, which ap-
pears to be the nearest equivalent to the South African model, 
is currently in on hold, due to massive abuse. Whatever the 
case, it appears that modalities have to be found to address the 
vulnerability of people affected with HIV/Aids ­ beyond ARVs. 
 
Source: 
http://www.nationaudio.com/News/DailyNation/Today/Comment/Comment311020032.html
 
Copyright ©2003, Nation Media Group Ltd.
 
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A. Odutola
mailto:chps_abo@yahoo.com

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