By Henry Kijimwana Mhango, The Telegraph
Thousands of people living with HIV and Aids in Malawi are “silently” dying of hunger, even as the government spends huge sums of money procuring life-prolonging drugs.
The small southern African country has one of the highest rates of HIV and Aids worldwide, with roughly one million people suffering from the deadly disease.
But over the last 15 years the government has ramped up efforts to tackle the epidemic, gaining global recognition.
By 2018, 79 percent of adults living with the illness were on antiretroviral therapy (ART), which is used to suppress HIV/Aids and prevent new infections.
By contrast, the regional average rate of ART use across east and southern Africa is just 67 per cent, while that figure drops to just 53 per cent in west Africa.
But a rising threat could hamper Malawi’s steady progress — food insecurity.
Food shortages are increasing at an alarming rate in the nation after severe floods and droughts ruined this year’s harvest. At the end of last year, the UN named Malawi as one of nine countries in southern Africa at risk of a “hunger crisis”.
For those taking ARTs, the lack of food could have a devastating impact on their life expectancy.
Moses Munthali, a frail 14-year-old who contracted HIV during an unsafe circumcision three years ago, understands the challenges all too well.
“I become very weak when I take the drugs without eating anything, so I don’t take the drugs when there is no food,” he said, perched on the veranda outside his family’s small grass-thatched hut in a remote village some three hours from Zomba, Malawi’s former capital city.
But five months after hunger forced him to stop taking the vital treatment he was admitted to hospital with a crippled immune system.
“This was the worst experience I had never gone through and I can’t believe I’m alive,” he said. “I could [only] live on blood and water drips and was hopeless about life. I saw a shadow of death hovering around my face.”
Moses slowly recovered but his grandfather, Ndawonga Munthali, is worried that history will soon repeat itself. For the last five days Moses has once again stopped taking the ARTs as food shortages take hold and hike up prices.
“I’m equally worried about my grand children’s health,” Mr Munthali, the family’s main breadwinner, said. “I don’t even sleep for him but there is nothing else I can do to help him because I have nothing to earn more money to buy him food.”
Both the World Health Organization and UNAIDS recommend ARTs to be taken on a full stomach to prevent side effects from the powerful drugs.
But Cosman Munthali, an activist and chairman of the local branch of Malawi’s Forum on HIV and Aids, said that Moses is just one of thousands of people facing a difficult decision — take the ARTs and suffer negative side effects, or stop the therapy and allow the HIV to flourish.
“We have a lot of defaulters of ARVs due to side effects related to food problems such as extreme body weight loss, lack of appetite and other body changes,” Munthali told The Telegraph.
“Unfortunately, many of these people are poor and victims to acute hunger that has hit the country. The situation only takes them to their graves silently and untimely.”
The situation is not completely unprecedented. In 2005, the same year that the government introduced the ART programme, Malawi was also hit by severe hunger.
In that year alone, the country’s National Aids Commission registered close to 64,200 Aids related deaths. In 2018, this figure had fallen to roughly 13,000.
But Karen Iron Msiska, corporate services and public relations officer at the National Aids Commission, told The Telegraph that it is too soon to identify whether hunger has caused a national increase in Aids-related deaths this year.
“There is some information that needs to be updated before we share to the world,” he said, adding that the ART programme was essential in reducing HIV death rates.
But according to regional data from Karonga, a district on the Tanzanian border, health authorities have identified some 6,400 people who have stopped taking ART, more than 40 per cent of the 14,200 HIV and Aids patients who are using the drugs.
David Sibale, In-Charge for Karonga district’s health team, said that Karonga had recorded 2,254 new infections between June 2018 and July 2019.
He added that there is a high chance that those who stopped taking the ARTs to had contributed to the new infections because they are at higher risk of spreading the virus than those following the treatment schedule.
Munthali said that the solution is to incorporate nutrition support for people living with HIV and Aids into ART programs.
“Donors, however, should come second after our government. We really need to intensify the combination and integration of the policy to support the people living with HIV and Aids with compatible services including food security,” he told The Telegraph.
Macdonald Sembeleka, another HIV and Aids activist, has also called on the government and donors to consider food security as part of a package to prevent people stopping ART — and therefore avert deaths.
“ART should be treated as the only critical aspect of driving the epidemic away but rather it needs to have some accompanying elements inclusive of the nutrition support,” he said. “Unfortunately, both government and donors feel less obligated to support the nutrition element.”
In response, spokesman for the Ministry of Health, Joshua Malango, told The Telegraph that the government had not yet established whether people defaulted on ARTs due to food shortages or other factors.
“We have no evidence to such claims… [and] the introduction of ART services in Malawi has saved the lives of thousands since its inception in 2005,” Malango said.