Africa's Hunger Crisis Complicates AIDS Response

Southern Africa is the region with the highest HIV rates in the world. The disease is multiplying the impact of poor rains on local harvests, adding up to a severe food crisis. AIDS is pulling productive people out of the fields either because they're sick or they have to care for the sick. Amid the shortage, some people desperate to eat are trading sex for food.

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Aid agencies say millions of people in southern Africa don't have enough food to survive until the next harvest in April. The primary cause of the crisis is a lack of rain, but HIV and AIDS are also playing a role. As subsistence farmers in southern Africa become sick or die from AIDS, their fields become less productive. In addition, health workers say, the dire food situation is leading to behavior that could further spread HIV. NPR's Jason Beaubien reports.

(Soundbite of baby crying)

JASON BEAUBIEN reporting:

In the town Chiradzulu in southern Malawi, women line the hall of an unlit, dilapidated health center. Most of the women have babies strapped to their backs with colorful cloths. Some are waiting to see the nurse. Others are waiting for distribution of corn-soya-blend powder from the World Food Program. The women are supposed to use the enriched-maize meal to make porridge for their children, but several say it's the only food they have and they share the monthly ration amongst the whole family. Twenty-six-year old Patricia Dominico says often she has no food during the last two weeks of the month.

Ms. PATRICIA DOMINICO (Chiridzulu, Malawi, Resident): (Foreign language spoken)

BEAUBIEN: `When we run out of food,' she says, `my eldest son and I dig through other people's gardens in search of cassava roots that were left behind during the last harvest. That's how we survive: on boiled cassava root.' Other times, she says, she sends her children to eat at her neighbors' houses.

Dominico is HIV-positive. She learned that she had the virus when she was pregnant with her second child in 2002. After she became pregnant with their third child, her husband left her.

Ms. DOMINICO: (Foreign language spoken)

BEAUBIEN: `The nurse said we must use condoms, but he refused,' Dominico says. `Eventually he moved out and found another wife. Now I'm alone, taking care of all the food problems and the children.'

Like 80 percent of Malawians, Dominico is a subsistence farmer, but this year, she says, her small plot of corn and peanuts produced nothing. She blames the crop failure on the drought, but admits that at times she was too sick to tend the field. Now with no harvest, no husband and a food ration from international donors that only lasts half the month, she's forced to do day labor for about a dollar a day.

Ms. DOMINICO: (Foreign language spoken)

BEAUBIEN: `Sometimes I transport sugarcane from one area to another,' she says. `Other times I go to the river and carry sand from the riverbeds for the men who are doing construction.' But Dominico says she can only do this work when she's feeling healthy, and she worries that she might soon become too sick to feed her three children.

Her situation has become all too common in southern Africa. The World Food Program estimates that eight and a half million people in the region face dire food shortages in the coming months. At the same time, southern Africa has the highest rates of HIV infection in the world. In some nations, 40 percent of adults are infected.

Mr. NELSON MATAKA (Malawian Agriculture Development Division): We have a lot of death at the moment. We have a lot of people in our hospitals who are sick, and these are the people who were supposed to be working.

BEAUBIEN: Nelson Mataka, a district manager with the Malawi government's Agriculture Development Division, says Malawi's economy is dominated by small-scale farming. He says HIV is devastating the economy because it's keeping some of the most productive members of society out of the fields.

Mr. MATAKA: Those that are not sick spend much of the time looking after the sick or attending to funerals. It's real to say that HIV-AIDS is impacting negatively on the economy of the country.

BEAUBIEN: The World Food Program says this is the worst food shortage to hit southern Africa in more than a decade. Despite this, the agency has only been able to raise enough money to feed about half the people who, it says, will run out of food in the coming months.

Meanwhile, health workers in Malawi say the food crisis is leading to the further spread of HIV. Hungry widows, who very well may be HIV-positive themselves, seek new husbands or trade sex for food in order to feed their children. AIDS orphans are sent off to the city to fend for themselves. And mothers who are HIV-positive continue to breast-feed even though it puts their infants at risk of contracting HIV because they can't afford baby formula.

(Soundbite of people's voices, child crying, someone whistling)

BEAUBIEN: Maria Demetri Ampanda(ph) runs a clinic for HIV-positive mothers at the Chiradzulu district hospital. She says even in the best of times, the stigma attached to being HIV-positive makes it extremely difficult to get her patients to stop breast-feeding and do what she calls `replacement feeding.'

Ms. MARIA DEMETRI AMPANDA (Clinic Director, Chiradzulu District Hospital): Most of the mothers--they are waiting to do the breast milk feeding, but they are afraid that in their community they are going to point at them--at fingers--that this one is HIV-positive.

BEAUBIEN: Many people never would have been able to buy commercially produced baby formula. But if the harvest hadn't failed, Ampanda says, some HIV-positive mothers would have sacrificed to try to protect their babies from the virus. But now, she says, most of her clients are breast-feeding. In a part of the world that regularly struggles to feed itself, this is just one more example of how HIV and hunger continue to make each other worse.

Jason Beaubien, NPR News, Blentar(ph), Malawi.

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