AIDS in a time of hunger

Somehow I wish that all the AIDS experts and politicians gathering in Mexico City this weekend could have been with me two years ago, when I met a young man in a nameless, dusty village in Malawi. It was easily the most memorable encounter of my life — royalty, heads of state and celebrities included.

The man was in his mid-30s and badly emaciated. His eyes were pink at the edges and I remember thinking they were somehow on fire with rage. But there was really no anger in him — just exhaustion, anguish, confusion. After gently pushing ahead of the others in the crowd, he asked:

"Why are you keeping me alive? Why give me these AIDS medicines? I am too hungry and weak to work and care for my family. Why torture me this way?"

Needless to say, these were not questions I expected. My hosts had a well-scripted visit to a field project prepared for their new goodwill ambassador to generate publicity. No one was prepared for this man or the depth of his pain. It seemed odd that one of the few Africans fortunate enough to receive the expensive antiretroviral drugs that hold AIDS at bay would complain so bitterly. But we in the donor community had unwittingly given him a humiliating life no longer worth living.

What could I do? I assured him we would get him food, and later, the government of Dubai contributed to the World Food Program's operations in Malawi to help families like his. I like to think he is now working and taking care of his family with some sense of dignity. But how could donors have missed anything so basic as food in the battle against AIDS? Tens of billions of dollars have been pledged to combat AIDS, yet donor countries have largely overlooked the role of nutrition, somehow managing to ignore both the scientists and the beneficiaries. The donors have been asked for help often enough and there are United Nations and NGO projects out there to fund but they are not getting the cash they need to provide good, nutritious food to people like the man I met in Malawi.

For a while, it was the fashion in the aid community to speak about "participatory development," in which projects were planned based on the wishes of their intended beneficiaries. But over time, this has proven to be more rhetoric than reality, and the treatment of communities suffering from AIDS offer perfect examples of how we simply fail to listen. Peter Piot, executive director of UNAIDS, was stunned when he first met families devastated by the disease — they did not ask for medicine or money, but food.

With the steep climb in cereals prices worldwide, the situation grows worse. There is no better evidence that something is amiss than articles in Nairobi newspapers reporting that people being treated for HIV have been selling their anti-retroviral drugs to buy food for their children, and that began even before this year's alarming food shortages.

The obliviousness of donors to the role of nutrition in treating and coping with disease exists beyond Africa and AIDS. Last year, a food assistance project in Cambodia ground to a halt for a lack of donations. Many of its beneficiaries suffered from tuberculosis. Food security and proper nutrition has long been recognized as a critical component in treating TB. A monthly food ration draws TB patients in for their drug treatment and medical monitoring and helps build their strength to overcome the disease.

My husband, Sheik Mohammed, donated $1-million for food to restart the project and donations came in from the United States and Spain. Worried by the situation in Cambodia, the Lancet later ran an editorial on the growing danger of drug-resistant TB and how crucial it is to keep patients properly fed, so they do not become poorly nourished incubators for a deadly disease that threatens us all.

There are some organizations engaged in what I call "next generation" thinking — principally Médecins sans frontières (Doctors Without Borders). MSF has begun to promote food itself as necessary for healing, and not just for those affected by AIDS or tuberculosis. MSF is beginning to see special nutritious foods as medicine and that is an exciting development. After all, hunger and malnutrition remain the leading cause of death worldwide, including the loss of three million children a year. This all undermines our national efforts to reach the UN Millennium Development Goals.

Sadly, the aid community is slow in adopting the innovative thinking at MSF. Even traditional food aid has plummeted by 70 per cent just since 1999 — the lowest level since the founding of the World Food Program in the early 1960s. The chances that the special nutritional needs of people living with HIV and TB will be met grow slimmer.

Adults with HIV infection require 10 per cent more energy and as the disease progresses, that need rises to between 20 and 50 per cent. Micronutrient deficiencies often plague HIV-infected adults and children, and they can only be ended with diversified diets, fortified foods or supplements. As food prices soar, poor families are already substituting less nutritious foods for meat, fish, eggs and vegetables. For people who are already sick, this can have drastic health consequences. The poorest families are being forced to choose between food and medicine for loved ones.

If we do not do a better job of helping poor HIV-affected families today, what chance will the next generation have for health and prosperity? It is time to change the way we help. Drugs alone are not a solution for AIDS or TB. What doctor would admit a patient to a hospital, give them the most advanced medications — and then leave them to starve?