Lusaka, Zambia — Scattered wheelbarrows litter the ground outside Kanyama Health Center's anti-retroviral clinic in Lusaka, Zambia. Just beyond them, a long line of patients has formed, each waiting to see the sister-in-charge, as the head nurse is called.
For years, the wheelbarrows were used by young men and women to wheel sick relatives to the clinic for HIV testing and whatever treatment was available. The crude "wheelchairs" symbolized the hopelessness and poverty that HIV brought to many households in southern Africa.
Today, the wheelbarrows have new significance. More and more Zambians - who were previously too ill too walk - return to the clinic each month to refill their anti-retroviral (ARV) drug prescriptions. Now strong, and walking under their own power, patients use the wheelbarrows that once carried them to cart away bags of maize provided through a unique partnership among several organizations - the local health district, the United Nations World Food Programme (WFP), Zambia's Catholic dioceses, and two U.S.-based non-governmental organizations, Catholic Relief Services and Project Concern International.
The free food is essential for many ARV patients, nurses said. Patients taking ARVs risk malnutrition and harmful side effects unless they can increase their overall caloric intake by as much as 40 percent. Many Aids patients in Zambia have difficulty getting enough food to tolerate the highly-toxic drugs.
Poor rains have increased food insecurity in many parts of the country, which worries organizations providing anti-retrovirals and home-based care. The World Food Programme warned last November that more than 1.6 million Zambians will need food assistance in the coming months.
"For someone to be taking medication every day, it's a challenge," Project Concern consultant Shampulula Kabamba said. She currently trains and supports home-based care volunteers in Mongu, the capital of Western Province, Zambia's poorest region, where food insecurity is a huge obstacle to successful ARV therapy. The volunteers monitor patients as they begin their treatment, as missed pills can lead to the virus becoming resistant to the drugs.
Kabamba said that when Zambia's government announced in August that it would provide free anti-retroviral drugs to all Zambians who need them, it provoked a flood of clients to HIV testing centers, many of whom were placed on the ARV therapy. The home-based care and food distribution programs, ultimately funded by the WFP and the U.S. President's Emergency Plan for Aids Relief (Pepfar), fill the gap to ensure that even the poorest Zambians can get the food they need to tolerate treatment.
From her base in Mongu, Kabamba's 26 HIV-positive volunteers look after 440 people receiving ARV therapy. Through a home assessment, they've determined that 343 clients -- 78 percent -- need food rations to combat side effects and comply with their treatment schedule.
Nationwide, the WFP will provide food to 20,000 people on ARV therapy in the coming months, said WFP spokesperson Jo Woods by e-mail. About 40,000 people are receiving ARVs in Zambia, but the government hopes to scale up the program to offer treatment to the estimated 200,000 Zambians who need it.
But even free ARVs and free food programs do not guarantee a smooth ride for sick Zambians receiving treatment.
Kabamba said transport costs are a significant obstacle to ARV adherence for the majority of Zambians who live far from the nearest treatment clinics. Kabamba said nurses will sometimes take up collections to help rural patients who have exhausted all their resources by getting to the clinic and are stuck without money to catch a minibus home.
Transport and adherence are especially a problem for HIV-positive children, who often have an elderly grandparent traveling to the clinic each month to fill their prescriptions. Some grandparents are too sick themselves, or too poor, to make the trip - or they simply forget, Kabamba said. U.S. and Zambian government officials, as well as representatives of non-governmental organizations, said they are looking at transport as the next hurdle to conquer in the national ARV rollout.
Still, adherence to the life-saving treatment in Mongu is over 95 percent, Kabamba said, and rates are similarly high in Lusaka, the capital of Zambia.
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Members of an HIV-positive support group at Kamwala clinic in Lusaka said many of their friends and neighbors are still suspicious of ARVs' efficacy in treating Aids. But they urged an end to the rumours and skepticism.
"We don't want any people to die and leave kids behind, so we think they should take ARVs so they can see their kids growing up," said Leyford Hanangala, who has lived with the virus for almost 20 years. Hanangala said he regularly sought treatment from traditional healers, which never worked.
In fact, just one member of the Kamwala support group, Mary Chapo, said she had never sought help from traditional healers. When Chapo found out she was HIV-positive, she asked her parents to take her to a hospice to die.
Today, Chapo says she is living positively with the virus, and her children even remind her to take her ARVs at the same time every day.
"We want people to know that ARVs work and you can go back to life," she said.
