Taking ARVS on empty stomachs: The tribulations of Kibra children

11.17 am. 
A sharp stentorian scream fills the air in Kibra, Nairobi bringing everything at Mugumoini Community Centre to a standstill.

Two emaciated female teenagers are calling out for help while dragging another aged 16 who seems to be fighting to stay alive.

“ Our friend is a person living with HIV/AIDS , though she was born with it and is usually on antiretroviral drugs (ARVs). She has not had anything to eat for four days, which is why we brought her here ,” Zipporah Achieng (20) another young lady living with HIV/AIDS discloses to Healthy Nation.
The Christian-based community centre, which is located at the heart of the slum, serves as a source of refuge and hope  to  locals. “I am a HIV champion, which means I dedicate a lot of time in creating awareness and talking to young people who are increasingly testing positive for the virus because I have lived with it for 20 years. I was born with it.

“The journey has been long and full of many disappointments but now lack of food when you are taking medication is making things worse by the day; especially because many people can no longer get odd jobs to do due to the pandemic ,” the young champion says.
Miss Achieng, a Form Three student, was born in a family of five, where she and her mum are the only ones battling the virus.
“I have never known my father, I only know that he fled after getting my mother pregnant with me.
“When I gave birth to Zipporah in 2001 I did not know that I had acquired the virus.She turned out to be a very sickly baby, which was very worrying. I was in denial at first when I was told that I was positive, refused to take any medication but by the grace of God I resolved to fight this virus together with my baby because I wanted her to stay alive,” Jennifer Akinyi (40), Miss Achieng’s mother,  reveals.

She says when she tested positive, save for her mother, everyone in her family took off while the community in Kibra stopped engaging her.

“Kibra is big so we have had to change where we live many times because at first no one wanted to associate with me, let me use their utensils or share a meal with me. The stigma that comes with that is what you cannot even wish for your worst enemy but we have learnt to navigate over the years because medication helps. The bigger challenge all of us living with HIV are facing in this part of the world is food because the pandemic has beaten us to pulp,” the mother of five says.

Do business

According to Miss Achieng, the constellation of NGOs and government initiatives set up in the slum  to help thousands of Kenyans living with the virus are as dead as a dodo.
“The food that is meant to be distributed, the aid, and drugs do not reach the people who genuinely need them. Some people have moved to Kibra to do business at the expense of our lives and they are known, “the champion says.

Last year, Miss Achieng gave birth to her first baby.
“I have a daughter who is negative, thanks to the ARVs that I religiously take though it’s tough to take those pills without food because they are super strong and sometimes your body almost gives up.
“Her dad rejected me when I got pregnant, offered Sh3, 000 in an attempt to compel me to get an abortion but I vehemently refused because I believe life is sacred and must be protected at all cost.”

"I didn’t want to live with the guilt of  maybe denying Kenya her first female president because you never know what the destiny of this baby is, which is why she eats what I eat and if there’s nothing to eat we both go to bed famished and sometimes it happens for very many days .” 

The young lady agrees with her mother that the community centre, which feeds at least 500 people a day and is funded by Christian well-wishers mostly from America, is what keeps them alive.
“It is a blessing when you have somewhere you can run to, find people to talk to and in this case people who can listen and offer assistance. However,  Mugumoini cannot solve everyone’s problems because it is carrying a burden that belongs to the government. Due to corruption, too many middlemen and officials who are out to benefit themselves at our expense, the system is rigged, faulty and totally dead,  which is why the government has abandoned us,” Miss Achieng says.

Mr Josiah Mwangi Munyotu, the head teacher at St John Primary School in Kibra , reveals that the situation gets worse when  students are on mid-term or on holidays. “I have lived in Kibra for 30  years, and I have never witnessed what is happening now.
“I have many children who are living with HIV and simply put they totally have nothing to eat apart from depending on the ‘githeri’ we provide once or at most twice a week when we can and for this reason the attendance is usually at its peak at those times .”

He believes that no one seems to care about the many starving slum families.
“As the situation is, the health of the many children on ARV’s here is deteriorating by the day,” Mr Munyotu highlights.

Pastor Eric Agoro Simba, who was born and bred in Kibra and then founded Mugumoini Community Centrer under Christian Best Camps of Kenya,  says the organisation has been providing for destitute children for the last 10 years, serving everyone in the community.

“Other than the feeding programme, we have an urban farming project where we teach the community to grow food so that they are food-secure despite the challenges they are grappling with.
The people who suffer the most in Kibra are children and they do so in a number of ways. Many children living with HIV/AIDS are forced to become parents of children-led homes because their parents died from the virus. And due to stigma, some parents  hide from the general population and so they suffer in silence. There is also lack of access to ARVs,” the pastor explains. He further points out that the pandemic has totally mauled many families in Kibra.
“The focus during this pandemic has been on infections, vaccinations and isolations, which led to many people who hail from Kibra to be locked out from getting the vital drugs they need such as ARVs.
“There has also been reduced funding for ARVs as USAID walked away from her partnership with the government, making people in Kibra who solely rely on this ARVs to suffer as they cannot afford alternative medicine,” he tells Healthy Nation. 

The pastor says his community centre has taken upon itself to set up a HIV/AIDS support group for teenagers and children, which constantly meets to share the challenges they face. It also offers counselling and food whenever it can.
Speaking to Healthy Nation in a telephone interview, Dr Stellah Wairimu Bosire, a Kenyan physician who previously served as the vice-chair of the HIV and AIDS Tribunal of Kenya, says as the disease progresses from stage one to stage four, it causes what is known as an increased catabolic state where the body breaks down available long term sources of energy such as fat stores;  hence the loss of weight among patients that are not in care.
“The progression of the disease also increases the risk of opportunistic infections, which is worsened by caloric and nutrient deficiency.”
Studies have also shown that nutritional deficiencies can indirectly accelerate HIV infection. 
“Patients on antiretroviral treatment (ART) who are undernourished or malnourished also face serious adverse side effects of the drugs,” she explains. 
The former CEO of Kenya Medical Association urged the government to urgently make food available. 
 
“Lack of adequate food also has a direct impact on access to care- children and adults most often than not do dot have the energy to access care, so disruption of clinical follow-up. 
Children can also drop out of school as a combined effect of lack of food and progression of the disease or severe side effects of the ARVs,” Dr Bosire highlighted. 

Healthy Nation sought comment from the Ministry of Health, which said it is not its role to feed anyone.
“ When it comes to developing guidelines , training , policy and research, we can be involved but when it comes to implementing programmes related to food and nutrition depending on what the matter is, you have to talk to the Ministry of Agriculture and county governments who deal with providing food ,” a high ranking official who sought anonymity explained. 

However, the Ministry of Agriculture in a telephone interview did not agree with its Health counterpart.
 “The Ministry of Health has a Nutrition department, how do we come in? When it comes to ARVs the National AIDS & STI Control Program (NASCOP), which is an arm of the Ministry of Health,  does everything from sourcing of funds to supplying ARVs, they are in charge of everything.
 “As the Ministry of Agriculture we have never talked about implementing nutrition in any meeting,” an official from the ministry said. 

Dr Catherine Ngugi, the Head of NASCOP, and Dr Ouma Oluga, the Director of Medical Services at Nairobi Metropolitan Services, did not pick calls or respond to text messages sent by Healthy Nation. 

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