Kenya has adopted an aggressive approach in its bid to control the spread of the devastating coronavirus pandemic since its outbreak in March. It has been proactive, employing the stick and the carrot in its bid to ensure that its already sick healthcare system is not overrun by Covid-19 positive patients.
This strategy has generally paid off, but is proving to be the undoing for poor workers living with HIV. For the lucky few, the pandemic has reduced their already meagre income, but for most, the earnings they previously counted on to feed themselves and their families have dried up. This is worrying because eating balanced diets is crucial to boosting their already compromised immunities.
Health experts have taken note and now fear that the Covid-19 measures could unintentionally erode gains made in Kenya’s bid to contain Aids. It is a fear that has been gnawing at Ms Evelyn Atieno since she lost her job two months ago.
Before the Covid-19 outbreak, the mother of four children between the ages of eight and two years would walk from her home in Korogocho Ngomongo slums to Eastleigh estate in Nairobi; nearly a 10-kilometre journey, and hope to make between Sh200 and Sh300 per day washing clothes.
But things have changed. Fears of the spread of Covid-19 have made it hard for her to get work. "Our clients are afraid that people like me may have contracted the virus, bearing in mind the living conditions in slums, thus most of the time I go and come back empty handed," explains the 30-year old. And whenever she goes back empty handed it usually means that she and her household sleep on empty stomachs.
"It is a struggle to get food. Sometimes we take porridge, or if we are lucky, we get a treat of ‘ugali’ with chicken feet or ‘omena’, but most times my children and I don't get anything at all to eat, and we have to go to bed hungry," she says.
This has adversely affected her antiretroviral (ARV) HIV drug intake.
"I have to take medication every morning at 8am, meaning I'm supposed to take a healthy diet, but that is not usually the case. You cannot take these drugs when you haven't eaten, thus sometimes I'm forced to miss my dosage for one or two days," she says.
The import of this is that her CD4 cells- the white blood cells that play an important role in the immune system- fluctuate dangerously. A healthy immune system normally has a CD4 count ranging from 500 to 1,600 cells per cubic millimetre (cell/mm3) of blood, according to HIV.gov. When a CD4 count is lower than 200 cell/mm3, a HIV positive is considered to have progressed to Aids.
Unlike Ms Atieno, Ms Florence Muthoki has to worry not only about her health, but also that of her children who were born with the virus.
The 28-year old single mother also washes people’s clothes for a living and says she has been met with the same stigma as Ms Atieno as hitherto welcoming hands are now turned away over Covid-19 fears.
"Before Covid-19, I would be assured of between Sh300 and Sh500 daily from my laundry work. I was able to provide for my children and we could afford three meals a day, unlike now where it's only one meal or sometimes nothing at all. We mostly rely on well-wishers," she says.
Ms Muthoki adds that their ARV drugs regimen is particularly harsh on an empty stomach.
"It is not easy to take the drugs without a proper meal, as you can either vomit or feel dizzy, hence sometimes we are forced to miss our ARV drugs," she explains.
There has been fear that people living with HIV are at a greater risk of contracting the coronavirus disease. Experts, however, say that people on effective ARV drugs, and following the right health directives against coronavirus, are not at an increased risk. It is the HIV positive patients who have a compromised immune system who should be extra cautious to prevent coronavirus infection, they say.
Dr Cleophas Ondieki, Project Director for LVCT Health noted that though most ARVs used in Kenya can be tolerated with or without food, inadequate nutrition will lead to low immunity which will make them (patients) susceptible to diseases that may complicate HIV care.
"The bottom line for people living with HIV is that they should ensure that they eat locally and readily available foods that will fulfill the demands of a balanced diet. For instance, legumes such as beans provide proteins just like meat, which may be expensive to buy," he advices.
Dr Ondieki, however acknowledges that even the beans may be beyond the buying power of most of the poor HIV patients, pushed out of their reach by the social-economic strain the Covid-19 pandemic has on Kenyans.
"This is likely to lead to cases of client default from HIV care. This means there will be an increase in the number of HIV viruses due to uncontrolled replication inside the CD4 cells, which are important in defending one against infections. Accumulation of HIV viruses in the CD4 cells will lead to its death with a resulting reduced immunity, meaning that the person will be prone to opportunistic infections such as Tuberculosis, cryptococcus meningitis, pneumocystis pneumonia etc, which complicate HIV care. Accumulation of HIV viruses in the CD4 cells also increases chances of HIV transmission," he says.
Dr Ondieki warns that travel restrictions and lockdown of towns and estates may also affect the routine ARV refills and eventually drug doses.
According to Dr Lilian Otiso, LVCT Executive Director, as an organisation that deals with people living with HIV, they have ensured that they continually educate them on the importance of adhering to their medication.
"We issued all our clients with three months dosage of anti-retroviral medication to reduce their visit to our clinics and in mitigation in case we got into a lockdown. We advised those with high viral load to adhere to their treatment to suppress the HIV virus, hence improve their immunity, among other steps," says Dr Otiso.
But drugs alone are not enough to ensure healthy living for the HIV positive patients. Health experts maintain that they should eat the right food, exercise and look after their mental health.
According to Dr Otiso, majority of people living with HIV in the country come from poor backgrounds, exposing them to more challenges and at times lacking basic needs like a balanced diet.
"We (LVCT) usually get people who are in need of help for basic needs including food, payment of rent and school fees for their children. We also work with at risk populations like sex workers in the HIV prevention programme and with the bars closed and curfew imposed, they are unable to earn a living, and have become desperate for money for food and rent to feed their children (majority have small children at home). Many have faced violence due to the desperate lengths they go to get food," says Dr Otiso.