Violet Tinah, 40, a resident of Korogocho slum in the Kenyan capital, Nairobi, is living with HIV and was recently diagnosed with tuberculosis, but her biggest problem today is not disease - but hunger.
"When I went for the results that informed me that I had TB, I was very hungry; I'd had no breakfast and lunch and could barely walk," she told IRIN/PlusNews. "I had to be supported and put in a wheelchair to collect the drugs.
"Often I go without food and during such times I feel dizzy and nauseous after swallowing the [TB and HIV] drugs," the formerly prosperous carpenter added. "Putting food on the table is like a dream."
On the day she spoke to IRIN/PlusNews, Tinah had had only a cup of black tea for breakfast and no lunch; a concerned neighbour has brought her some porridge "to help me swallow my drugs". Tinah was hoping her unemployed nephew would pass by later with a little food.
Many of the slum's residents live on food salvaged from a nearby rubbish dump and sold on the streets of Korogocho.
According to a 2009 World Bank poverty assessment, the poor in Kenya spend 70 percent of their income on food on average - those in the poorest 20 percent of the population spend 77 percent. Sharp increases in the price of staples in 2008 - maize flour rose by as much as 130 percent between 2008 and 2009 - and a national food crisis in 2009 mean poverty has been on the rise.
The urban poor, most of whom do not farm, have been particularly hard hit.
Korogocho location chief Rebecca Balongo told IRIN/PlusNews that many programmes supporting HIV-affected households had collapsed. "It is not unusual to have a family share only a plate of food in a day," he said.
The Kenya Network of Women with AIDS, which until 2009 provided food assistance to about 4,000 HIV-positive people in slums in central Kenya, has had to shut down its feeding programme due to lack of funding.
"We are no longer giving food at our drop-in centres in Korogocho, Kiambiu, Soweto and Mathare slums in Nairobi, Kiandutu slums in Thika and Kiawara slums in Nyeri town," said KENWA advocacy programme officer James Ndung'u.
"KENWA is only providing highly nutritious porridge to the very weak and bedridden clients.
"The slums have high HIV prevalence rates and without food there are challenges; our nurse has reported clients failing to collect ARVs on schedule - they say they are busy looking for work to buy food," he added. "ARVs require one to have a proper diet, but on an empty stomach, there is a tendency to default and consequent risk of drug resistance."
A few programmes continue to provide support in the form of food or cash transfers. Concern Worldwide has started a cash transfer programme in Korogocho to provide food subsidies of about US$20 per month to 2,000 extremely vulnerable households, including bed-ridden HIV-positive people.
However, Concern's programme is due to end in June, after which the government is expected to take it over. Slum residents and officials are not optimistic; chief Balongo says the government did not send any food support to her area in 2009.
Employment is scarce for the slum's residents, especially if they are weak. Frederick Egesa works as a watchman, earning about $47 a month. He walks to work, has no days off and is docked two-and-a-half days’ pay for every day he misses work.
"Look at my many dependents - I spend 1,000 shillings [$13] on rent and have 200 shillings [$2.60] daily for food, so we have to skip eating at times," he said. "When I collect my ARVs I am advised to eat well, but how do I manage a balanced diet?"
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