For instance, before ARVs became available in June 2005, mortality rate in adults between aged 15 and 59 was 9.8 deaths per 1000 people per year. 

Eight months after the first clinic that provided Anti-retroviral therapy (ART) opened, the overall mortality in the adults decreased by 10 percent to 8.7 deaths per 1000 people, thanks to the drugs.

HIV drugs, due to the nature of their potency, require one to eat adequately, and eat nutritious food. This is why in the early days, HIV treatment programmes came complete with a nutrition component. Patients were provided with peanut paste commonly known as chiponde and other supplements. 

However, due to change in approach and focus by government and donor partners, the nutrition component appears to be slowly being withdrawn, if not withdrawn altogether.

Dr Rose Nyirenda, director of the department responsible for HIV, AIDS and Hepatitis in the Ministry of Health says they stopped giving the food supplements to those on ART because the type of ARVs the people are receiving currently are good enough to help the people look health. 

“In the past years people leaving with HIV were given chiponde but with the coming of ARVs, we were no longer seeing many people with HIV that are malnourished that is why we stopped, but still others, especially children are still getting the food supplement”, says Dr Nyirenda. 

The current situation means that patients have to take it upon themselves to find nutritious food which they should take along with the drugs to ensure effective treatment. 

As if that is not enough, the situation has lately been worsened by the recurrent hunger situation that has affected many parts of the country. Adherence to the treatment seems to be affected as some on ART and TB treatment stop taking drugs arguing they cannot do so on an empty stomach. 

For over 13 years, this woman we shall call Eluby (not real name), a single mother of seven, has been HIV positive and on ART. For many years she has religiously adhered to treatment until the past months when hunger hit her family. 

In the 2023/2024 season, according to a Malawi Vulnerability Assessment report over 4 million people face foot shortage as a result of floods and dry spells in the previous farming season. 

Just recently, President Lazarus Chakwera declared that 23 of the country’s 28 districts are in a state of disaster due to food insecurity and called for support from both within and outside the country.

Eluby says sometimes she finds herself at the crossroads of whether to take ARVs on an empty stomach or not. 

he says although the drugs are aimed at improving her health, taking them without food puts her life in danger too as they are so powerful and can make her sick.

Eluby claims a number of her colleagues whom she started the treatment with, have died having stopped taking the drugs due to unavailability of food in their homes.

“Please help us, we may lose our lives because our friends have lost their lives due to this problem,” says Eluby.

This other young lady we shall call Gertrude is from Zomba, one of the districts recently declared as hunger stricken. She has been on ART for about five years. 

For more than once, she claims she has been taken to the hospital after experiencing strange feelings in her body after taking ARVs without taking a proper meal.

 She fears that if she continues her HIV treatment with the current hunger situation at her home, her life will be in danger. 

“The drugs we are using now are very powerful, whenever I take them without proper meal, I feel weak, I’m not sure what is happening, maybe it’s because I sometimes take the drugs on an empty stomach”, said Gertrude. 

Thirty-four-year-old James Banda from Likuni in Lilongwe is also another person on ART. He also says he struggles to find adequate food for himself and his family, yet he is required to take ART drugs daily. 

He suggests government, non-governmental organizations and the private sector should join forces to address the problem by ensuring that those on ART receive food supplements either at hospital or in their communities to help them adhere to and respond effectively to treatment. 

Not only those on HIV are being affected by the food shortage but TB patients with low-income levels too. Davie Chikhosi is another person on ART and chairperson of a community led monitoring group for ART and TB treatment in Lilongwe. 

He says for instance, out of 5000 plus people on ART that access ARVs from Likuni health Centre, about 35 percent are not religiously adhering to treatment. 

He says HIV/AIDS and TB related deaths are also on the rise due to the situation. 

He says currently, on average, in his catchment area of Likuni, at least three people on ART die every day. He too suggests the need for provision of food for those on ART and TB treatment. 

Sharif Chiunjiza from Traditional Authority Kaphuka in Dedza is on TB Treatment. He also says each time he takes the TB drugs without proper meal he starts having strange body feelings. 

Professor Adamson Muula, a public health expert says food is very crucial in the uptake of medicines for all health conditions including HIV and TB. 

“I thing measures need to be done to ensure that in the interim people living with HIV have access to adequate nutritious food but in the long term and sustainably all of us should have access to good livelihoods,” says Muula. 

MANET plus executive Director Lawrence Khonyongwa, while admitting that the hunger situation has greatly affected those on ART, encourages people not to default on drugs. 

Dingaani Mithi is Journalists Association Against Aids (JournAids) programs manager, he suggests the need to review food policies and legislations to ensure all people including those on ART are food secure. 

“The only solution right now is possibly to review these food policies otherwise the hunger problem will continue and this will effect achievement of some Sustainable Development Goals such as those that target to end HIV as a public health threat by 2030” says Mithi. 

The current HIV management policy in Malawi requires that everyone who tests HIV positive should begin treatment right away. 

It is a step toward achieving the 95; 95; 95 UN policy; in other words that 95% of all people living with HIV to know their HIV status, 95% of those diagnosed positive receive sustained ART, and 95% of those on ART have suppressed viral load. 

UN’s Sustainable Goal Number Two talks about the need for countries, including Malawi to end hunger by 2030, and Goal Number Three aims to prevent needless suffering from preventable diseases and premature deaths by focusing on key targets that boost the health of a country’s overall population. 

In Malawi, this is unlikely to be attainable unless deliberate efforts are done to ensure less privileged people that are on ART and TB treatment have access to nutritious food, a key component in the effectiveness of any drugs.