Tuesday, December 25, 2007

Food Scarcity and HIV in Uganda

The New York Times published an article today on Food Scarcity and HIV in Uganda. It's actually more of an opinion piece/narrative than a true news story. The author is a grad student in Public Health who is researching whether food scarcity and transport costs affect health outcomes in HIV patients. Duh!

As obvious as the answer to this question is to Mr Tuller or to me, I agree with him that it is important to study and publish the results. Otherwise Aid money will not help pay for food in patients who do not have enough to eat, much less for transport costs. How can we afford hundreds of dollars per patient per year for ARVs, but not a few dollars per month to help cover food costs?

Our program in Busia does not help patients with food costs and does not pay for transport to clinic. Most of our patients do not seem to be hungry, but I would say the majority of them have trouble scraping together enough money to get to clinic for scheduled visits. They often request less frequent appointments. This puts us in a difficult position; we would like to see new ARV starters weekly, rather than monthly, but often the patients cannot afford to get to clinic even once per month. On the other hand, the Kenyan Ministry of Health does not cover the full cost of medicines dispensed by public hospitals, much less the cost of food or transport. Some people would argue that Aid organizations should not cover costs for medicines, services, food and transport because such programs are not sustainable once the aid dries up. Complicated issues come up when you are dealing with poverty and chronic care. I think this is why MSF prefers to stick to natural disasters or conflict situations. It's less complicated when you can just come in during an emergency, help patch things up, then leave.


truedre said...

Very interesting!

Carrie said...

NELL! I'm so glad to hear what you're up to! I hadn't even realized you'd left NYC for life as a traveling Dr. What a great adventure you're having! I wish I could come see you! I'm busy with two little boys. Mostly a joy but also feels pretty tied down and life is so serious with mortgage and school costs... Oh well. I guess I asked for it. I hate legal work I've decided after a few years as a lawyer. I want to try to get back to politics. Anyway - MISS YOU! - Your Cousin Carrie

audra said...

Paul Farmer's opinions about this issue are pretty interesting. Especially interesting is how he's been able to sustain his program of providing meds AND food and shelter for so many Haitians, despite the 'unsustainability' of it all.

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