On a scorching day in Zimbabwe’s Buhera District, approximately 300 people queue to receive food handouts. All of them are beneficiaries of the food packs that local NGO Dananai Home-Based Care (HBC) has been distributing to people living with HIV and AIDS for the past five years.
Though Dananai HBC’s main mandate is to provide care and support to critically ill people living with HIV and AIDS it became apparent to the group that further interventions were needed to help improve patients’ living conditions.
In 2002, Dananai HBC partnered with Africare and WFP to provide food handouts in an attempt to meet the nutritional needs of people living with HIV and AIDS involved in the home-based care program and their dependents.
As the sun threw its hot rays across the sky, a slight easterly wind breezed through the slender gum trees at the local clinic, which serves as the food distribution point. The hordes of people chatted among themselves, some waiting for their turn to receive the food handouts, while others pushed wheelbarrows filled with maize sacks back and forth.
Some sat on the sacks, waiting for cattle-driven scotch carts to take them across the hot landscape to their homes. Meanwhile, an old woman crouched onto her knees and began picking at the grains of maize that had fallen to the ground, putting them slowly into a green plastic bag. As the bags of maize are pushed and shoved, some inevitably tear, and maize grains fall out.
Three women in the queue told her stop but she shot a retort back at them and they turned their attention back to the business of receiving food rather nonchalantly. The old woman began curtsying as she concentrated on picking the fallen maize grains.
‘We see this all the time. The people cannot tolerate the sight of maize grains on the ground. No grain can be wasted, so they pick it, one by one,” an Africare program officer responsible for overseeing food distribution said.
Africare, an INGO is responsible for the actual distribution of the food and the recipients of the aid are identified through the Dananai Home-Based Care project. If a recipient living with HIV dies, their family is allowed to continue collecting the food for six months before their handouts are cut.
The food handouts are popular in the community due to the high levels of poverty. The rainfall pattern in the area is erratic and subsistence farming, which many of the people in the district practice, has suffered immensely as a result. The district has experienced four consecutive droughts in the past decade alone.
“I have been to many households in the district, and many do not have any grain stocks. The situation is pathetic,” said Nonia Temberere, coordinator of Dananai Home-Based Care project.
Many of the households in the community are headed by women, either because they have been widowed or because their husband works and lives elsewhere. It is through the eyes of women that the impact of HIV and AIDS on this community is best reflected because they have been forced to work hard to feed their families as well as to provide care and support to the sick.
It is no coincidence that many of the people in the food queue are women. According to Africare workers, special care is taken to make sure that women are the main recipients as men tend to be less responsible with the provision of the stocks.
But the availability of food is creating a schism within the community and has resulted in increases in the numbers of people requesting HIV tests. Due to the levels of food, those receiving food through the home-based care program are perceived as better off than others because they have access to food.
So the demand for inclusion in the program is growing and hordes of people have been reporting to the HIV-testing facility at the Roman Catholic-funded Murambinda Mission Hospital.
“Some people get sad when they test HIV-negative,” said the coordinator of the New Start Voluntary Counselling and Testing centre, which conducts provider-initiated HIV testing at the Murambinda Mission Hospital.
If patients tests positive for HIV, they are immediately referred to the hospital or the Medecines San Frontieres (MSF) opportunistic infection clinic that distributes antiretroviral drugs (ARVs). Critically ill patients are incorporated into Dananai HBC programs through volunteer caregivers living in their community.
But testing positive for HIV is not enough and to enroll in the program patient must be on ARVs, in a critical and disadvantaged state and they must need food assistance.
This message does not seem to have reached some members of the community and there have been some accusations that community leaders, responsible for selecting beneficiaries, are biased and have only selected their friends and relatives.
As the old grandmother picked the fallen maize, it was clear from her bedraggled stature that she badly needed some assistance. She is, however, not on the list of beneficiaries and she is angry at the blood tests she took.
“I have taken three blood tests but they have not said anything to me. They can take more of my blood if they want, but for God’s sake, they should also give me food,” she said, scooping a handful of maize grains mixed with soil from the parched ground.
“I have a problem with my back from a pregnancy operation that I had in 1952,” she said, adding, “If my son was still alive, this could never happen to me.”
She pulls a wad of documents out of her green plastic bag and selects the record of her son’s death.
“I look after his three children. I also showed them this but they still refused to include me in the list. These organisations should go to the community and see the favouritism that takes place in the selection process,” she said.
“One of the problems is that as sick people receiving ARV treatment become well, and are able to perform normal duties and still receive food ahead of household that may be less privileged. There are always accusations of favouritism,” an Africare worker said. “The food is meant for those that are ill.”
According to Africare’s records, the number of people on the waiting list for food aid is overwhelming. MSF, which is also partnered with Dananai HBC, has seen a huge increase in the number of people needing ARVs.
The availability of food is one of the keys to helping Dananai HBC recipients to regain control of their lives. In the absence of nutritious food, the success of ARV treatments is severely compromised.
Many of the households in this district, which relies on subsistence farming, face food insecurity and find themselves hard hit by a disease that preys on society’s weakest. The challenges faced by Dananai’s HBC project mirror the challenges facing the country in general. At the heart of the problem is the need for food.
Poor access to water is also a problem for many communities. It is ironic that though the Bangure area in Buhera has the large 1970s Rundi Dam, the only benefit to the community is the supply of fish from the water catchment.
The need for food makes many of the communities in this area overly dependent on external assistance. Hungry stomachs appear to make many of the communities lie on their backs with legs crossed and lethargy seems to stalk the land.
The communities are just beginning to awaken to the need for HIV testing and the power of ARVs, but they are also fully aware of the fact that food security remains a big challenge.