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The bright-eyed little girl in the torn blue dress is almost all that’s left of Mrs. Adhiambo’s family. Mrs. Adhiambo’s brother, two sisters and husband are all dead.

Emily’s mother is alive but ill, and refuses to be tested. Emily has been tested and is HIV positive.

Mrs. Adhiambo needs to take drugs called anti-retrovirals, or ARVs, and so will Emily. Taken regularly, the medicine can prolong life by years, possibly decades. But if taken sporadically, the medicine will lose its effectiveness.

Patients say the medicine can cause nausea, fatigue and diarrhea at first, especially if there is no food to go with it, said Ms. Greenaway. The drugs also cause a ravenous hunger as the body starts to recover.

The clinic gives 400 of its patients, Mrs. Adhiambo among them, “prescribed food” to eat with their medicines so they will continue the treatment.

But most take the meals home to share with their families, said Mr. Kamito. The program has a long waiting list. The financial crisis means there is no money to expand it.

Globally, there has been about a 10 percent decline in HIV/AIDS funding, said Michel Sidibe, UNAIDS executive director.

The world’s top funder of public health programs - the Global Fund to Fight AIDS, Tuberculosis and Malaria - has disbursed $15 billion since 2002, but it cannot afford to pay for any new or expanded programs until 2014.