NAIROBI, KENYA — Rosalia Adhiambo won't take the free anti-HIV drugs that would prolong her life. The spiraling price of food in Kenya means she can't afford to feed both her grandniece and herself.
So she feeds 5-year-old Emily and doesn't take her own medicine, fearing that the nausea she would get from taking the drugs without adequate food will make her too weak to look for work.
Prices for staple foods this year are almost twice as high as in 2009, the U.N.'s Food and Agriculture Organization says.
The rising prices and a dwindling of funds for HIV programs mean countless poor families must decide whether to focus on the health of an HIV-positive adult or on a child's hunger.
Valerian Kamito, a nurse at the clinic that gives Mrs. Adhiambo her food, says some patients are refusing to start treatment for HIV and about a quarter of his 1,555 patients on anti-HIV drugs are skipping their medication.
"They say they cannot take them on an empty stomach," Mr. Kamito said. Before prices rose, he said, "it was very rare."
HIV-positive adults need 10 percent more calories than other people just to maintain their body weight.
Children with HIV need between 30 percent to 50 percent more calories than other children. They will lose weight and be vulnerable to infections without those calories, said nutritionist Kate Greenaway from the aid agency Catholic Relief Services (CRS).
Annual inflation in Kenya is near 20 percent, but wages haven't kept pace. About half of all Kenyans live on less than $2 a day, including 52-year-old Mrs. Adhiambo, who makes $1 each day she does housework.
"When there is nothing to eat, we go to bed hungry. I tell Emily it is because God did not send us food today," said Mrs. Adhiambo, motioning to a cardboard picture of Jesus on the wall of their corrugated iron shack.
"Emily stands before that picture and prays, 'God, please remember to send us food tomorrow,"' said Mrs. Adhiambo.
She had work for two weeks last month, but younger women get most of the jobs.
Mrs. Adhiambo relies on her daily free meal of rice, beans and vegetables from a clinic run by Catholic Relief Services in the Mathare slum, though she sometimes misses that if she is searching for work.
The staffers there are trying to persuade her to take her anti-HIV drugs.
But Mrs. Adhiambo carries the food home and gives most of it to Emily, who isn't signed up for the CRS program, though workers there are trying to get her into it.
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.