– But new dilemma encountered along the way
AMIDST heightened emphasis on reducing stigma and discrimination against Persons Living with HIV/AIDS and the emergence of  remarkable evidence of the efficacy of antiretroviral therapy (ART), there seems to be a new and disturbing trend which makes life nearly as uncomfortable for such persons.  

It has been noted that where PLHIV on ART begin to display signs of ‘looking and feeling better’ after consistently adhering to therapy, many people are becoming insensitive to their (PLHIV) needs.  
Reports are that some people contend that once on therapy, PLHIV are ‘good to go’ and should be able to cope on their own. Surprisingly, such reaction has been coming even from close family members, as the HIV/AIDS Mailbox has found out.
As a result, the support that many PLHIV on ART have been receiving from family members, friends and other stakeholders in the fight against HIV/AIDS has been waning, to the extent that they now face new challenges.
Invariably, the persons likely to suffer most as a result of this sort of indifference or insensitivity are the unemployed, or those in the lower income bracket struggling to eke out  a living for themselves and children, some of whom may also be infected with HIV and have special needs.

From wasting to bouncing
One of the stories told by unemployed PLHIV was that they were actually denied humanitarian assistance provided for PLHIV in need, because persons responsible for the selection process probably considered them to be in such good shape after being on therapy, they thought they did not qualify for assistance.
“But what does our physical appearance have to do with other struggles we are going through?” they ask, adding that they have a host of other needs. “We want jobs; jobs that can give us earnings to pay our house rent, utility bills, send our children to school and put food on the table for us and our families.”  

Can’t hire you
The hidden but stubborn truth, however, is that even though they are now looking and feeling better, there was a time when, prior to getting treatment, some of them would have become so sick they literally entered the ‘wasting’ stage and were forced to quit working.  
By then, word would have gone around that they were HIV-positive.  Now that they are on therapy and the treatment is working for them, they are faced with two dilemmas:
(a)    Some claim that now that they are on ART, feeling better and looking bouncy, they desire to work again, but the stigma of being a PLHIV remains, and as a result, many people are reluctant to hire them.
(b)    For others (particularly single mothers who are heads of households), their income is very small and cannot see them and their children through. But  relatives and friends who previously were there for them in time of need, have now shaken them off, contending that ‘things hard’, and since they now feel better, should be able to cope on their own.        

The reality is that it is difficult for them as PLHIV on the poverty line.  They experience having to skip many meals while taking their medication, going without so that their infant children could eat. Very often they cannot find the return bus fare to take them to and from clinic to be evaluated and receive further medical supplies.

PLHIV needs
The reality is that only he who feels it knows it, and so, invariably, not many people would be aware of the real plight of the average PLHIV on medication who lacks the wherewithal to live and eat as the treatment demands.  Particularly in the face of a deepening economic crisis where the price of food is rising steeply and many PLHIV are unemployed, it becomes a matter of great concern when PLHIV are well enough to work, but are not being given a chance to do so.
And why? Because stigma and discrimination put up barriers against them, or where people have become insensitive to their needs and no longer want to help.
We at the HIV/AIDS Mailbox honestly do not subscribe to anyone insensitively throwing their burden at another person’s door, and fervently support the principle of empowering PLHIV to help themselves.  
However, we strongly advocate for systems to be put in place to help PLHIV get back on their feet once they are healthy enough and willing enough to help themselves.  We say that cases should be dealt with on the basis of merit.  If loan schemes are set up, it should not be with draconian conditionalities as this would stress the borrower out.  Stress is not good for PLHIV.
Some PLHIV shared with the HIV/AIDS Mailbox the outcome of their attempts at income generation.  What their experience has taught them is that the fastest and most reliable businesses for unemployed persons, in the face of the present economic realities, are: Food business (selling food and snacks) and selling shoes and clothing.
The red flags encountered are: (a) They cannot get into the food selling business; and (b) in order to sell shoes and designer clothing and be competitive, they need capital which they cannot afford.  
Those in the dressmaking business claim that with so many places selling designer clothing, women are not going for custom made clothing that much.
That apart, even to the jobs as security guards are not always available to PLHIV in good condition, since some security firms are subjecting persons to an HIV test as a condition of employment.  The other consideration is that many such women, because of their experience in life, are reluctant to leave their children at home alone while they work night shifts as security guards. As a result, they would prefer not be employed as security guards.
PLHIV have different needs, and being responsive to those needs does not necessarily mean automatically carrying the person’s load — physical or financial — while they sit back. A PLHIV has right to a full range of care, support, treatment and prevention.  This means having help with any other medical problems, as well as emotional support.  It takes into account their psychosocial needs, economic needs and overall wellbeing.   In other words, a holistic approach should be taken when addressing the needs of a PLHIV.
Any approach to addressing their needs should be holistic, and a variety of people and organizations can come together to provide a continuum of care, with different  persons doing different things.  These include family members, doctors/counselors, members of the workplace and members of the community.

Psychosocial support
Psychosocial support has been defined as an ongoing process of meeting emotional, social, mental and spiritual needs, all of which are considered essential elements of meaningful and positive human development.  It goes beyond simply meeting the PLHIV’s physical needs.  It places great emphasis on the his psychological and emotional needs, and their need for social interaction.

Nutrition and HIV
Though very often neglected by stakeholders, there is a direct correlation between nutrition and HIV, and UNAIDS and the World Food Programme (WFP) have agreed that nutritional support is a vital component of all HIV and AIDS interventions.  The WFP estimates that in 2015, 1.5 million people receiving ART treatment will be in need of nutritional support.
This often overlooked issue took centre-stage at the XVII International AIDS Conference held in Mexico City in 2008. One of the many fora at which it was widely ventilated during the caucus was a press conference hosted by a team of officials from the United Nations (UN) and the Food and Agriculture Organisation (FAO).  
Panelists were: UNAIDS Special Advisor, Robin Jackman; Professor Alan Whiteside, Health, Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal; and Dr. Martin Bloem, Chief, HIV/AIDS and Nutrition Service, UN WFP.
Journalists were all ears as Jackman poignantly declared: “In making progress against HIV and AIDS, we must not overlook one of the most important but less recognized components of the response — good nutrition.”
According to Jackman : “Putting people on treatment without ensuring they have enough to eat is like sending your kids to school without any books.”   She observed that with high food prices here to stay in the foreseeable future, it is critical to supplement HIV and TB programmes with a nutritional component.
“If we fail now, there will be more dramatic consequences for poor people living with HIV,” Jackman reiterated.  She explored the impact of high food prices and lack of resources to handle the increased appetite that comes with starting drugs (ARV), mentioning too that many PLHIV often cannot afford the cost of traveling to clinic. “As a result, people are not starting treatment, and others on treatment are discontinuing their drug regimen,” she remarked.
Professor Whiteside, in his presentation, had this to say: “As food prices continue to rise, people in developing countries are struggling to afford a balanced diet, which is crucial to the success of antiretroviral (ARV) treatment. Millions living with HIV lack adequate food and basic nutrition necessary to maximize the drugs’ effectiveness, or to support young children orphaned or affected by HIV and AIDS.”
He warned that “…advances in the treatment of HIV risk being undermined, unless the international community acts to mitigate the effects of the global food crisis and provide basic nutritional support to those in need.”
As Dr. Bloem declared: “People underestimate the impact high food prices have on nutrition. Nutritional support  is especially important, as the present food crisis poses a fundamental threat to millions of vulnerable people.”
Noting that micronutrient deficiencies and protein energy malnutrition — both having detrimental effects on the immune system — are on the increase, he said: “This obviously means higher mortality, especially for those living with HIV.”
The challenges for PLHIV on antiretroviral therapy (ART), as outlined by Jackman et al, exactly mirror those experienced by PLHIV locally, who must have adequate nutritional intake, among other things, in order to maintain drug adherence and not wind up with drug resistance.