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149 her, take her to the place where she is being taken care of, clean the house, and if the house is clean, after taking a shower, then I leave and go to work. At the place of work, I may find a customer waiting for me—I am a saloonist—sometimes I am called while still in the vehicle [in the public transport to work]. When you arrive, you start being busy with your work (R34:
married woman, aged 18-25 years, 67).
In the statement above, the female participant emphasizes the need for one diagnosed to be actively engaged as opposed to staying idle. She contrasts her case with other PLHIV who just stay idle, whereas they could be meaningfully occupied with something positive.
An FGD participant, commenting on the necessity of continuing with one’s occupations and keeping on with what one used to do before diagnosis had the following to say, “Once you have been found to be HIV positive, you are not supposed to abandon what you were doing in the past. Even if it is employment, continue doing it. Even if it was exercising such as jogging in the morning [continue doing it] (FGDMY-004, 254).
The participants’ accounts emphasize the importance they attached to continued engagement with the normal everyday occupations as a coping strategy. According to their narratives, these occupations could provide a means of earning a livelihood and of keeping them busy.
5.6.2 Producing own Food and ensuring good Nutrition
Being on medication with ARVs is important for PLHIV because ARVs help contain and reduce the spread of the HIV in the body. Food is an essential component in complying with treatment regimen. Therefore as part of coping strategy, the PLHIV mentioned struggling to ensure they could provide for their own nutritional needs.
Nutrition played a very important role among the PLHIV regarding adherence to medications.
PLHIV are counselled and trained that nutrition is one of the key elements of effective HIV care and management. As such, the PLHIV were advised to make every effort to ensure they had proper nutrition. The response by one of the male participants is a good case in point:
The methods I ought to be using appropriately, I must maintain the use of my medications…
Thirdly, I must try to get good food and eat food that is relevant and at the correct time so that the medications do not get when my body is weak (R43: married man, aged 26-35 years, 80).
The following quotation, still emphasizing the primacy of good nutrition, talks about it in terms of an indispensable aspect of the care and management practices whose neglect is considered tantamount to destroying one’s life. As the participant in the next excerpt puts it, it was something over which one cannot afford to be careless.
150 [What] I am cautious about, to not destroy my life? I must be careful about food. I must look for good food to eat, a balanced diet to eat so that I use it to take care of my life. And also medication to take my drugs in good time (R12: 31-year-old married woman, 83).
According to discussions in FGDs and with KIIs, nutrition was critical to proper coping. One male youth FGD participant, commented thus on the importance of nutrition:
Then apart from the most basic things is positive living. What is positive living? You should do the right thing at the right time. And also balance diet, nutrition. You should eat, if it is proteins, you make sure you eat a well-balanced diet. Vitamins should also be there. It is not only ARVs and that is all? Apart from that, food is also contributing. Because drugs can’t work,—if you are taking ARVs alone, you cannot survive. Also nutrition is a very important thing. That is positive living (FGDMY-002, 242).
The participants clearly understood what it meant to eat well or what the components of good nutrition were. They expressed good nutrition in terms of a balanced diet, sufficient amounts of food, and eating at the right time. In describing what she understood by good nutrition, one female participant had this to say:
I must eat well. Eating well does not mean eating flesh. When I get vegetables, I cook that vegetable of mine well and then eat. Habits like skipping lunch, I must at least look for something small that can keep my stomach. I must also just carry water. Every time I go on a journey, I must just carry my water (R39: 47-year-old widow, 83).
Having good nutrition was also defined in terms of having access to a variety of foods. It was therefore not enough to eat a balanced diet. The balanced diet needed to consist of a wide range of foods. For example, one man talked elaborately on different varieties of fruits, vegetables and proteins as the following quotation suggests:
I can get some fruit and eat, avocadoes, mangoes, oranges, beans. These little things I eat them like that. Sometimes also if I come across carrots, I eat. I eat with all my children because whatever I eat they must also eat. Even eggs when they are available, I eat. Chicken also if I get, I eat. Fish, I alternate them like that. But if those are not there, even vegetables, the bitter ones like mto, dek, bo, osugah, [these are traditional vegetables] if we get milk, we put in it, we just proceed like that (R4: married man, aged 35-46 years, 55-61).
The above statement also suggests flexibility to know that there will be times when there will be no food that one may desire. The most important point however is to eat what is readily accessible and take advantage of foods that are locally available.
151 Various reasons were advanced as to why they needed to ensure that they had good nutrition.
Among the reasons mentioned was the compromised immunity of the body due to the activity of the virus. As such, good nutrition was important in equipping the body to successfully fight off OIs and for the medications to work effectively. The participants also wanted to ensure that the condition of the body was maintained in its equilibrium so as to ensure a good life.
The other reason they advanced was the potency and toxicity of medications and their adverse effects if taken on an empty stomach. According to the lessons they learnt from the PSC, lack of good nutrition may limit the therapeutic benefits of ARVs.
They achieved self-reliance in providing food either through self-employment, full-time paid employment or as volunteers with the PSC. A married man aged 26-35 years had the following to say:
The things I do–because I have some plot I was given as I am the eldest son I was given some plot there–I can sometimes plant maize, beans. So sometimes the harvest can help me, like when our pay delays. So sometimes I get some eight tins [a tin is the equivalent of two kilograms] of maize and this can help in the house here (R20: married man, aged 26-35 years, 68).
The value of providing their own food by working in the farm was echoed by a female participant who stated that:
I still work in the farm, like [growing] vegetables or on a small plot I can grow maize.
Potatoes also I can grow in a small way. So these are the means by which I can get to feed myself…What I find of a greater…the farm because it is from where we get our daily food (R13: 51-year-old widow, 59, 77).
Capacity to produce their own food and to meet their own nutritional needs and that of their families was an essential plank in the coping strategies adopted by some of the participants.
As a good number of participants had access to arable land, and given the benefits of nutrition in adherence to medication, producing one’s own food was a useful avenue for increasing access to good nutrition. Even for those who were in employment, produce from the farm went a long way in augmenting their sometimes insufficient incomes.
5.6.3 Developing Income-Generating Activities
A number of participants indicated having saved and invested in various types of IGAs so as to secure for themselves a means of livelihood. The IGAs were in various fields such as agribusiness, small-scale businesses, bricklaying and welding. Some who were still in active
152 employment also had some investments that they managed on the sides. Others saving portions of their incomes with a view to getting into self-employment in the near future. A female participant underlined the importance of having a source of income when she said that: “In the past, I would relax, I would not work very hard. Currently, I work very hard to have a means of sustenance so that my life can continue in a good way” (R17: Widow aged 26-35 years, 117). A married man aged 26-35 years also emphasized the necessity of an income-generating activity (IGA) when said that:
Now, you must have something [crop] which you can plant so that even when you have a problem, or you want to look for some money then you can sell it, and then you get some money or clothing. Something you can even sell to get food to eat. You need to also have a programme for your household (R3, married man, aged 26-35 years, 89).
According to these participants, it can be seen that in spite of being HIV positive, and perhaps because of this, they now had to alter their pattern of living and had to deliberately assure themselves of a source of income and livelihood support.
The most popular form of IGA for these participants, however was agribusiness. Those who practiced this form of IGA not only grew food for consumption but also for commercial purposes. One lady had this to say:
Even mto and dek I have already bought. If I prepare some ground and plant them, then I will water them so that they grow because I will not be able to buy vegetables. When I sell the bananas, I would like it to take care of cooking oil. Tomatoes I have to buy because tomatoes does not do well here. Because even if I plant it will require someone who has prepared something [greenhouse]. Yes, that is what can manage tomatoes because you [referring to herself in the third person] do not have ability to go buying insecticides all the time (R12:31-year-old married woman, 97).
The vegetables (mto and dek) mentioned by the participant in the preceding excerpt are very high-value traditional vegetables in very high demand and are not very demanding in terms of labour input.
Whereas agribusiness is undertaken by both male and female participants, some investment areas were mostly male-dominated, given that they are more labour intensive. These included bricklaying and light industrial activities like welding. A 41-year-old married man who was engaged in bricklaying had this to say:
153 I think that the adjustments that I can make, if I can get a better job that I can earn [well], and I plan myself well with whatever is needed for my life, then I will be just very okay…Activities, Now what I am doing apart from that voluntary work, I am a brick maker. I [also] do small farming. Those are the things that keep me moving on (R22: 41-year-old married man, 65, 67).
According to the preceding quotations in this sub-section, participants often engaged in more than one IGA. Participant R22, for instance, was engaged in farming, voluntary work at the health facility and bricklaying. Engagement in IGAs, particularly producing their own food from their farms, were important coping strategies that helped the participants to earn a decent livelihood and ensured adequate nutrition necessary for enhanced ARV effectiveness.