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KATAKWI, Uganda, March 22 (Thomson Reuters Foundation) - S even-year-old Esther Agutti weighs 7 kilos - a third of the weight of the average child her age.
She has been in hospital in Katakwi, eastern Uganda, for three days. She was painfully thin when she was admitted and had diarrhoea and vomiting, said Loyce Akelo, a senior doctor.
Esther's family, who are farmers, have been hit hard by the drought that has scorched East Africa. They have had to ration the little food they have to survive - but this is particularly dangerous for Esther, who, like her parents, is HIV-positive.
Esther is receiving anti-retroviral (ARV) treatment - which slows the development of HIV and holds off its progression into AIDS. But crucial to the proper functioning of these drugs is good nutrition, doctors say.
"The hospital has received 232 children, more than half of all the children on HIV medication in the district. They lack food and have been malnourished since the start of this year," Akelo told the Thomson Reuters Foundation in Katakwi.
"It is important that someone with HIV first takes a meal before taking on drugs."
Poor nutrition can affect the absorption of the drugs in the body or leave the body less able to tolerate the medication.
Akelo said the hospital is giving Esther meals to help her take her drugs but the arrangement is just temporary and she will soon be sent home.
Esther's father, Moses Agutti, said the family was hoping to receive government food handouts but they weren't yet being distributed in his village.
"We have been to the county offices and officials there have promised us that there will be food relief coming though they are not sure of when," he said.
"I am struggling to get some food for the family from the garden. It's not enough because of the drought."
In December, Uganda's President Yoweri Museveni announced he was redirecting funds budgeted for roads to provide relief food to areas affected by drought and hunger.
A poor rainy season has led to extensive drought across East Africa, destroying crops and killing livestock. Uganda's neighbour Kenya has already declared a national disaster, with the Red Cross estimating 2.7 million people are in need of food aid as a result of lack of rains.
In Uganda, the worst affected districts are in the north and east, where district authorities have warned the drought may disrupt ARV treatment as HIV-positive children and their elder relatives are hungry and unable to take the drugs.
Walter Elakas, a district head in Katakwi, said parents of HIV-positive children are struggling to give their children a meal before midday.
David Tumwesigye, an official at the Ministry of Gender Labour and Social Development, said in a news conference last month 11.7 million Ugandan children are on the verge of dying of hunger and pneumonia due to lack of food and proper housing: that means about six in 10 children are starving.
"The situation has been worsened by the dry spell that has hit the country hard and if action is not taken many children are likely to die or have permanent effects on their health," he said.
An estimated 1.5 million people live with HIV/AIDS in Uganda, of whom nearly 100,000 are children under 15, according to UNAIDS.
The effects of drought are also felt by adults living with the virus.
In Acholi village on the outskirts of Moroto town in northern Uganda, Teddy Adwin, a 30-year-old mother who was HIV-positive, was still being mourned a week after her death.
Her sister, Mary Akol, who also lives with HIV, said Teddy was one of four in their family who had died during the drought.
"I feel dizzy after taking the drugs without having a good meal," Akol said. "The medicine we take becomes toxic to the body whenever we miss a meal."
Mariko Ingodi, an HIV-positive army veteran in Acholi, said doctors had warned him that he would die if he continued taking ARV drugs without food.
"Many of us have stopped taking the drugs as we can go three days without eating; we have resorted to eating the leaves of wild trees," he said. (Editing by Ros Russell; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, resilience and climate change. Visit news.trust.org)