Background: Tremendous progress has been made in controlling and reversing the HIV trend in Kenya. However, despite the significant progress, there remains a high new HIV infection rate among young people and key populations. Further, the HIV response in arid and semi-arid areas which experience cyclical drought and accompanied high levels of food insecurity and malnutrition remain a concern. With the well-established links between malnutrition, food insecurity and HIV, a good number of PLHIV and their households are classified as food insecure with high levels of negative coping mechanisms. Further, gaps are experienced in service delivery with nutrition and HIV services often offered separately and gaps persist in prevention of mother to child transmission, antiretroviral treatment coverage, and in the coverage and distribution of health facilities and personnel.
Methods: A mixed methods research approach was used in data collection in kilifi, Turkana and Kitui counties. Three comprehensive care clinics (CCCs) from each county were selected as the entry point. 1272 children aged 2 to 14 years, adult men and women were sampled. Household Dietary Diversity Score (HDDS) was assessed using one 24-hour recall period. Household Food Insecurity Access Scale (HFIAS), Coping strategies, Coping Strategy Index (CSI) and levels of malnutrition were assessed using BMI and Z scores. data was stripped and analyzed thematically using SPSS v24.
Results: Drought affected access to HIV care, treatment and adherence. PLHIV prioritized finding food over accessing medicine; food scarcity also forced PLHIV to skip or discontinue medication. Ignorance was noted on PEP, PrEP, female condoms use. There was increased risk of HIV transmission through transactional and commercial sex, gender-based violence and disruption of social networks. PLHIV adopted strategies to cope with the effects of drought including controlled food consumption, reduced portion sizes, reduced number of meals, and relied on less preferred foods.
Conclusions: Strengthened inter-sectoral linkages between nutrition, HIV, WASH and communicable diseases in coordinating drought responses that are cost-effective are needed. Consideration of mixed livelihoods when designing drought response and resilience programmes can be used as a strategy to build resilience into communities to reduce outlays on emergency responses.

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