SIBONGILE Khumalo eats cow dung with her anti-retrovirals - because she has been told to take the drugs after meals, but has no food.
Five years ago she tested HIV- positive .
With no money to buy food, and unable to receive a social grant due to not having an ID book, she now fills her stomach with cow dung before taking her life-preserving medicine.
For more than a year, the mother of four - who gave the Sunday Times permission to use her name - has eaten dung five times a week.
"I have to eat ... there is nothing else ... or I would have died by now," said Khumalo, 45, who once earned R50 a day as a domestic worker.
Her plight is not uncommon in the informal settlement known as Tin Town in Hluhluwe, about 240km north of Durban.
More than 136 families in the settlement scrounge through refuse dumps and forage for dung on nearby farms.
Although the families recently started receiving food parcels from two non-governmental organisations - Qedusizi from Hluhluwe and Durban-based Akehlulwalutho - the food is often not enough.
Khumalo divides the food between her children and supplements her share with dung.
Not having an ID book means she cannot apply for a social grant.
Diagnosed with diabetes and high blood pressure, Khumalo often eats the manure with scraps of meat and vegetables collected from a dump site.
"I cannot take my anti-retroviral drugs on an empty stomach," she said, adding that although the dung was not an ideal supplement, it at least filled her stomach. "I have been surviving on it for a year."
Dr Dave Spencer, head of the adult ARV programme at Right to Care, a Johannesburg non-profit organisation, described Khumalo's situation as dreadful and unacceptable.
"Cow dung contains bacteria and organisms that will be harmful to human beings. And eating it is not going to help their HIV. In fact, E.coli and bacteria in the intestines of animals could give rise to all sorts of diarrhoeal illnesses."
Spencer questioned how, in a country with a government, churches and food kitchens, people could be allowed to eat dung. "This is an extremely unhappy situation. It's a dreadful story and it's not an acceptable situation."
Qedusizi founder Sibongile Mthembu, who tries to deliver food parcels at least once a week, said she was aware that some of the residents in Tin Town ate dung.
Her parcels, which can sustain a family of three for a week, contain 2.5kg of maize meal, tinned fish, beans and a litre of milk.
"On average we feed about 200 people a week," she said.
The NGOs are also assisting residents of the informal settlement to get identity documents so they can access social grants.
Khumalo could not recall the last time she had eaten fresh vegetables and meat before the NGOs started distributing food parcels several months ago.
"We have always survived on rotting food ... at the dump site we can find rotten cabbage, tomatoes, onions, meat and potatoes which we take back and wash before we cook."
Ntombifuthi Fakude, 34, who tested HIV-positive in 2004, said while she had never eaten dung, she knew of families in the settlement who added it to their daily diets.
Fakude and her neighbour, Deliwe Shongwe, 62, who has been HIV-positive since 2008, gave their permission to be identified.
Shongwe said she knew of several people who foraged on farms and dump sites for manure. "That's our way of life here. We have no other choice."