Part of a Kampala street that was flooded after a heavy down pour.

Drought exacerbated by the El Nino weather pattern could lead to a spike in new HIV infections in southern Africa as women and girls turn to sex to survive and patients miss treatments, the United Nations children’s’ agency UNICEF said on Tuesday.

More than 60 million people, two thirds of them in east and southern Africa, are facing food shortages because of droughts linked to El Nino, a warming of sea-surface temperatures in the Pacific Ocean, according to the United Nations.

Uganda is among the countries that experience El Nino that in some cases triggers landslides especially in the mountainous regions of Bududa and Bundibugyo districts.

The Report says many patients are refusing to take anti-retroviral therapy (ART) on an empty stomach, others are deciding to spend their limited income on food rather than transport to a health facility, UNICEF said.

“People sometimes are having to resort to these extreme choices between eating and taking life-saving medication,” Patsy Nakell, UNICEF spokeswoman, told the Thomson Reuters Foundation.

“This is the global epicenter of the HIV epidemic and when you have a situation like this where people are struggling to have access to food and to clean water then you know (they) will resort to what we call negative coping mechanisms.”

The situation was especially difficult in Lesotho, Malawi, Mozambique, Swaziland and Zimbabwe, which have adult HIV prevalence of more than 10 percent, and have been hard hit by El Nino, Nakell said.

“This is like a double whammy in many ways,” she said in a phone interview from Johannesburg.

“When you don’t have anything to begin with, your ability to stretch and be flexible is very limited.”

Nakell said UNICEF had anecdotal evidence of women and children in southern Africa resorting to selling sex to get money for food, which was exacerbating their risk of infection.

She said the agency was concerned the situation in the region might get worse with the arrival of La Nina, a weather pattern linked to floods and droughts, when waters in the eastern Pacific Ocean cool after a phase of El Nino.

The agency has been helping people with access to clean water, vaccinations and HIV awareness program, Nakell said.

UNICEF has secured half of the $200 million needed to fund the response to El Nino, but was struggling to secure the rest, she said.

Weather forecasters in Japan, Australia and the United States predict a 50 percent to 75 percent chance of La Nina developing in the second half of 2016.