Swaziland a Nation at war with AIDS
It is a valuable opportunity, but also a difficult task to highlight the struggle of the Swazi nation in combating a disease that threatens its existence. In fact, this country with a tiny population of less than one million people is at risk of dying rapidly as a result of AIDS. From a humble beginning of the first AIDS case reported in Swaziland in 1987, the spread and impact of the disease has been absolutely phenomenal and needless to say, extremely callous.
The advent of potent antiretroviral therapy (ART) in 1996 led to a revolution in the care of patients with HIV/AIDS in the developed world. In Swaziland, it is estimated that there may be between 20 000 to 26 000 people living with HIV/AIDS who are in urgent need of antiretroviral treatment. The national target for emergency antiretroviral therapy programme is set to put 13 000 AIDS patients on ART by the end of 2005.
Although Voluntary Counselling and Testing services have been available for some time in the country, provision of ART to people living with HIV/AIDS only began in November 2003. In fact, 2003 is the turning point in the fight against this fatal disease in Swaziland. Apart from the provision of free antiretroviral drugs at two treatment sites in Mbabane, the prevention of mother to child transmission (PMTCT) has been launched through an integrated pilot programme by Swazi and Swiss Red Cross in rural Swaziland.
In the public sector provision of antiretroviral therapy started late 2001 in Mbabane Hospital but it was only until November 2003 that free-of-charge antiretrovirals were offered to the public. At present, about 2000 patients are under treatment.
The PMTCT pilot programme funded by Swiss Red Cross for the prevention of mother to child transmission is actually a comprehensive treatment programme based in Sigombeni rural clinic near Manzini which includes pregnant women and their family members. The entry point into the programme is through Voluntary Counselling and Testing which is manned by well-trained counselors who in part come from the community of people living with HIV/AIDS.
Seropositive pregnant women are given a single dose of Nevirapine at the onset of labour. Their babies will also receive Nevirapine within 72 hours of birth. Counselling is provided on infant feeding option. Prophylactic medicines such as Co-trimoxazole is provided to all infected persons and babies exposed to HIV. Triple regimen therapy is given to all infected persons that meet the set down criteria for treatment.
Though prevention will remain central to all HIV interventions, universal access to antiretroviral therapy for everyone who requires it according to medical criteria will open up ways to accelerate prevention in communities in which more people will know their HIV status and, critically, will want to know their status.
Rolling out effective HIV/AIDS treatment is the single activity that can most effectively energize and accelerate the uptake and impact of prevention. Attitudes will change, and denial, stigma and discrimination will rapidly be reduced.
Excerpts of the paper presented by Dr. Jamiu O. Peleowo at the
aidsfocus conference Living with HIV/AIDS. Treatment and Care for All: