12 Dec 2008 | Article

One in four adults is infected with HIV/AIDS in the small landlocked kingdom of Swaziland, where the geographical remoteness of health centres is a major obstacle in the fight against AIDS and tuberculosis (TB).

 

The Kingdom of Swaziland enjoys political stability and a wealth of farming, forestry, mineral and industrial resources. However, despite its status as an intermediate income country, 69% of the people live under the poverty line and there is almost certainly not a single Swazi family that is not affected by the dual HIV/TB epidemic.

 

The prevalence of HIV in Swaziland’s adult population is the highest in the world (26%) and the number of reported cases of tuberculosis is in excess of 1,200 per 100,000 a year - the rate of HIV/TB co-infection is over 80%. For a country with a population of just 1 million and a life expectancy of only 32 years, the future looks rather bleak.

 

In rural and semi-urban areas, huge numbers of orphans live (100,000 have already been registered nationwide – a tenth of the population), households under the responsibility of the elderly or children are commonplace. Soaring inflation on basic consumer goods and transport costs and loss of earnings of working-age people who are unfit to work have disastrous consequences for many households whose incomes are already low. In a country where 80% of the population lives in rural areas, many in small, isolated homesteads, far from the main lines of communication, getting healthcare is difficult for a large number of families.

 

MSF, working in Swaziland since 2007, is decentralising care for HIV positive and TB patients through local hospitals andf health centres and also rural community clinics. MSF has also employed a number of 'expert patients' who are people living with HIV who encourage testing and treatment adherence.

 

Since 2007, MSF has placed more than 1,850 HIV-positive people under ARV treatment. “Our main focus is to reinforce community level health care through deployment of additional staff and equipment. MSF-experienced doctors and nurses will also mentor the clinic’s staff. Only complicated cases, such as patients suffering from drug-resistant tuberculosis, should be referred to the health centres and hospitals for intensive care,” explains Dr Zerihun Tefera, medical coordinator with MSF in Swaziland. “Adapted infection control measures both in clinics and communities are also essential to prevent further spread of TB, particularly among HIV patients,” adds Tefera. “Testing services must be provided at the community level to effectively detect cases.”