In Swaziland, a national push for an HIV-free generation
Today, the Government of Swaziland launched a framework to mount the final push toward achieving the goal of eliminating new HIV infections among children and improving the health of women within the next two years.
UNICEF reports on programmes in Swaziland that are helping HIV-positive parents lead healthy lives and have HIV-free children.
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By Suzanne Beukes
ZOMBODZE, Swaziland, 22 March 2013 – Every morning, Khanyisile and Mcebo Dlamini take turns jogging around a football field near their home in Zombodze, Swaziland.
“One of us stays here to watch Sethu,” says Khanyisile, pointing to their 1-year-old son, a quiet spectator to his parents’ daily routine. “The other one goes round the field. Then we exercise together.”
This rigorous activity is part of the couple’s routine to stay healthy and fit. Both are HIV-positive. Eating a balanced and nutritious diet, together with exercise, they say, is an important part of living positively with HIV.
Learning to live with HIV
Almost two years ago, Khanyisile went to her local clinic to take a pregnancy test. After discovering she was expecting Sethu, she was encouraged to take an HIV test. It was then that she met Goodness Dlamini and struck up a relationship that would change her life.
Goodness works for the NGO Mothers2Mothers, which she describes as “an organization that saves babies”. She is also HIV-positive. Prior to taking the test, Khanyisile was counselled by Goodness on how to cope with the result, if it came out positive.
“When I first met Khanyisile,” recalls Goodness, “she was afraid to be HIV-positive. But I spoke to her about how we can help her stay healthy and that the baby can be born HIV-negative.”
When the positive result came in, Khanyisile was put on the prevention of mother-to-child transmission of HIV (PMTCT) programme. She was given antiretroviral prophylaxis throughout her pregnancy and delivery.
Little Sethu was born healthy and HIV-negative, and weighed 3.1 kg. “When I found out my baby was negative, I was so very happy!” says Mcebo. “I jumped. I sang. I kissed my baby, and I kissed my wife.”
Sethu was born HIV-free to Khanyisile and Mcebo Dlamini, both of whom are HIV-positive.
Results are starting to show
Swaziland has the highest HIV prevalence in the world. In 2010, an estimated 41 per cent of pregnant women in the country were infected with HIV.
The programme in which the Dlamini family took part has been helping to make sure babies born to HIV-positive mothers are born HIV-negative and that their mothers receive the treatment they need to stay healthy.
The Government of Swaziland, UNICEF and partners started the PMTCT programme in 2003 in response to the high HIV prevalence, and in an attempt to stop transmission of the virus from mother to child. The programme was initially available in three clinics. By 2010, it had expanded to more than 150 healthcare centres – which means that 88 per cent of facilities offer the treatment.
UNICEF Health Specialist Makhosini Mamba says that, now, “[t]he majority of pregnant women who test positive for HIV are provided with treatment to protect themselves and their baby during pregnancy and delivery.”
In 2011, 95 per cent of women living with HIV were receiving antiretroviral drugs excluding single-dose nevirapine for PMTCT, compared to 57 per cent in 2009. During the same period, there was a 7 per cent reduction in mother-to-child transmission – to 11 per cent, in 2011.
National vision for an HIV-free future
The national Strategic Framework for Elimination of New Infections among Children by 2015 and Keeping Mothers Alive was launched on 22 March. In it, the Government of Swaziland and United Nations partners outline some core challenges and ways to overcome them. The goal is not only to reach the global plan virtually to eliminate new HIV infections by 2015, but also to reach a new national goal of reducing new HIV infections among children to 5 per cent in 2014.
The framework highlights a number of areas for improvement. One is early antenatal attendance of pregnant mothers. It has been proven that, when women attend antenatal care earlier, they can be diagnosed and access treatment sooner – which means that their children stand a better chance of being born HIV-free.
Mr. and Mrs. Dlamini speak with Goodness Dlamini, a mentor with partner NGO Mother2Mother. Through a programme for prevention of mother-to-child transmission of HIV, HIV-positive parents are able protect their babies from HIV - and look after their own health.
At present, only 28 per cent of pregnant women attend antenatal care services during their first trimester.
Postnatal care for mothers is also a concern. According to Mr. Mamba, “Just about 50 per cent of women who received [antiretroviral] prophylaxis during their pregnancy and delivery are on antiretroviral treatment for their own health. This means that there are more HIV-positive women out there who need to be convinced to accept antiretroviral treatment. Otherwise, maternal mortality will continue to rise, compounding the country’s orphan crisis – which is already a major challenge.”
Other factors highlighted as challenges to achieving the national goal are: poor postnatal attendance (only 22 per cent of mothers attend postnatal care at 6 weeks); shortages of trained health personnel, particularly in rural areas; inadequate infrastructure and equipment; and stigma and lack of accurate knowledge and information on HIV-preventive behaviours.
Male involvement key to success
“There is also a need to step up male involvement and participation in the whole HIV and AIDS response agenda in Swaziland,” says Mr. Mamba. “Except for a few men like Mcebo, male involvement is significantly lagging behind, and this is one area of serious weakness in the HIV response.”
Goodness highlights tradition and fear of the unknown as factors holding back progress. “Our culture doesn’t allow men to hold babies,” she explains. “A lot of men don’t want to come for testing because they don’t want to be known that they are HIV-positive.”
This was not the case for Mcebo, who accompanied Khanyisile on her second clinic visit to be tested for HIV. Like Khanyisile, he is on antiretroviral therapy.
According to Mcebo, “Generally, men don’t want to talk about this subject. Some wouldn’t even hear any of it, and others wouldn’t take me seriously when I talk about it.”
“There is a result, which is them”
Khanyisile continued her treatment while exclusively breastfeeding Sethu for the first six months of his life. The boy is happy and healthy, and his parents are proud and dedicated to his, and their, continuing good health.
The Dlamini family have demonstrated that, by following the treatment programme and receiving the right support, it is possible to have an HIV-negative baby and to live a healthy life.
The hope is that, by implementing accelerated strategic measures outlined in the framework, all families affected by HIV will benefit from what has already become a fruitful programme – and that Swaziland can truly achieve an HIV-free generation.
“When I look at the [Dlamini] family, I become very happy – because I can see my results. It gives me power to continue doing my work because there is a result, which is them,” says Goodness, proudly.