Seven-point plan to fight HIV/AIDS

Swaziland's ailing health care system is expected to undergo major changes this year as the government prepares to tackle increasing rates of HIV/AIDS infection. A seven-point programme of action, focused on addressing HIV/AIDS, is said to be in the pipeline. Principal Secretary of the Health Ministry, John Kunene, told IRIN that plans were underway to increase the number of voluntary testing centres (VTCs) throughout the kingdom's four regions. "We are targeting 100 percent coverage, where any Swazis living anywhere can have access to HIV testing within a reasonable distance from his or her home, along with the counselling that is so necessary both before and after testing." Kunene added: "Project Number Two will be a rolling out of 'PMTCT-plus' - Prevention of Mother-to-Child Transmission, but expanded to include the father. If we find a mother is HIV positive, we will employ the necessary medicines to halt transmission to the child, but we don't want to leave it at that - the woman's male partner must be given assistance." A national Safe Blood Initiative will also be expanded, highlighted by the opening of a national blood bank and testing facility in the country's commercial hub, Manzini. Swaziland is currently experiencing a blood supply crisis, and a public awareness campaign has been initiated to prompt voluntary blood donations. The blood centre in Manzini will be equipped to bring the country in line with international standards, complemented by the expansion of medical laboratory services planned this year at Mbabane Government Hospital in the capital. "There is a new structure, fully operational, at the hospital. We Swazis say it is not opened until it is officially dedicated by a national leader. But, until that time, it is undergoing an expansion that will see a National HIV/AIDS Reference Laboratory," said Kunene. The fifth initiative is a much more aggressive rolling out of antiretroviral (ARVs) drugs. "Last year, one to two thousand people benefited (out of 200,000 Swazis believed to be HIV positive). Ten thousand patients will be on an ARV regimen by the end of this year, and no less than 14,000 by the end of next year," said Kunene, who admitted that while the number of patients being treated was rising exponentially, only a fraction of the HIV positive people in the country had access to ARVs. More of them will receive ARVs, Kunene remarked, as Swaziland participates in the United Nations "3 by 5" initiative, which aims to have three million HIV positive people worldwide receiving ARV treatment by 2005. "Swaziland is one of the first countries in Africa to take up this initiative. Already a country assessment has been done, which is a prerequisite, and we are in the implementation phase," he said. The sixth area of emphasis this year will be an expansion of home-based care. Widespread poverty, which is exacerbated when breadwinners succumb to AIDS, means medical supplies have to be provided to caregivers by the government or donor agencies. Supply depots, where medicines and items like rubber gloves and sheets are dispensed to caregivers, are currently located in each of the country's 55 constituencies. The health ministry's goal is to extend the supply network to community level. "Caregivers are burdened enough without needing to travel long distances for supplies. We have started placing supply depots at chiefs' residences," Kunene noted. By December, a network of supply centres for Swazis tending to family members who have HIV/AIDS, or caregivers assigned to neighbours with HIV/AIDS, will be in place nationwide. A new initiative to "pole vault" over the hurdle of lengthy times for lab analysis of sexually transmitted infections (STIs) will also be undertaken this year, with financial assistance from the European Union. "It's called Syndromic Management of STIs, in countries where they have introduced this method, and it has resulted in a lowering of the HIV infection rate, so we are eager to begin it here," said Kunene. "Instead of requiring lab analyses of diseases - our labs can't handle the load - we have adopted the approach of immediately treating a patient who displays symptoms of STIs. We start treatment without waiting for the test results, for both the patient and his or her partner," he explained. Because of the proven link between STIs and HIV, early treatment of the former, such as treating breaks in the skin surface that can pass on or receive HIV-tainted blood, reduces the chance of HIV transmission. "There is no question of the skill and dedication of health personnel in Swaziland. We need more of them, and more resources," said Kunene. "But we are serious, and we have a willing donor community, internationally, willing to assist."