Locals in Swaziland Use Personal Experience to Raise HIV Awareness

The country has the highest HIV rates in the world.
An MSF counselor teaches women about HIV testing and treatment. (Photo: Fellipe Abreu)
Dec 25, 2015· 4 MIN READ
Fellipe Abreu is a Brazilian photojournalist focused on social issues, conflict, the environment, human rights, and culture in Latin America and Africa.

It’s still early, but the sun burns as if it were noon. In the sky, there is not a single cloud to soften the strong rays. Dry trees with few leaves scatter the ground, creating scarce shadows where dogs and goats are resting. On the horizon, the dry, yellow soil contrasts with the dark blue sky.

Women cook in large iron cauldrons marked by time while others hold buckets on their head filled with water collected from the nearest drinking-water hole. The men, from different homes, walk to the Kudla Inhloko—a circular plaza surrounded by tree branches.

This is where the male community leaders meet for special occasions or to make important decisions. Today they’re performing a traditional local ceremony, the Cow Head Meeting, when a cow’s head is prepared on the grill and eaten as they discuss the issues the village is facing.

Teaching women about HIV medication. (Photo: Fellipe Abreu)

But today the village has special visitors. Taking advantage of having the male leaders together in one place, a team from Doctors Without Borders (MSF) has come to counsel them about HIV.

The small village, Qomintaba, is located in Shiselweni, a southwest region of Swaziland—the country with the highest HIV rates in the world. According to UNAIDS, 27.4 percent of adults have HIV.

“Before 2007—when MSF began working in Swaziland—the prevalence rate was 42 percent, much higher than today. In our culture, funerals are held during the weekends. But so many people died at that time, the funeral rites began to be made throughout the week,” says Zanele Zwane, communication officer of MSF in Swaziland.

She says that in the mid-2000s, health services were very centralized and that people could only undergo testing and treatment in the few large health centers that existed. Also, because most of the population lives in rural areas, people had to travel long distances to the nearest center, many times by foot, and wait several days to receive results.

“When the MSF arrived here, it implemented a process of decentralization of health services for rural areas, which is where approximately 78 percent of the population lives, and this concept of decentralization was implemented first in Shislweni, where we are,” says Zwane.

But beyond creating rural clinics, every day of the week the MSF mobile teams—such as those we are following today—face long dirt roads to personally visit isolated communities like Qomintaba.

Within the Kudla Inhloko, men are sitting with their backs against the fence made of tree branches, while a small group of four women settle on the other side.

At one point, Busi Gumbi and Sylvia Khuzwayo extend two small straw mats on the floor, sit down, and start talking to people. While Khuzwayo speaks to the men about the importance of the examination, Gumbi advises a group of four women about how they should take care of their health during antiretroviral treatment and how they should tell their children that they are carriers of the HIV virus.

Gumbi and Khuzwayo are counselors of Doctors Without Borders. But unlike most of the professionals who receive formal education in medicine or nursing, what makes them unique are their personal experiences. Both are living with HIV and using their own lives to raise awareness and help local communities, showing that it is possible to still live with HIV provided the treatment is taken seriously.

(Photo: Fellipe Abreu)

“One of the key points of the MSF work in Swaziland is working with people who are HIV-positive. In addition to playing an important role with new people who decide to be tested for HIV, they also provide support and counseling for HIV-positive people throughout the treatment,” comments Zwane.

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“I found out I had HIV on October 18, 2004, when I was pregnant. Two years later, I decided to announce that I had the disease to my community. After that, I gradually got involved with the cause and began, on my own, to motivate people of my community to also perform the exam,” says Gumbi. She explains that when MSF visited her community for the first time in 2010, the community chief told the counselors about the work she had been doing to help people with HIV, and soon after she was asked to be an adviser for the organization, talking to community people about her experiences.

“I talked to women and encouraged them to perform the test on their children and to start the treatment immediately for those who are diagnosed positive. I also talked about the precautions to be taken during treatment, both for them and for the children.” Gumbi says that even after a person discovers he or she is HIV-positive and gets treatment, she continues her counseling work.

But the lack of information and prejudice remains a major barrier to treating the disease. In today’s talk, the women argue that often, when women decide to be tested for HIV, they are abandoned by their husbands, who expel them from their homes. Consequently, many of them fear taking the exam or receiving treatment.

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Ruth Ndlangamandla is one of the four women who heard Gumbi’s advice today. Her husband was diagnosed as HIV-positive in November 2005, and she discovered that she was also positive in 2006 but only began treatment in 2013.

She says that at first she cried a lot and became depressed. She could not tell their children that she was sick, because she worried about what they might think about how she contracted the virus, as HIV is associated with promiscuity in her society.

“In my heart, I knew that HIV kills, and my biggest fear was to die and leave my children behind. A few years after diagnosis, I received my first visit from Busi Gumbi. I remember she talked about her status, and the way she spoke, it seemed possible to have a normal and healthy life if I followed the treatment,” she says. In 2013, seven years after discovering she had the disease, Ruth decided to get treatment.

“Finally, I managed to stop stigmatizing myself, because the stigma is first internal. Gradually, I began to accept me the way I was, and now I feel comfortable with being a carrier of the HIV virus,” admits Ruth.

“The counselor’s job is critical. Being HIV-positive also generates a very strong bond with the local community. Like any treatment, there are difficult times. But people think, ‘If the director has been there and is well, I can too,’ ” says Zwane.