What Nigeria can learn from Swaziland about HIV/AIDS

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It’s obvious that Swaziland has outperformed Nigeria in fighting HIV/AIDS. What Africa’s biggest country learn?

Even though Nigeria makes 66% more money than Swaziland (with a GDP per capita of $5,900 against Swaziland’s GDP per capita of $9,800), Swaziland has been able to achieve a feat that Nigeria has been grappling with for a very long time.

A research team led by Velephi Okello of the Swazi Health Ministry revealed in a presentation at the 2017 HIV science conference in Paris that since 2011, the national HIV incidence has dropped by almost half. This is a country where about one in three adults are infected with the HIV.

They could achieve this by vastly expanding public programmes to test people for HIV infection and put them on life-saving anti-retroviral treatment (ART). According to the researchers, the country is currently focusing on sustaining these achievements because of its importance in curbing severe HIV epidemic.

Data from the Swazi government shows that in 2011, 31 percent of adults (aged 18-49) out of a total country population of just over 1.2 million, were infected with HIV. This made Swaziland the country with the highest national rate of new infections, said the authors of the new study, as well as the highest proportion of people living with HIV.

The latest data, based on blood tests from about 11,000 people aged 15 and over, showed that 27 percent were HIV-positive in 2016.

This translated to an infection rate of 1.39 percent among 18 to 49-year-olds, down from 2.58 percent in 2011, a 46% reduction.

“Incidence was higher among women than in men,” said the report to the International AIDS Society conference. The decline was also steeper for men at 52 percent than for women at 40 percent. The survey showed that 73 percent of people on ART had achieved suppression of the virus, compared to 35 percent in 2011.

ART not only stops HIV from replicating and attacking a patient’s immune system, but also curbs its spread to sexual partners.

The gains were the fruit of a much-improved HIV treatment programme, said the researchers. The number of HIV tests conducted in Swaziland more than doubled from 176,000 in 2011 to 367,000 in 2016, and the share of infected people on ART rose from 37 percent to 74 percent.

Developing a culture of “DOING”

At the first Nigeria Health Watch Forum held on April 20th, 2017, the Director General of Nigeria Agency for the control of AIDS (NACA), Dr. Sani Aliyu talked about localization of certain efforts to combat HIV/AIDS as against sole dependence on foreign aid and importation of almost all consumables and anti-retroviral drugs. He also iterated the need to locally fund efforts aimed at combating HIV/AIDS to minimize the impact of donor fatigue. Despite these lofty recommendations, there hasn’t been any development or meaningful progress in this area since the forum although there was news of partnership with the private sector.

The lack of political will continues to hamper the sustainable development of the health sector despite the goodwill and good intentions of its leaders. This has resulted in a tradition of saying more and doing less. Those in positions of authority continue to pay lip service to healthcare but are quick to dash off to other countries for medical treatments, an act that was recently condemned by the South African Minister of Health.

Overcoming cultural barriers

According to Nosizwe Amanda Sigwane, a Programme Assistant at African Union’s Department of Science Technology and Innovation (STI), the high prevalence of HIV was cultural because people were embarrassed to seek treatment. To address this, there was massive campaign to destigmatize HIV with the king playing a major role.

She said: “Leadership contributed to this success with the king playing a major role. We even had a slogan of HIV free generation and everyone worked towards achieving it”

“Because people with HIV were more embarrassed than discriminated, the Minister and corporate companies got involved including the king himself”

All these efforts helped to change the narrative by making HIV testing a norm.

“Public testing became more of a must do. When going to the hospital before any treatment you were tested for HIV. We also promoted the use o protection before sexual intercourse.”

According to Nosizwe, “Condoms were readily made available almost everywhere and we had a lot of concerts on HIV free generation where we would have leaders coming to support and would lead by taking part in voluntary counselling and testing.”

“Getting condoms and Antiretroviral drugs (ARVs) became a norm and no more a disgrace because more than anything, people were embarrassed”

“With these campaigns, they were able to get the feeling of disgrace off their heads, get treatment and live healthier lives”

“There really isn’t need to waste money researching and developing medications when patients won’t even use them due to discrimination”.

If Nigeria must win the war against HIV, achieve the 90-90-90 target and improve healthcare for its teeming population, there is need to act as evidenced in the decisive and intentional efforts by the Swazi leadership.

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A medical scientist and global health enthusiast. ICFP2016 and AIDS2016 rapporteur, country coordinator (Nigeria) for the International Youth Alliance for Family Planning.

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