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Expert patients help rural Swazi clinics treat  HIV, TB clients

Page history last edited by Rosemary 12 years, 1 month ago

People who are living openly and positively with HIV/AIDS in southern Swaziland have become part of the treatment teams of rural clinics, despite initial skepticism from government and health authorities. Eleven “expert patients” or “expert clients”, trained by Médecins Sans Frontières (MSF) in HIV/AIDS and tuberculosis counseling and testing, currently assist overloaded nursing staff in the rural clinics. It is part of a strategy to build the community’s capacity to deal with HIV/AIDS and TB by giving people living with HIV/AIDS an expanded role in fighting the spread of the disease.

Sylvia Khuzwayo has volunteered at the Mbabane Government Hospital-based Voluntary Counselling and Testing services (VCT) for five years. “People get motivated by listening to someone who openly declares their HIV status and is living a positive life because this person becomes a role model, thus making others see that one can live a positive, fruitful life with HIV,” she says. “In my opinion, using 'expert patients' is very effective because there is better understanding between us and patients because we are both in the same boat.”

Popularly known as sitjifiri (beautiful and well-kempt woman in SiSwati), Sylvia - mother of three and grandmother of two - travels around Shiselweni region in southern Swaziland, talking about living with HIV. After her husband's death, Sylvia joined an HIV support group called Swaziland Aids Support Organization (SASO); they encouraged her to go for testing, which she did in 1998. She started treatment in 2001.

Expert clients like Sylvia try to be “on top of the game to give people the correct information” and that means reading, using the internet, and listening to the radio as well as learning from the MSF doctors. “Remember HIV/AIDS is very dynamic and it keeps changing all the time and an expert client has to use different media to enrich their knowledge,” Sylvia says. She recently did a three-month course on HIV counselling that included home-based care, palliative care, positive living, stress management, and public speaking.

Expert patients know, for example, that treatment causes loss of body shape. “This is something I went through and I was really frustrated,” Sylvia says. :”As an expert client who has been through this, you have to encourage people to accept their new bodies. I always tell people that it’s better to have poor body shape than no life at all.”

Given that Swaziland has the world’s higher HIV/TB co-infection rate with 80% of HIV-positive patients also infected with TB, MSF believes that training community members in HIV and TB counseling and testing can assist the clinic’s nurses. "Nurses should focus on the medical part [of the clinic operations], while counselling and testing should not take too much of their time," says Aymeric Péguillan, head of mission for MSF Swaziland.

MSF is working to assist local clinics in remote areas of southern Swaziland to provide combined TB and HIV/AIDS services to co-infected patients. Currently, most HIV/AIDS and TB services are offered only in city hospitals, out of reach for most of the rural population. By the end of 2009, MSF hopes to be working with all 19 health clinics in the region so they can offer TB and HIV/AIDS counselling, testing, TB treatment and antiretroviral (ARV) therapy all in one place, closer to peoples' homes.

Since last year, MSF has been providing rapid HIV testing as well as sputum tests for TB to nine clinics in Shiselweni region. MSF then transports the samples to the hospital laboratories. "The idea is that the sample should travel but not the patient," says Péguillan.

This story was compiled from three sources: Expert patients: the positive attitude in Swaziland, MSF News, Dec. 12, 2008; HEALTH-SWAZILAND: 'Role Models in the Community' -  Mantoe Phakathi interviews expert client Sylvia Khuzwayo; and Swaziland: Patients Fail to Adhere to TB Treatment, by Mantoe Phakathi, Inter Press Service, Mbabane, January 9, 2009. The picture of Mumcy, one of the expert patients, was taken by Jonathan Heyer and can be found on the MSF website.


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