It’s the 1st of December and it’s World Aids Day. World Aids Day is all about raising awareness to stop the spread of HIV /AIDS and working together to do this. Stephen Lewis, a former United Nations' special envoy for HIV/AIDS in Africa who has seen the bigger picture of what HIV/Aids is doing to people and nations and has been persistent in trying to stop this devastating disease. In Stephen Lewis’ World Aids Day Message last year, he stated “prevention is not yet working. For every two people whom we put on anti-retroviral treatment so that they might live, there are five new infections. Prevention remains an elusive goal in the high-prevalence countries.” It is becomingly more widely known that Swaziland has the highest HIV/AIDS rate in the world. Therefore it is a central focus to many of the projects and strategies in Bulembu. To give more information on what Bulembu is specifically doing to help fight against HIV/AIDS, we interviewed Niel Geldenhuys, manager of the Bulembu Clinic.
How many medical staff work at the clinic?
“Wiseman a nurse, and myself, Margret who is a Midwife and Vera who is funded by ICAP (Aids Care and Treatment Programs) from Columbia University but works for us.”
How is Bulembu clinic dealing with HIV AIDS problem in Swaziland on a day-to-day basis?
“ Bulembu Clinic offers volunteer counseling and testing for any and every patient in the community at no cost. If they want to come to the clinic for an HIV test then they don’t pay anything for it. What happens when patients tell us they want an HIV test done, we open a file for them and there is a woman here that specifically works with HIV/AIDSpatients. She is called an expert client which means her HIV status is positive and she is on anti-retrovirals herself. She gets paid to speak to people about her HIV status, how the drugs are affecting her, how she is getting better and that it actually works. That is her job, so any of us, either the nurses can do the testing or counseling, but she is here full time to council and she is effective because she can relate to the patients.”
How do you test for HIV/AIDS and how do you deal with AIDS patients?
“The Aids test is a finger prick test. We use two different rapid tests just to make sure that the results are accurate. If both rapid tests are positive then we tell the patient their status. We do pre-test counseling and post-test counseling, explain to them what it means and what the road forward looks like from here. From then onwards whoever does the test would bring the patient to me and I will do a general examination of the patient and clinically stage the patient, see how sick the patient is, determine what stage of the disease the patient is at, then we also take bloods from them and run tests on them e.g. test their liver, test their kidneys, check their CD4 count. “
“We then follow them up and so it’s patient dependent. If I have a patient with a CD4 count of 1000, I tell them to come back in three to six months, set a date for them and test them again and see if their CD4 count is lowering or if they need any other medicine to keep them healthy. Once we make a decision that a patient needs anti-retroviral therapy they go to Piggs Peak Hospital for the first initiation day of therapy then they will initiate them there and start them off on medicine and every time from then on a monthly basis the patience come to Bulembu. We do a full medical workup on them, check that they are taking their tablets properly, actually count their tablets make sure that they are taking the tablets at the correct time that they don’t build up resistance, draw bloods here and monitor their CD4 counts and if we need to, their viral loads. That is all for free of charge.”
Who is subsidizing all the HIV/AIDS tests and anti-retroviral medication?
“Everything is run by the Swazi government. Apart from that everything else is private at the clinic. Most of the patients however that we do test come in with another opportunistic infection. In other words they have some infection that they are prone to have because they have HIV/AIDS. While dealing with that we usually suggest to them that they need to have an HIV test and we council them through it.They would still pay the $1.50 for the consultation of the other problem but all the HIV is free of charge. Donors from Canada and around the world fund the Clinic general operations, indirectly by supporting Bulembu.”
What do you think can reduce the HIV rate in Swaziland?
“I believe that an effective way of tackling AIDS in Bulembu, instead of having mass campaigns like they have been doing, putting posters up and handling out pamphlets is to speak to people one-on-one. So every patient that comes through here gets offered an HIV test. If they don’t want to do it, they don’t have to do it but to me it’s made a big difference. When I started off here, we did about 12 to 15 HIV tests a month and at the moment we test roughly 60 to 80 patients a month. We are encouraging them on a one-on-one basis to take the test. If they want an HIV test done, they will ask the nurse and have an HIV test done but more often than not, if you don’t ask a patient and say: listen I really think you should have an HIV AIDS test done. Nine out often would be too scared to have it and not do it. We also council the patient on prevention of HIV and family planning.”
“Females are usually more willing to test than what men are. Men are usually a bit more stubborn when testing. A lot of the times we will have the women coming and we would suggest that they bring their boyfriend or husband when they comet o the clinic and the guys don’t want to test. We probably have more women on anti-retroviral medication than men.”
The Bulembu Clinic sees a large number of patients every day and administers medical care and medication to the community and the greater population of Swaziland. Niel and his staff are filled with hope and expectation to help many more lives in the years to come as the clinic’s capacity to treat more people is increasing and meeting an ever growing need. “Of course we can turn the tide on AIDS in Africa. It just takes your help, sprinkled with a touch of imagination and love.” – Stephen Lewis