Friday, January 18, 2013

HIV/AIDS in Swaziland

Today, we had a presentation on HIV/AIDS, which is a much larger part of life in Swaziland (and sub-Saharan Africa in general) than it is in the States. Before going to the presentation, I was talking to one of the Swazi students about it at breakfast. He said that he didn’t like how they talked about it so early on, like it was one of the most important things in the country. That’s the mindset I hope you take when reading this – AIDS exists, but it doesn’t define the country. At all. Please don't ever think that. Swaziland is so, so, so much more.

While statistics can’t possibly tell the whole story, I think that it’s almost necessary to include some, just to show how HIV/AIDS is common. While again, it doesn't define the country, it’s not some rare disease that you can live your life without ever noticing.

Note: All facts on HIV in this post are from the presentation. If you see something entirely wrong, feel free to correct me in the comments with a source URL, and I’ll revise the post accordingly.

1. The overall HIV/AIDS prevalence is 26%, the highest in the world.
2. The highest prevalence is in the 30-34 year-old group, where over 50% of the people have HIV/AIDS.
3. The prevalence among 15-19 year olds is about 20%.
4. Over 50% of the population is under the age of 15.
5. The average life expectancy is less than 50.

Okay, now I’m really interesting in public health and epidemics and medicine and all that, so the related portion of the presentation really interested me. There is no cure for HIV/AIDS, but ARVs, taken as one pill a day, can cause the virus count to go way down, and the CD4 (a body cell) count to go way back up.

Here’s the thing – while in America you would be starting on ARVs as soon as you test positive for HIV/AIDS, due to cost issues for these clinics here, you cannot start on ARVs until your CD4 count is below a certain number. While that might not seem that significant, more and more diseases are likely to occur when your CD4 count is low, and there are a bunch of diseases that you are likely to get before your CD4 count gets to the line to start ARVs, which is about a third of the ARVs a healthy person would have. Because of cost, it’s hard to avoid, but it seems really, really wrong.

The other thing is the stigma about HIV and taking ARVs – the presentation was given by a doctor from a local clinic, and he said he’s had patients who have agreed to chemotherapy right away, and didn’t want to take the ARVs, which are much easier, and just one pill a day.

Now, in Swaziland, HIV is mostly spread through body fluids mixing, so namely, sex. There was an interesting table included in the presentation, and while I don’t remember the exact numbers, I’ll try to describe it. It showed that if you have sex with one other person, and they’ve had sex with one person, you’ve only had sex with each other, and unless one of you has HIV already, you’re not exposed. Assuming that everyone has the same sex habits as you, if you have sex with two people, you’re being exposed to you partner, your partner’s other partner, your partner’s other partner’s two partner’s, and so on. The graph went on down the line, and once you got down to having had about seven or eight partners, you’d have been exposed to about a thousand people. In a country with and HIV prevalence rate of 26% on average, that means that having sex with two or more people has probably exposed you to HIV.

Again, while HIV doesn’t define Swaziland, it’s something that’s essentially unavoidable as a part of life that you notice.

I’m not sure what else to say about HIV/AIDS here. Walking down the street, people have AIDS, but it’s not like you can tell. It’s just ordinary people. Some people were born with HIV, and some contract it, but you can’t tell by looking that they have it. It’s not contagious, and you’re not going to get it if you touch something they’ve touched. It’s kind of just that it’s there, but after this whole presentation and hullabaloo, nothing changed. We walked out of Assembly Hall, and kept going with our day. Just like the flu doesn’t shut down life, HIV doesn’t shut down life. Even in the other respect, with ARVs, HIV/AIDS treatment is really rather good, despite the cost restrictions in the country. Getting HIV is no longer an absolute death sentence, Swaziland or elsewhere.

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