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Blog: HIV testing in Swaziland's rural clinics

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HIV and renewed hope - Nursing Times blogger and Swaziland public health worker Susan Elden on the heartbreaking stories that come with producing the Good Shepherd hospital’s annual report

Like most hospitals, it is time for Good Shepherd Hospital to produce its annual report. In the HIV testing department, I ask all the staff members to tell about their experience of working with patients and the challenges they face or how they have helped someone. This is the first report that I received back from one of our staff members, Steven.

Steven provides HIV testing and counselling in our rural clinics. When I first arrived, I went and observed the community HIV testing. I was shocked by numbers of people who had walked to clinics to be HIV tested and also by their stories.

On the first day I came to the clinic we saw a grandmother bring her 16-year-old mentally and physically disabled grand-daughter in for testing. The grandmother explained that some days when she has to go to the market she can’t stay home to protect her grand-daughter from some of the neighbourhood boys.

She was HIV positive and I watched the staff explain this, saw the look on her grandmother’s face and wondered how she was going to care for this girl in her old age.

We also had a husband and arrive for testing. The husband was HIV positive, and the wife was HIV negative. We don’t often find discordinate or mixed status results in married couples.After the couple left, the woman returned to the room alone and said she was sure she would get infected later because her husband refused to use condoms.

Sometimes I think that often the social, gender, poverty and other societal influences are far more powerful than any of our advice or talk of “behaviour change.”

Here is the story that Steven submitted for our report:

“During our visit to one of the local clinics, I met a 15-year-old lady who entered my room to have her CD4 count taken. When I asked her name, she told me but she was full of tears on her face. I asked her what was wrong and what I can do for her. She started to narrate her story.

She is orphaned and lost both parents. Now she stays with her brother and sister in law and what she had come for today is a CD4 count. When I asked how had she come across that situation, she says she was raped by one of her uncles when she was at the age of 14 years. Now what made her to cry is that she had lost her virginity in this and had tested and found to be HIV positive, claiming now she does not have a future.

I tried to talk to her and how she can cope with this situation, like now the availability of ARVs (anti-retrovirals) if her CD4 count is below 200. I asked her to come back with her sister in law (brother’s wife, but who is like her mother since both parents are dead). Then when she comes back for the results, we can share how to live a positive life.

They both finally came for the collection of the results. I was able to educate her and her sister in law about HIV and how the sister in law can help her to cope with her positive status. On that day, the sister in law also decided to go for the HIV test.

Now the situation is finally coming together. The sister in law was also found to be HIV positive. So they can now help each other and live in the open about this situation.”

I asked Steven why he selected this particular story he said to me, “Because you see, this is good news and we are helping people.” Actually, he’s right. Some days I fail to see it because I am so focused on the tragedy of it all.

I have to remember that less than a year ago we didn’t even have the ability to get testing strips, phlebotomy for CD4s or our staff out to the rural clinics. Now the clinic nurses can offer testing to all their patients and we can transport and report back the CD4 counts.

We’re getting better services out to patients. Often times it is still too little, too late in my opinion. Over half of our patients die before they can even begin HAART (Highly active anti retroviral therapy).

Some days I am sure that the HIV pandemic here is Swaziland is the one winning, not us. Other days, I see staff members like Steven going out everyday and doing this job, one patient at a time, and I feel so encouraged. I think it is the only way forward.

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