Delay to testing and treatment; stigma, beliefs and fears
Today I was speaking to a man who had been diagnosed with HIV for 9 years. Unfortunately he has suspected Tuberculosis, an extremely common infection in Swaziland, particularly amongst the HIV population. We got to talking about how he became infected with HIV; he told me that on occasions he drank a few too many beers and then, common sense just goes out the window….he told me that although he understood the way in which HIV was transmitted, by unprotected sex, however he had had unprotected sex with sex workers. The next morning he regretted not having used condoms during sex. Once diagnosed with HIV he said it came as a shock and understandably he was upset, confused and scared. He told a few people about his diagnosis; his close friends and family, over the years he said have been very supportive. Although he told his closest friends and family he explained that not everyone one in Swaziland is so understanding, he helped me understand a little more about the complex issue of stigma belief and fears surrounding HIV. I will talk about each of these three topics briefly.
Stigma
Since being in Swaziland I have seen that a large proportion of people try to keep their HIV status concealed, not telling their close friend families and sometimes not even partners. When I have asked why , most people say it is mainly because of the stigma that surrounds the disease. I have been told that some people do not allow you into their house if they find out that you are HIV positive. This could be because they do not understand how the virus is transmitted and are ill informed about how you can contract the disease. Also school children if their class mate know about their HIV positive status can get teased at school and called derogatory names.
Use of condoms
Although I have been told that condoms are widely available around Swaziland, there is still a proportion of people having unprotected sex and risking not only the chance of having hIV but also contracting other STI’s such as gonnorrea, syphilis, warts and herpes to mention a few. This lack of condom use is most likely for many reasons, however it is reassuring that supply is not one of them. Unfortunately the remaining contributors are more difficult to resolve. I have been told that other factors include; a lack of feeling close to your partner, as well as people do not believe that condoms work- there are signs on the road side here saying “trust condoms”. Another reason for not using condoms, and one that surprised me, is that there is a stigma around using condoms – if a woman suggest uses a condom with her male partner, he may think… “so she thinks I’ve got HIV!” Or in reverse, “maybe she has HIV…..” Both these thoughts are undesirable during that special moment! So make the subject of condoms a taboo. When I’ve been travelling across the country on my weekends off I have been on many a long bus journeys, where I have spotted many adverts on the road side advocating the use of condoms the message is simple: a big bright blue road sign stating “TRUST CONDOMS”.
Beilefs
I have been told that there are many misinformed ideas about HIV, some of which I have already discussed. One of the most sticking theories that I have been told some people believe why HIV is so prevalent in Swaziland is that HIV was made by richer western countries and has knowing been given to poorer countries such as Swaziland to keep the them in poverty. I how no idea how many people believe this, the person who told me about this knew this was not true however he had heard other speak about it. Obviously this is not true however beliefs such as this are a setbacks to overcoming the HIV problem, firstly because it means the truth is not known but also it creates a blame attitude where nothing can be resolved. It is important therefore to dispel mistruths such as these.
One very important contributing factor to the lack of compliance to ARV drugs is because there is a long tradition of visiting the witch doctor, which heals with herbal remedies. Herbal remedies have been given to improve immune system and combat HIV. Beliefs in these medications in some cases prevents early attendance to conventional medical clinics.
Fears
Factors that propagating the delay to test and treat have been discussed these include; stigma associated with the disease and how this will impact on a person in society, the acceptance of disease and of the outcome, a belief that traditional medicines will provide therapy. All these factors, as well as many more, prevent testing and treatment. Saving lives mission is to promote early testing which in turn leads to early treatment on antiretroviral medication which leads to a better outcome and prolongs life. This message is extremely important and one that is much needed to be more widely received in this country.
Interestingly propagating the fear about HIV, is that people in village and town see family and friends becoming very sick and also dying form HIV. This is obviously strikes fear into people who are newly diagnosed with HIV as they believe it is a death sentence. However the reality is that if you know you are HIV positive as early as possible and commit to taking the medication regularly then people lead long and healthy lives. However people who are in this healthy category tend not to disclose their status to others. So there is a misrepresentation of what people may see, the only people they may know with HIV have been unwell. So it is easy to understand why there is such a fear surrounding HIV when you see people you love die from it. Perhaps if more people who were HIV positive, on treatment and subsequently living healthy and full lives disclosed there status to everyone, it would be illustrate that HIV is not a death sentence and would be an advocate for a positive attitude towards HIV. However, this is far much easier said than done, what with the deep rooted stigma and fear I have discussed. Also the advocates to diminish the stigma surrounding HIV should not be left solely to those infected with the disease. I have faith that there is hope to diminish this by campaigning, positive attitudes by health care professional as well as better education in all areas of the country and last but by no means least perseverance ….
Currently there is much promotion going on in Swaziland to increase awareness about HIV , encourage testing and reduce its transmission. The mains one I have seen include- encouraging testing
 |
 |
|
Currently there is much promotion going on in Swaziland to increase awareness about HIV , encourage testing and reduce its transmission. The mains one I have seen include- encouraging testing |
Discouraging polygamy, which still prevalent in tradional Swazi culture. The king for example has about 14 wives , people I have meet in smaller villages had 4 or so wives. This advert was in a local newspaper |
 |
 |
| This billboard is above the local bus station. | To encourage circumcision- which reduces the rate of males contracting HIV. |
