World AIDS Day 2016: Let HIV/AIDS produce no more orphans

Alice Sagwidza-Tembe, CNS Correspondent, Swaziland
Leafing through my birthday good wishes from friends, family and foes, on my Facebook, WhatsApp, Tweet, Instagram, Skype and other social media accounts, I realised hundreds of postings were well designed cards, songs, articles about the World AIDS Day commemoration.

Companies, churches, schools, governments, non-state actors, groups, individual of every creed, race and religion were gathering and posting pictures and speeches remembering their loved ones lost to HIV/AIDS, those living with HIV and those caring for the sick. It reminded me that some couple of decades ago the 1st of December would have been a very different day for me, characterised by a birthday cake, friends and family gathered, lots of fried chicken, non-stop telephone calls with well wishes. Well there was no Facebook then. But today my birthday wishes are juxtaposed with grim reminders of the devastation caused by the deadly HIV.

According to the WHO, in 2015 there were an estimated 1.4 million TB deaths, with 400,000 deaths resulting from TB disease among people living with HIV (PLHIV). There does not seem to have been much movement from the year 2012 which saw 1.3 million TB with 320,000 being among PLHIV. Three years down the line, TB and HIV programmes still host individual conferences attracting thousands of specialists, unsung heroes living with HIV and TB, activists and researchers; medications are still being developed independent of the other, hoping that they will interact well in the human body carrying the two co-infections; TB and HIV community programmes still work in silos; and antiretroviral refill programmes still do not co-dispense TB medication while the co-infection continues to ravage the human race.

With 27% of its population living with HIV, Swaziland has the highest HIV prevalence in the world. As per UNAIDS report, in 2015 there were an estimated 220,000 PLHIV, out of which 10000 were children aged 0-14, in the country. Not only were there 11,000 new infections and 3800 AIDS related deaths, but 47,000 children aged 0-17 years have been rendered orphans by the disease. 15 years old Susan Mamba is one such orphan. Living in the peri-urban Tshaneni area in Swaziland, Susan shared that she lost both her parents 5 years ago. She explained that they, especially her father, had become sick much earlier than that. But they would just call the local church prophet to pray for them regularly and drive away the bad omens and spirits that were supposedly residing in their 4 bedroom house they had built in an undeveloped area. Despite visits from the local community health worker, Susan’s father would refuse to listen to the health education sessions. It was Susan who would sit through the sessions along with her mother and two younger siblings. Her mother eventually got tested and was diagnosed positive for both HIV and TB. Unfortunately, both parents had multi drug resistant TB (MDR-TB), but were treated for drug susceptible TB. They did not get any better and died within 3 months of each other. Ignorance about TB and HIV/AIDS cost them their lives. It also took away Suasn’s childhood as she was forced to become a parent to her siblings at the age of 9 years, and remains one to date.

This is just but one story of many young people who have grown in child headed households as a result of deaths that could have been prevented. It is therefore essential, as defined by the WHO, to invest in integrated care, ‘…a concept of bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency.’ “This approach will maximise use of the already overstretched healthcare human resources, minimise (rather than double) the cost of overheads for both HIV and TB programmes, fast track research into combined response to the co-infection and increase ease to the patient for improved quality of life,” said a TB Nurse at the Swaziland National TB Hospital in Manzini. The human immunodeficiency virus (HIV) attacks and weakens the immune system (CD4 cells), which is the body defence system against infections. As the attack strengthens, there is increased production of the virus, while the CD4 cells get fewer, meaning that any passing infection, including TB, can infect the body. These are called opportunistic infections because they use the weakened system to easily attack the body. HIV is transmitted from one person to another through the blood, semen and breast milk of the infected person like.

On the other hand, TB is caused by Mycobacterium tuberculosis—a bacterial species that is airborne and anyone who breathes the air carrying the bacteria can get infected. Once inside the human body, the bacteria may not make a person sick instantly, but remain dormant (latent TB), waiting for the opportunity to attack. HIV infection that weakens the body defence system opens up that opportunity for the latent TB to become active. PLHIV are especially vulnerable to TB in countries where TB is common, with roughly 75% of PLHIV who contract TB living in sub-Saharan Africa. During a webinar organised by CNS, Nomampondo Barnabas from the International Union against Tuberculosis and Lung Disease stressed upon the importance of community engagement in the response to TB and HIV/AIDS. “To end AIDS by 2030 we have to stop neglecting TB. We have failed to educate communities about their rights and failed to position TB within human rights agenda. We need to use the same strategies and advocate about TB also as we did for HIV, if we want to end TB by 2030. We have to increase community mobilisation around rights based responses to TB”, she said. Monisola Ajiboye, a PLHIV and a TB survivor from Nigeria lamented that awareness about TB is very low in the PLHIV community. According to her “We need more awareness and more funding for TB programmes. We also need more community engagement especially in rural areas.” WHO estimates that 8.4 million lives have been saved from 2000-2014, through integrated and collaborative TB-HIV activities. There are still many more lives to save and more needs to be done to achieve universal access and to eliminate HIV-associated TB deaths.

Alice Sagwidza-Tembe, Citizen News Service - CNS
December 10, 2016