Using Health Communication To Fight Swaziland's HIV Crisis Addressing the World's Highest HIV Rate

One in Three Swazis Are HIV Positive

Although one of Africa's smallest countries, Swaziland has the highest prevalence of HIV in the world.

Almost a third of the population (31%) is HIV positive (ages 18 - 49) and HIV is the country's leading cause of death. In 2015, 35% of all deaths were HIV-related.

HIV Prevalence in Swaziland (SHIMS 2011)

The Health Communication Capacity Collaborative (HC3) is seeing positive results through the use of health communication to help stop the spread of HIV in Swaziland by reaching high-risk and hard-to-reach populations. With support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and U.S. Agency for International Development (USAID), HC3 works with local partners such as Nazarene Compassionate Ministries and Family Life Association of Swaziland (FLAS). Highlighted here are three approaches used in Swaziland.

  • Initiating community engagement workshops with traditional leaders, such as chiefs and their spouses
  • Facilitating empowerment activities for young women through the DREAMS Partnership
  • Supporting mobile health services in remote areas for outreach and care to key populations

The following describes in detail each of these three health communication activities and progress achieved thus far in Swaziland. All activities are designed to reduce the spread of HIV and associated stigma as well as to encourage treatment-seeking behaviors.

COMMUNITY ENGAGEMENT THROUGH TRADITIONAL LEADERS

Within the four regions that make up Swaziland, there are smaller chiefdoms, led by traditional leaders or chiefs. Receiving buy-in for HIV communication activities from Swaziland's chiefs is key for community engagement, but having the chief and his spouse on board is even better. Both are revered community members with the credibility needed to convey life-saving messages.

CHIEFS AND THEIR SpouseS CONVEY HIV MESSAGES

HC3 held training sessions with chiefs and their spouses to work towards greater acceptance of HIV messaging in the larger community. The sessions - led by HC3's team of interpersonal communication facilitators - were designed to help the leaders and their spouses recognize the important role they play in helping to keep their communities healthy through community-level HIV prevention activities.

Eighty chiefs and spouses received training where they were shown how to lead community-level engagement activities about general HIV prevention as well as the DREAMS Partnership, a global project designed to empower young women and reduce gender-based violence. In addition to the chiefs, 2,698 other community leaders received similar training.

Mr. Mduduzi Small Joe Dlamini, Ministry of Tinkhundla Administration and Development
“HC3 HAS ACKNOWLEDGED LEADERS NOT ONLY AS VEHICLES BUT ALSO AS INFLUENTIAL PEOPLE CAPABLE OF CONTRIBUTING TO THE REDUCTION OF HIV IN THEIR COMMUNITIES AND AS BENEFICIARIES OF HIV PREVENTION INFORMATION BECAUSE WITHOUT IT, THEY ARE ALSO AT RISK” - Honorable Mduduzi Small Joe Dlamini

Results

REACHING ADOLESCENT GIRLS AND YOUNG WOMEN

Reducing the high rate of HIV among adolescent girls and young women (AGYW) is crucial to address Swaziland's HIV crisis. Studies show transactional sex between young women and older men who provide them materials goods - often called "Blessers" - contribute to the spread of HIV. AGYW infected by these older men can pass the virus to partners their own age.

REACHING Young WOMEN TO PREVENT HIV's SPREAD

To halt new HIV infections among young women, HC3 is using a combination prevention approach and strengthening community capacity to address the socio-behavioral risks that influence HIV infection. Meaningful community participation is essential to ensure the sustained demand of high-quality essential family planning and HIV services, as well as to foster local ownership and accountability.

With funding from the DREAMS Partnership, HC3 has been working with chiefs and their spouses as well as their inner councils to create safe spaces for young women by addressing the social and gender norms that place them at risk. This activity uses a Community Leaders Manual that culminates in action plans and a pledge of their commitment to reduce vulnerability for young women. As a result, chiefs have committed to addressing teen pregnancy and safeguarding the well-being of young women. One way that they are putting this into action is by ensuring that young women are not married off at very young ages. They enforce this by asking for birth certificates and collecting a fine from men who marry underage girls.

Michael Magongo is an "Indvuna" or head of a governing body known in Swaziland as the ”Inner Council,” which means he is second-in-command to the Chief.
“WE AS TRADITIONAL LEADERS CANNOT WATCH YOUNG GIRLS ACQUIRE HIV AND BE EXPOSED TO SEXUAL ABUSE IN THE NAME OF MARRIAGE” - INDVUNA MICHAEL MAGONGO

At the same time, HC3 supports the economic and social empowerment of young women ages 20-24 through financial literacy self-help groups. These groups meet weekly to conduct savings and loan activities as well as gain information and skills around financial literacy to strengthen their economic assets, HIV prevention strategies, how to be assertive and communicate their needs and wants, job skills such as resume development and interview techniques, and networking with mentors using a manual HC3 developed for this purpose.

Below are some materials developed by HC3 for AGYW: Young Women's Saving and Empowerment Clubs - Guide for Mentor's and Swazi Girls4Health - A Standardized Module for Interpersonal Communication.

Nosiphesihle Mdziniso, who leads the Young Women's Empowerment Program, explains how the program's activities make a difference in how Swazi's young women (20-24) approach life.

EMPOWERING YOUNG WOMEN TO REDUCE NUMBER OF SEXUAL PARTNERS

Results

Reaching Key Populations

Key populations - including sex workers and men who have sex with men - are the hardest hit by Swaziland's HIV crisis.

The Swaziland Behavioral Surveillance Survey (BSS) showed an astounding 71% HIV prevalence rate among female sex workers (FSWs) (Baral et al., 2014) It also found that men who have sex with men (MSM) have a 17% rate and nearly 70% of men are unaware of their status (Baral et al., 2013).

HIV Prevalence Rate among FSWs and MSM

Confidential Services Provided by Mobile Vans

Mobile health vans reach key populations

Because Swaziland's key populations – particularly sex workers – are highly mobile, reaching them consistently with services can be challenging. Further, their working hours and the stigma associated with their trade often makes it difficult for them to seek services from static facilities. HC3 therefore partnered with the Family Life Association of Swaziland (FLAS) to deploy mobile health clinics across the country between 2014 and 2016.

Operating at night, the mobile clinics provided overall health evaluations that included HIV testing, screening for sexually transmitted infections, and psycho-social counseling among other health services including blood pressure monitoring.

Khabo Dlamani

Khabo Dlamini, a recipient of the mobile van's health services, appreciated the convenience and privacy offered. She is now on antiretroviral therapy (ART) and counseling other female sex workers about the importance of using condoms, getting tested and treated.

Sibusiso Masango

Sibusiso is a KaMhlaba Ambassador for MSM and FSWs. These Ambassadors conduct onsite dialogue and sensitization sessions for healthcare workers and nursing students. Their goal is to break down stigma and discrimination, thus opening the doors to HIV services for socially marginalized groups.

RESULTS

Key Populations Reached
Number of Tests Conducted (does not refer to individuals tested)

HC3 AppreciateS ITS STAFF WORKING IN SWAZILAND!

For more information, contact Beth Mallalieu.

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