Photos: Locals in Swaziland Use Personal Experience to Raise HIV Awareness
An MSF counselor teaches women about HIV testing and treatment.
It’s still early, but the sun burns as if it were noon. In the sky,
there is not a single cloud to soften the strong rays. Dry trees with
few leaves scatter the ground, creating scarce shadows where dogs and
goats are resting. On the horizon, the dry, yellow soil contrasts with
the dark blue sky.
Women cook in large iron cauldrons marked by
time while others hold buckets on their head filled with water collected
from the nearest drinking-water hole. The men, from different homes,
walk to the Kudla Inhloko—a circular plaza surrounded by tree branches.
This is where the male community leaders meet for special occasions
or to make important decisions. Today they’re performing a traditional
local ceremony, the Cow Head Meeting, when a cow’s head is prepared on
the grill and eaten as they discuss the issues the village is facing.
But today the village has special visitors. Taking advantage of
having the male leaders together in one place, a team from Doctors
Without Borders (MSF) has come to counsel them about HIV.
The small village, Qomintaba, is located in Shiselweni, a southwest
region of Swaziland—the country with the highest HIV rates in the world.
According to UNAIDS, 27.4 percent of adults have HIV.
“Before 2007—when MSF began working in Swaziland—the prevalence rate
was 42 percent, much higher than today. In our culture, funerals are
held during the weekends. But so many people died at that time, the
funeral rites began to be made throughout the week,” says Zanele Zwane,
communication officer of MSF in Swaziland.
She says that in the mid-2000s, health services were very centralized
and that people could only undergo testing and treatment in the few
large health centers that existed. Also, because most of the population
lives in rural areas, people had to travel long distances to the nearest
center, many times by foot, and wait several days to receive results.
“When the MSF arrived here, it implemented a process of
decentralization of health services for rural areas, which is where
approximately 78 percent of the population lives, and this concept of
decentralization was implemented first in Shislweni, where we are,” says
But beyond creating rural clinics, every day of the week the MSF
mobile teams—such as those we are following today—face long dirt roads
to personally visit isolated communities like Qomintaba.
Within the Kudla Inhloko, men are sitting
with their backs against the fence made of tree branches, while a small
group of four women settle on the other side.
At one point, Busi Gumbi and Sylvia Khuzwayo extend two small straw
mats on the floor, sit down, and start talking to people. While Khuzwayo
speaks to the men about the importance of the examination, Gumbi
advises a group of four women about how they should take care of their
health during antiretroviral treatment and how they should tell their
children that they are carriers of the HIV virus.
Gumbi and Khuzwayo are counselors of Doctors Without Borders. But
unlike most of the professionals who receive formal education in
medicine or nursing, what makes them unique are their personal
experiences. Both are living with HIV and using their own lives to raise
awareness and help local communities, showing that it is possible to
still live with HIV provided the treatment is taken seriously.
“One of the key points of the MSF work in Swaziland is working with
people who are HIV-positive. In addition to playing an important role
with new people who decide to be tested for HIV, they also provide
support and counseling for HIV-positive people throughout the
treatment,” comments Zwane.
“I found out I had HIV on October 18, 2004, when I was pregnant. Two
years later, I decided to announce that I had the disease to my
community. After that, I gradually got involved with the cause and
began, on my own, to motivate people of my community to also perform the
exam,” says Gumbi. She explains that when MSF visited her community for
the first time in 2010, the community chief told the counselors about
the work she had been doing to help people with HIV, and soon after she
was asked to be an adviser for the organization, talking to community
people about her experiences.
“I talked to women and encouraged them to perform the test on their
children and to start the treatment immediately for those who are
diagnosed positive. I also talked about the precautions to be taken
during treatment, both for them and for the children.” Gumbi says that
even after a person discovers he or she is HIV-positive and gets
treatment, she continues her counseling work.
But the lack of information and prejudice remains a major barrier to
treating the disease. In today’s talk, the women argue that often, when
women decide to be tested for HIV, they are abandoned by their husbands,
who expel them from their homes. Consequently, many of them fear taking
the exam or receiving treatment.
Ruth Ndlangamandla is one of the four women who heard Gumbi’s advice
today. Her husband was diagnosed as HIV-positive in November 2005, and
she discovered that she was also positive in 2006 but only began
treatment in 2013.
She says that at first she cried a lot and became depressed. She
could not tell their children that she was sick, because she worried
about what they might think about how she contracted the virus, as HIV
is associated with promiscuity in her society.
“In my heart, I knew that HIV kills, and my biggest fear was to die
and leave my children behind. A few years after diagnosis, I received my
first visit from Busi Gumbi. I remember she talked about her status,
and the way she spoke, it seemed possible to have a normal and healthy
life if I followed the treatment,” she says. In 2013, seven years after
discovering she had the disease, Ruth decided to get treatment.
“Finally, I managed to stop stigmatizing myself, because the stigma
is first internal. Gradually, I began to accept me the way I was, and
now I feel comfortable with being a carrier of the HIV virus,” admits
“The counselor’s job is critical. Being HIV-positive also generates a
very strong bond with the local community. Like any treatment, there
are difficult times. But people think, ‘If the director has been there
and is well, I can too,’ ” says Zwane.