Increased Antiretroviral Access Needed In Swaziland, Health Officials Say

Revised UNAIDS projections indicating that twice as many HIV-positive people living in Swaziland are in need of antitretroviral treatment than previously thought underscore the need for the government to take increased measures to expand treatment in the country, IRIN/PlusNews reports. UNAIDS used a new model to estimate that 62,000 people are in need of antiretrovirals -- almost twice the previous figure of 34,000. The new projection widely is considered to be accurate because of the country's HIV/AIDS prevalence rate of 26%, according to IRIN/PlusNews. However, the "new numbers will require the Health Ministry and nongovernmental organizations working in the AIDS sector to devise new strategies to rapidly scale up treatment," IRIN/PlusNews reports.

Anthony Nkambule, an HIV/AIDS advocate in Swaziland's Manzini region, said that the "reality is shocking because it shows how far we have to go, immediately, to save lives." Velephi Okello, the antiretroviral therapy coordinator at Swaziland's National AIDS Program, said that their estimates of needed services and distribution systems were based on initial projections, adding, "We are trying to be careful about setting expectations, but there's no doubt the [antiretroviral] rollout must be accelerated."

Hannie Dlamini -- founder of the Swaziland AIDS Support Organization, the country's first group for people living with HIV/AIDS -- said that the government's treatment program already appears to be under strain, adding, "There is a shortage of [antiretrovirals] from time to time from bottlenecks in the distribution system. People's schedules for taking the drugs are thrown off, and this can make the drugs ineffective for them." The government hospital in Mbabane, which serves as a main antiretroviral distribution point, periodically runs out of the drugs, according to Dlamini and local press reports.

IRIN/PlusNews reports that 8,000 HIV-positive people last year dropped out of Swaziland's treatment program -- almost one-quarter of all patients receiving therapy. A health ministry survey revealed that a lack of antiretroviral distribution centers and inadequate counseling are some of the primary reasons that patients do not adhere to regimens, IRIN/PlusNews reports. Okello said that a main reason often given by HIV-positive people for defaulting on treatment is a lack of transportation to hospitals. As a result, efforts to decentralize drug distribution from a few provincial hospitals to 196 clinics across the country -- including 15 clinics in Lubombo and eight in Manzini -- have begun. A plan to increase counseling efforts -- which includes a partnership between the government and the Swaziland Network of People Living with HIV/AIDS -- will train people living with the virus who have been on treatment for a long period of time to counsel people initiating therapy about the side effects and importance of treatment adherence.

Health officials estimate that in 2009, more than 200,000 people in Swaziland will be HIV-positive and in need of monitoring (IRIN/PlusNews, 12/3).