HIV self-testing now available in Shiselweni

Date: 
22 June 2017

HIV self-testing now available in Shiselweni

I grew up in the early years when Swazi TV was the station of choice. The programming offered different series that kept you glued on the screen. For our young impressionable minds, there was: The Muppet Show, Popeye the Sailor Man, Doctor Who, etc. There was Dynasty, Dallas, The Professionals, Space 1999, and Starsky and Hutch for adults. The Sunday menu had American televangelist, Jimmy Lee Swaggart, whose telecast was transmitted to over 3, 000 stations and cable networks each week. The station screened “Football Made in Germany”, and in later years provided “The Road to Wembley”. We hid under the sofas to catch a glimpse of The Benny Hill Show or Return to Eden, when adult viewing was enforced and we were sent to bed.

Even with such programmes, the news bulletin remained the reason we had a running TV set in the house. On return from work, my father would ease into “his seat” and call out for one of us children, to come and read the newspaper to him. He took pride in correcting one’s pronunciation of the Queen’s language and would proudly state that the “Royal English” he had learnt in his formative years, was superior than what we were being taught in school. These sessions would be interrupted only by the start of the news bulletin on TV. During the news, you could hear a pin drop as no one dared cough.

The early experience left a lasting impression on me. To this day, I spend my last coins buying newspapers. I make regular time for television and even though the Swazi TV programming has deteriorated badly, I religiously watch their news bulletin - which I must add, has a very predictable order. It starts with Royal assignments, then the Prime minister’s diary, followed by Cabinet Ministers’ business, and then anything else goes. My agonizing news watching habit (I forever mumble about the quality or lack of) rubs many the wrong way because regardless of what anyone may have been watching, the reality is that at 7pm, Swazi TV rules. It is not surprising therefore, that by the time the weather forecast is completed, some itchy hands are already on the TV remote.

Surprising life lesson from soapy

As the unwritten rule is that from 7:30 pm to 9.30 pm, the Mzansi Magic bosses the TV screen, the hand holding the remote quickly tunes into 161, immediately the news end. Quite often, during this time I find a distraction but other times I sit and watch what the South African shows offer.

Recently, I watched the latest Manzi telenovela dubbed, Isithembiso. The show follows the lives of two young people (Sim’lindile and Zamani) who go to Johannesburg (The City of Gold) in search of their fortunes, familial ties, opportunity and education. The millennial migrant story digs deep into the lives of South African youth today, their ambitions, choices and the consequences of these choices. Central to the young people’s story, is one Banzi Montaung (played by Hamilton Dlamini), a notorious business man, whose “Sheep skin’ fools many, including the gullible Sim’lindile.

The episode that I recently saw, held my attention from the start. It showed an agitated woman that I learnt was Banzi’s wife, who had recently found out about her husband’s infidelity and was unsurprisingly, concerned about her health. She was especially worried about her exposure to HIV infection. To allay her fears, she decided on taking an HIV test. To my surprise and joy, she chose to do an HIV self-test - a process whereby a person who wants to know his/her HIV status collects a specimen, performs a test and interprets the test result in private. Much to her relief, it showed that there was no presence of HIV-1/2 antibodies or HIV-1 p24 antigen.  

She knew however that hers was just one part. Her husband also had to take an HIV test to determine if he had not contracted HIV. To facilitate that he did, she brought home a self-test kit for him to screen himself. However, Banzi was not ready for this. His posture went into resistance mode and you could see the resentment of his wife’s suggestion, burning in his eyes. As it happens with most TV couples, the result was the wife asking Banzi to move out of their bedroom and not return until he had taken the HIV test, and disclosed the result to her. As Banzi blankly stared at the HIV self-test kit, the credit rolled up, signaling the end of the episode.

The episode bowled me over and I wished the whole Swazi nation had been watching with me. We often dismiss much of what we see on TV as polluting young people’s minds, but the scripting of HIV testing, especially the use of HIV self-testing (HIVST), into the story line, provided much needed health education. In less than thirty minutes, the telenovela had broached an important social issue and provided the basis for discussion on HIV testing and the different available options. It emphasized the importance of HIVST as part of the “love test”. Further, it brought to the fore, the potential of HIVST contributing to an increase in the number of people who have access to testing, who know their HIV status, are diagnosed and initiate treatment. It also raised the importance of timing and presentation needed to convince a partner to take an HIV test.

HIVST now available in Swaziland

Last Thursday I was at Eqinisweni Primary School, where the 2017 Day of the African Child was commemorated. The event provided an opportunity to network and I grabbed it and visited the various information stalls present. Imagine my surprise then, when I got to the Doctors Without Borders (MSF) information stall to find them actively promoting the use of the HIVST kits. Some may be aware that HIVST kits are already available in the country informally in some shops, but seeing the MSF team freely promoting HIVST, meant the kits were now formally available. Unfortunately, the HIVST kits are only available in the Shiselweni region, in selected facilities and communities that the Ministry of Health through MSF is piloting the HIVST project.

With the knowledge of HIV status at 76% in Shiselweni in 2014, the start of the HIVST pilot project in the region indicates political commitment to bridging the testing gap (with signs of stagnation in uptake of HIV testing services starting to show) and reaching the 90.90.90 targets. The pilot project itself, will provide a learning opportunity for the health system and its delivery in the community, and has the potential to improve the health of the Swazi people. On the other hand, MSF is well established In the Shiselweni region. It targets all people (including key populations) and provides various services, including prevention of mother-to-child transmission (PMTCT B+), Pre-ART, ART, TB and HIV testing services. Further, MSF supports all the Tinkhundla in the region, offering community ART and community TB treatment. This makes them the ideal partner for government to use as a vehicle for piloting HIVST.

The HIVST pilot project is targeting everyone above 16 years of age, with unknown HIV status, living in the Shiselweni region. Key to the uptake of this model of testing will be the targeting of specific communities (at facility and community level) with the aim of sensitizing and engaging community members about its benefits. Specific populations, including adolescents, factory and seasonal workers, miners, will be targeted. There will also be programmes for key populations including sex workers and men who have sex with men. The key principle to be followed is that of consent, confidentiality, information / counseling, convenience, and connection to care.

Potential benefits and challenges of HIVST

Potential benefits include increasing access to testing; earlier diagnosis for people who do not have routine contact with health services where HIV testing is offered; and greater convenience, autonomy and privacy for test users, some of which are currently not using HIV testing and counseling approaches. These include men who have sex with men, transgender people, people who inject drugs, sex workers, health workers and general populations like couples or partners, serodiscordant partners, frequent re-testers and adolescents. Research suggests that HIVST may reduce sexual risk behavior, increase testing frequency as well as facilitate disclosure within couples or partners, and complement existing HIV testing and counseling and public health strategies to reduce the risk of exposure to and transmission of HIV.

On the hindsight, there is need to guard against human rights violations from the misuse of HIVST, violence or self-harm.  There should be concern with operational issues such as the sensitivity and specificity of rapid diagnostic tests in the hands of untrained or non-proficient users, risk of operator error, testing in the window period, misinterpretation of results, and linkage to care. There are also ethical, legal and social concerns, including potentially increased risks of inter-partner violence or coercive testing, for vulnerable populations. It is comforting however, that the World Health Organization (WHO) provides clear guidance on the critical requirements for all forms of HIV testing, including the guidance that all testing must be voluntary. Mandatory or coerced HIV testing, including self-testing, is never warranted.

 

The project will weigh the potential benefits and risks related to introducing and scaling up HIVST countrywide. If you live in the Shiselweni region and do not know your HIV status, an HIV self-test kit is available to you through MSF.