Less than a decade ago, people were warning that Swaziland – a country of about 1.3 million – could be wiped off the map, as HIV cut life expectancy to only 45.9 in 2005.
“Every weekend was a funeral,” says health activist Bekhie Sithole.
“My parents died because of Aids-related illnesses – although it was never really stated or proven,” he says, before delivering a training session on HIV risks in the town of Ezulwini, in western Swaziland.
But a push for prevention, tests and, since 2003, anti-retroviral treatment (ART) has slowed the spread of the virus and raised life expectancy to 49, although Swaziland still has the world’s highest HIV rate, with nearly a third of adults infected.
“Things have really improved. Where you used to see people thinning and dying before us – look. You rarely meet a thin person on the street,” says Sithole.
Widespread testing of pregnant women has led to about 90% of positive mothers being put on treatment to prevent transmission to their unborn babies.
“Ninety-eight or 99% of the women are being tested when they’re pregnant and from there they are easily linked to care,” says Nduduzo Dube, a doctor at the Aids Healthcare Foundation in Manzini, Swaziland’s second city.
ART was first given to people whose viral load was high. But Dube hopes a “test and treat” regime that involves giving anyone who tests positive ARTs for life, regardless of their viral load, will help to end the epidemic.
“This is treatment as prevention … Anyone whose viral load is suppressed, transmission drops by 96%,” he says.