HIV prevention and Impact mitigationi) HIV prevention with the youth
Compassionate Swaziland believes that the most effective way of reducing new HIV infections is by empowering young people to have the capacity to make informed choices as relates to sex and sexuality. Young people are disproportionately affected in the HIV pandemic. They face the economic and social impact of HIV/AIDS and they must be at the centre of prevention actions. Where young people are well informed of HIV risks and prevention strategies, they are changing their behaviour in ways that reduce their vulnerability. Compassionate Swaziland promotes education of teenage boys and girls aimed at delayed sexual debut and increased use of condoms resulting in a decrease in HIV prevalence in young people. Compassionate Swaziland works towards programmes that promote healthy adolescent development and provide them with age-appropriate knowledge and tools to make informed choices. Compassionate Swaziland programmes promote behaviour change, reduction of number of sexual partners, abstinence or delay in sexual debut, monogamy, and correct and consistent condom use for those who are sexually active. Compassionate Swaziland work also revolves around young people who are HIV positive as Compassionate believes they need care, treatment and support, as well as sexual and reproductive health services.
Dialogues and community engagement has been Compassionate Swaziland’s strategic approach to initiating change. Compassionate Swaziland works with youth through community and school. Compassionate works closely with school authorities and community leadership to engage teenagers in and out of school on issues around HIV, relationships, sex and sexuality as ways of achieving behaviour change outcomes.
Compassionate Swaziland promotes information discouraging Multiple Concurrent Sexual Partners (MCSP). For those who cannot abstain from sexual activity Compassionate promotes the advantages of one sexual partner among youth as a way of risk reduction.
It’s there therefore Compassionate Swaziland’s conviction that for effective HIV prevention programming in Swaziland young people must be at the centre of planning, implementation, monitoring and evaluation through youth friendly information, life skills development, youth-friendly health services, safe and supportive environment.
Through the support of community based volunteers Compassionate has been able to conduct Sexual and Reproductive Health sessions with parents/guardians aimed at providing them with the skills necessary for HIV and STI prevention. During the sessions the messages are specific to proper and consistent use of condoms, faithfulness to one partner and abstinence.
ii) Promotion of voluntary medical male circumcision among young people
Male circumcision is the surgical removal of the foreskin of the penis. It is one of the oldest and most common surgical procedures worldwide, undertaken for religious, cultural, social, and medical reasons. Approximately 30% of adult men worldwide are circumcised. In sub-Saharan Africa, about two-thirds of men are circumcised.
· To reduce the incidence of HIV infections to help create an AIDS free generation in Swaziland.
· To provide accurate information on male circumcision services.
· Ensure that male circumcision does not replace other known effective HIV prevention methods and is always considered as part of a comprehensive prevention package.
· Ensure that community and individual education programs provide sufficient and correct information on the partial protection provided by male circumcision and the continuing need for other HIV and sexually transmitted infection prevention measures.
iii) Promotion of abstinence among teenagers
Compassionate recognises that early sexual activity is a risk factor for unplanned and teen pregnancy, HIV/sexually transmitted infections, and associated negative health consequences in adolescence and beyond. Some recent studies have found that students who received abstinence education had lower rates of sexual activity compared to youth who did not receive abstinence training.
Compassionate Swaziland works towards public awareness campaign designed to drive provide several categories of information to parents about how to talk with their preteen or teenage children about sex. The information norms among teens, perceived barriers to communication among parents, broader related topics such as parent–child relationship quality and goal setting, establishing rules and expectations about dating and sex, teaching refusal skills, characteristics of healthy relationships, and other topics;
· What to do if the teen has already had sex
· What happens when a girl has been pregnant?
· What if a girl has used contraception and wants to abstain from having sex?
Compassionate Swaziland sets a target annually to teach abstinence from sexual activity for children under age 18
iv) Educating pregnant and teenage mothers LWHA on PMTCT and nutrition.
Compassionate Swaziland recognises that Prevention of Mother to Child Transmission is a complex process that that requires proper information, effective planning and routine follow up. Compassionate works with closely with the relevant government ministries and key stakeholders to provide information on key elements of PMTCT. Compassionate Swaziland targets pregnant teenage mothers and young adult mothers living with HIV/AIDS targeting the following areas;
· Primary prevention of HIV
· Prevention of unintended pregnancy
· Protection of children, and promotion of child survival
Antenatal Care;
Comprehensive antenatal services, group information session on HIV infection and PMTCT, routine offering of counselling and testing (rapid HIV testing). Women who test HIV negative need repeat testing at around 34 weeks, individual post-test counselling, routine CD4 cell count on ALL HIV-positive women, ARVs to prevent mother-to-child transmission of HIV, lifelong ART for mothers with CD4 < 350 OR clinical Stage 3 or 4, AZT from 14 weeks plus single dose NVP during labour and single dose TDF and FTC after delivery
Labour and delivery;
Optimal obstetric practices including:
· Avoid prolonged rupture of membranes
· Avoid assisted instrumental delivery
· Avoid invasive monitoring procedures
· Avoid episiotomy and prematurity
· Only suction the baby’s nose and airway when there is me conium stained liquor
· Wipe the neonate carefully at birth
Postnatal;
· Postnatal infant feeding counselling and support for exclusive breastfeeding or exclusive replacement feeding
· Early initiation of exclusive breastfeeding or exclusive formula feeding
· ARVs to infants to prevent mother-to-child transmission of HIV
· All HIV-exposed infants should receive single dose NVP post-delivery, and then low-dose NVP for six weeks
· Stop at six weeks if mother is on lifelong ART or if baby is not receiving any breast milk
· Otherwise continue NVP for as long as infant is receiving any breast milk
· Early infant testing (PCR testing at six weeks). Refer infant for ART if PCR positive
· Ongoing follow-up care and support for mothers and infants including early initiation of cotrimoxazole
· Family Planning
· Community support services
· Support group counselling and follow-up
Compassionate Swaziland works towards ensuring that pregnant and breast feeding mothers get the right information on the profound importance of good nutrition as pregnant and breastfeeding women with HIV will need:
- Extra food for body functions;
- Extra food for changes in their body and the needs of the growing baby;
- Extra food to replace nutrients lost due to HIV infection; and
- Extra food for growth and development if the mother is adolescent (12-16 years).
Mothers who eat wisely during pregnancy and breastfeeding are likely to:
- Be more healthy and not be ill so often;
- Gain enough weight during pregnancy and breastfeeding;
- Reduce chances of HIV transmission to their babies;
- Have babies with good weight and good health; and
- Feed and care for their babies properly.
v) Treatment literacy to children and parents
Many children continue to take ART continuously without understanding why this is so. Some parents who are on ART confess that they have not been able to explain to their children why they (children on ART) have to take their pills on a daily basis. This has caused many children on ART to default causing serious health challenges and even drug resistance. There is urgent need to develop treatment literacy programmes that target children on ART, their parents, family members and school teachers to provide effective support aimed at ART adherence. There is urgent need to empower parents on ARVs to be able to disclose their HIV status to their children. It’s also important that children LWHA are informed why they have to take ARVs for life.
