Aid group trains Swaziland laymen to fight AIDS

Nurses are taking on doctors' roles and community leaders are receiving rudimentary medical training to fight AIDS in Swaziland, a tiny kingdom with the world's highest incidence of HIV, an international medical aid group said Wednesday.

Doctors Without Borders said in a report that a "dire shortage" of health professionals prompted them to implement a plan using lesser-trained workers to treat the disease.

The aid group's project began in 2007 and has succeeded in reducing patients' need to make long, expensive trips to health facilities in Swaziland. Community workers are performing HIV tests and providing counseling in 21 health facilities in Shiselweni, the country's poorest and most remote region with the highest number of HIV cases.

HIV patients there can select a community member to supervise their treatment at or near home.

Shiselweni resident Nikiwe Mahlaba said her sister-in-law, trained by the group, administers her anti-retroviral drugs and monitors her medication at home. The program is important because community workers are close to patients, she said.

Girley Nyabeze, a nurse in the Shiselweni region, said the new program has shifted small tasks traditionally completed by nurses to community health workers, allowing her to do doctors' work.

"Patients are diagnosed early and also access treatment early," she said.

This decentralized health care model has been successfully replicated in two parts of South Africa, with outcomes of community health workers similar to outcomes of doctors, said Catherine Tomlinson, senior researcher at Treatment Action Campaign, a Cape Town, South Africa-based advocacy group for people living with HIV.

"It's a necessary policy in order to reach the number of people in the region given the shortage of human resources in the public sector," she said. The AIDS group has long advocated for community-based health workers.

The medical group, which is also known by its French acronym MSF, said vacancies in the health field are dire. In Wednesday's report, they cited statistics from 2004 in which they said 44 percent of posts for doctors, 19 percent of posts for nurses and 17 percent of nursing assistant posts were unfilled.

MSF said life expectancy in Swaziland, wedged between South Africa and Mozambique, has dropped from 60 to 31 in the past 20 years because of AIDS.


Associated Press writer Jenny Gross in Johannesburg contributed to this report.