Instructions

CASE STUDY 24.1: A NURSE’S STORY: PHOPHO SURVIVED HIV/AIDS IN THE KINGDOM OF ESWATINI

Case Study

I was diagnosed with HIV in 1990 when the disease was rampant, and people were frightened and dying. The annual death rate was about 348,600 internationally, and in Eswatini, it was around 7,000 deaths per year. At that time, there was no ART in Eswatini, and people across the world did not know much about this disease. Being diagnosed with HIV was like a life sentence. Things were complicated, especially for women. Unfortunately, my in-laws disowned me because of my HIV status; however, my husband stuck with me and continued his support. In Eswatini, if the woman discovers that she is infected with HIV before the man, the common belief among people is that the woman is the transmitter of the virus. She is the one who brings the devastating killer into the family and contaminates the polygamous circle of wives and her husband. But my husband was the first to be diagnosed with the disease, and he infected me as a result of his sexual activities with other women. We discovered around the same time that we were infected with HIV. Despite these overwhelming circumstances, my goal was to survive, live, and see my two children grow up and become active citizens in Eswatini. We stayed with my husband, their father.

I was in denial about this disease for several years, but I eventually accepted my status and began an active self-care plan. Because my marital family disowned me, I avoided my in-laws but disclosed my health status to my family and close friends. A balanced diet and exercise became a priority. I joined a support network, the Swaziland AIDS Support Organization (SASO), sponsored by the federal government through the Ministry of Health. In addition, I participated in other health-related groups in the community. The groups provided information and support and stressed coping skills and the use of available resources. To avoid reinfection, I used condoms during sexual activities. When I was not feeling well, I sought medical attention and received flu medications, oral rehydration salts for diarrhea, and other remedies.

After 2002, I could not receive ART because my CD4 count was considered to be too high. When the count requirement changed to 350/cell/mm3 by the government, some 19 years later (2009), I began the therapy—and, fortunately, by this time, the drugs were available to many more people in the Kingdom. The government provided the medications with support from the Global Fund, an international organization supporting treatments for HIV/AIDS, tuberculosis, malaria, and other diseases.

Over time, my progress was remarkable. Finally, however, I became critically ill and was admitted to the hospital in 2011 with a fungal infection in the brain. The disease caused right-sided paralysis. During this admission, I was diagnosed with AIDS as my CD4 cell count was 3 cells/mm3. I am grateful to be alive today. The cause of this life-threatening condition and hospitalization was “treatment failure.” Although I was religiously taking the ART medications (e.g., tenofovir, lamivudine, efavirenz), I got sick. While in the hospital, I began the second line of treatment and began to heal.

After years of treatment, I sometimes experience neuropathy in the lower extremities, but I can live with this condition. I have also been treated for tuberculosis in the neck glands and survived. Tuberculosis remains a common opportunistic disease among people living with HIV in the Kingdom. I am doing well. I am alive!

Discussion Questions:

1. Identify three issues that have contributed to HIV/AIDS spread in the Kingdom of Eswatini that are related to cultural practices, economic challenges, and geographic locale.

2. Create a plan of care that addresses the reduction of HIV and AIDS among women.

A. Detail culture-specific approaches for gender-congruent comprehensive care.

B. Identify your stakeholders for the plan to address the reduction of HIV and AIDS and your strategies to engage them.

3. Delineate the characteristics of the health system in the Kingdom of Eswatini and discuss and analyze recent policies/interventions—implemented by the government, nongovernmental agencies, and others—that have aided in the reduction and elimination of HIV and AIDS.

A. Discuss their effectiveness.

B. Discuss the challenges that impact their effectiveness

4. In your advanced nursing role, identify opportunities for advocacy and improvement in addressing global population health issues.