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Swaziland: An MSF Doctor Explains HIV-TB Co-Infection
An interview with MSF doctor Hermann Reuter
October 28, 2009
Swaziland 2007 © Alexander Glyadyelov
Doctors Without Borders/Médecins Sans Frontières (MSF) doctor Hermann Reuter works in a tuberculosis (TB) project in a rural district of Swaziland called Shiselweni. MSF is present in 17 clinics and three health centers here and Dr. Reuter rotates between the health centers, where most of TB patients are managed. Here, he explains the situation on the ground.
What do you see at the health centers?
On a daily basis, nurses manage the TB patients and refer the most severely ill to me. The cases I see are usually infected with multi-drug resistant TB, which means they would have already been treated with standard TB drugs without success. Other patients I treat have HIV/AIDS-related complications.
What are the main obstacles facing people with TB or HIV/AIDS here?
As Shiselweni is a rural district, distance is always a huge problem. Patients live on farms away from towns, many of them have to travel for hours to get to a health facility and they can spend their whole monthly earning on just one trip. This is unsustainable for them.
How have HIV/AIDS and TB combined into what is being called a dual epidemic here?
About 83 percent of TB patients in Swaziland are co-infected with HIV. The country has the highest level of HIV infection in the world, affecting one out of four adults. This complicates the clinical picture of TB—diagnosis becomes more difficult and there are more severe side effects to the drugs.
Why is MSF calling for an emergency response to this crisis?
In most of the conflicts or natural disasters where MSF intervenes around the world, the number of people dying is significantly less than what we are seeing today in Swaziland.