A pandemic of inequality: reflections on AIDS and COVID-19 in the southern African context.

In 2020, COVID-19 started spreading from Wuhan in China to the USA, the UK and Europe and then to the rest of the world. In Africa, the first case of COVID-19 was reported in Egypt on 14 February, while South Africa's first case was identified on 5 March. On 11 March, the World Health Organization declared a pandemic. At the time, it was said that COVID-19 would become the great equaliser because the virus made no distinction between first and third world countries, between the rich and the poor, and nor was it influenced by gender, sexual orientation or race. When someone contracted SARS-CoV-2, no guarantee could be given that the patient would survive, regardless of who they were or their status in the community.This stood in contrast to the early experience of AIDS before antiretrovirals existed and when HIV was spreading like wildfire in sub-Saharan Africa and other countries with low or lower-middle-income status. It seemed as if these countries were doubly cursed - by poverty and the AIDS pandemic that was causing as many as 6 000 mortalities per day in sub-Saharan Africa. This led to the South African president at the time, Thabo Mbeki, to assert that poverty was an even greater problem than HIV and AIDS.It did not take long to see that COVID-19 was not the anticipated equaliser. As lockdowns were enforced within most countries across the globe and resulting in economic slumps, differences between rich and poorer countries and their respective citizens were thrown into sharp relief once again. This article reports how both AIDS and COVID-19 adversely affected women, the impoverished and those without access to sustainable souces of food and medicine.

AIDS and COVID-19 in southern Africa.

By the end of the first year of the COVID-19 pandemic, in February 2021, the numbers of cases and deaths in southern Africa were low in absolute and relative numbers. The BBC ran a story (which was later retracted) headlined "Coronavirus in Africa: Could poverty explain mystery of low death rate?". A heading in the New York Post said: "Scientists can't explain puzzling lack of coronavirus outbreaks in Africa". Journalist Karen Attiah concluded: "It's almost as if they are disappointed that Africans aren't dying en masse and countries are not collapsing". We wondered if the knowledge that southern African countries have acquired in their struggle against AIDS has contributed to a more effective approach against COVID-19. The viral origins of the diseases through zoonotic events are similar; neither has a cure, yet. In both diseases, behaviour change is an important prevention tool, and there are specific groups that are more vulnerable to infection. Equally, there are important differences: most people with COVID-19 will recover relatively quickly, while people living with HIV will need lifelong treatment. COVID-19 is extremely infectious, while HIV is less easily transmitted.

"We Smoke the Same Pipe": Religion and Community Home-Based Care for PLWH in Rural Swaziland.

We draw on a study of a church-run community home-based care organization in Swaziland to explore how individuals living with HIV perceived caregivers' impact on well-being. Our primary concern was to examine how religion, as a heuristic practice of Christian-based caregiving, was felt to be consequential in a direly underserved region. Part of a larger medical anthropological project, we conducted semi-structured interviews with 79 community home-based care clients, of whom half (53%) said they would have died, some from suicide, without its services. We utilized a critical phenomenological approach to interpret semantic and latent themes, and explicated these themes within a 'healthworld' framework. Participants were resolute that caregivers be Christian, less for ideological positioning than for perceived ontological sameness and ascribed traits: "telling the truth" about treatment, confidentiality, and an ethos of unconditional love that restored clients' desire to live and adhere to treatment. Findings are intended to help theorize phenomenological meanings of care, morality, health, and sickness, and to interrogate authoritative biomedically based rationalities that underwrite most HIV-related global health policy.

Reckoning HIV/AIDS care: A longitudinal study of community home-based caregivers and clients in Swaziland.

The article is a descriptive case study of a community home-based care (CHBC) organisation in Swaziland that depicts the convergence of CHBC expansion with substantially improved health outcomes. Comprised of 993 care supporters who tend to 3 839 clients in 37 communities across southern Swaziland, Shiselweni Home-based Care (SHBC) is illustrative of many resource-limited communities throughout Africa that have mobilised, at varying degrees of formality, to address the individual and household suffering associated with HIV/AIDS. To better understand the potential significance of global and national health policy/programming reliance on community health workers (task shifting), we analysed longitudinal data on both care supporter and client cohorts from 2008 to 2013. Most CHBC studies report data from only one cohort. Foremost, our analysis demonstrated a dramatic decline (71.4%) among SHBC clients in overall mortality from 32.2% to 9.2% between 2008 and 2013. Although the study was not designed to establish statistical significance or causality between SHBC expansion and health impact, our findings detail a compelling convergence among CHBC, improved HIV health practices, and declines in client mortality. Our analysis indicated (1) the potential contributions of community health workers to individual and community wellbeing, (2) the challenges of task-shifting agendas, above all comprehensive support of community health workers/care supporters, and (3) the importance of data collection to monitor and strengthen the critical health services assigned to CHBC. Detailed study of CHBC operations and practices is helpful also for advancing government and donor HIV/AIDS strategies, especially with respect to health services decentralisation, in Swaziland and similarly profiled settings.

Reckoning HIV/AIDS care: A longitudinal study of community home-based caregivers and clients in Swaziland

The article is a descriptive case study of a community home-based care (CHBC) organisation in Swaziland that depicts the convergence of CHBC expansion with substantially improved health outcomes. Comprised of 993 care supporters who tend to 3 839 clients in 37 communities across southern Swaziland; Shiselweni Home-based Care (SHBC) is illustrative of many resource-limited communities throughout Africa that have mobilised; at varying degrees of formality; to address the individual and household suffering associated with HIV/AIDS. To better understand the potential significance of global and national health policy/programming reliance on community health workers (task shifting); we analysed longitudinal data on both care supporter and client cohorts from 2008 to 2013. Most CHBC studies report data from only one cohort. Foremost; our analysis demonstrated a dramatic decline (71.4%) among SHBC clients in overall mortality from 32.2% to 9.2% between 2008 and 2013. Although the study was not designed to establish statistical significance or causality between SHBC expansion and health impact; our findings detail a compelling convergence among CHBC; improved HIV health practices; and declines in client mortality. Our analysis indicated (1) the potential contributions of community health workers to individual and community wellbeing; (2) the challenges of task-shifting agendas; above all comprehensive support of community health workers/care supporters; and (3) the importance of data collection to monitor and strengthen the critical health services assigned to CHBC. Detailed study of CHBC operations and practices is helpful also for advancing government and donor HIV/AIDS strategies; especially with respect to health services decentralisation; in Swaziland and similarly profiled settings

Addressing the spiritual needs of people infected with and affected by HIV and AIDS in Swaziland.

Researchers seem to be in agreement that spirituality is an important component of the holistic care approach commonly found in palliative care. Shiselweni Home-Based Care (SHBC) is a faith-based organization in Swaziland working among people with HIV and AIDS in the poorest and most affected areas of the country. They endeavor to restore and build up each client's dignity through the way in which they are approached, not only when giving physical assistance, but also when they address their spiritual needs. This article emphasizes the need for spiritual care as part of the caregiving program and then also illustrates the positive feelings of both the SHBC caregivers as well as their clients as they share some of the experiences encountered during spiritual care.

Free love: a case study of church-run home-based caregivers in a high vulnerability setting.

The purpose of this study is to explore the concept of religious health assets (RHA) and its relevance to HIV/AIDS. This manuscript describes the experiences of caregivers with a church-run home-based care organisation in Swaziland, site of the world's highest HIV prevalence (42%). In light of reduced antiretroviral treatment rollout in some areas of Africa, strengthening mechanisms of treatment support with HIV prevention has never been more critical. One modality may be community home-based care (CHBC), a core feature of the World Bank's Multi-Country HIV/AIDS Program for Africa. Yet, these entities, and the frontline activities of local congregations, remain underexplored. Part of a larger anthropological study of religion and HIV/AIDS in Swaziland, this manuscript draws on 20 semi-structured caregiver interviews to discern patterns in motivations; perceived client needs; care practices; and meanings of religiosity. Thirteen participants were care coordinators who oversaw approximately 455 caregivers across nearly half of the 22 communities served. Grounded theory analysis suggested that caregivers facilitated vital decisions around HIV testing, HIV disclosure, treatment uptake/adherence, as well as reduced HIV stigma. Also salient was the importance of a Christian ethos, in the form of 'talk' and 'love', as critical culturally situated care practices. Having expanded to an estimated 600 caregivers and 2500 home-based clients between 2006 and 2009, Participants' reports intimated their roles as agents of broader social transformation. This article contributes to the expanding study of RHA and challenges authoritative global public health strategies that have largely marginalised local religious aspects of HIV/AIDS. Future applied research examining how 'home' and 'church' may be vital public health settings outside of, but integral to, formal health services and HIV programming is warranted.