MBABANE, Swaziland — At the military medical clinic in Swaziland’s capital city, Swazi soldiers often have to do the work of doctors.

A doctor from China used to work there, but he took a trip home a few months ago and hasn’t returned.

“We don’t know if he’s coming back,” said Patrick Kunene, who manages the U.S. Defense Department’s HIV prevention program in Swaziland. “That’s what we need most. We need a doctor.”

Nestled between South Africa and Mozambique, Swaziland is a country ravaged by AIDS. With an estimated 39 percent of the adult population infected by HIV/AIDS, according to the World Health Organization, the New Jersey-sized nation has the highest HIV rate in the world.

But it has no medical school, insufficient medical facilities and a shortage of doctors.

At the Phocweni Clinic, U.S. Defense Department funds are being used to train Swazi military medical staff and provide equipment for testing. But doctors are in short supply.

“The short staffing is a challenge for us. Another challenge is, we need more facilities,” said Lt. Banele Dlamini, a Swazi army nurse who works with HIV patients.

The clinic sees about 50 patients a day, with more than half coming from the civilian population, a common occurrence on the continent, Dlamini said.

The clinic’s services are free and include access to anti-retroviral drugs provided through the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The Defense Department’s HIV/AIDS program has dedicated $1.1 million to the efforts in Swaziland. It also invests in other initiatives across Africa. So far, prevention messages have been delivered to 575,000 African troops and family members; 160,000 soldiers have been tested for HIV and 73 labs have received equipment.

The DOD program is expected to deliver a doctor later this year to the short-staffed Swaziland clinic.

But it is an uphill struggle to curb the country’s HIV infection rates, which show no signs of decline, said Col. Schuyler Geller, command surgeon for U.S. Africa Command.

“You’ve got to break this cycle somehow. You’ve got to stop the transmission,” Geller said on a recent trip to the country. Preaching “abstinence and monogamy isn’t the best way to go. You’re running up against culture in some respects.”

In a place where there is a history rooted in polygamy, concepts about relationships are different, he said. The message needs to be about prevention through condom use, Geller said.

“It’s the only way in Swaziland,” he said.

At the military clinic in Mbabane, peer-to-peer counseling programs are now being conducted regularly in the hope of getting troops to protect themselves.

“Because we’re doing this focus on prevention, they’re getting more comfortable getting tested,” said Pvt. Xolile Mbingo, whose full-time job is to counsel soldiers, family members and civilians who visit the clinic.

“Sometimes you feel depressed. The people have many problems,” said Mbingo.

Gen. William “Kip” Ward, commander of U.S. Africa Command, toured the modest-looking clinic with Geller and others.

As he walked through the rooms, Ward wanted to know if the counseling was making a difference.

“Do they understand it and appreciate what’s being said?” Ward asked Mbingo. “Do you sense that they’re changing their behavior to stay well?”

Mbingo told the general she thought they were making a difference.

During a stop in the clinic’s humble laboratory, Ward noticed some equipment donated by DOD.

“There aren’t so many laboratories in this part of the world,” John Kunene, the top health official for the Swaziland Ministry of Defense, told the general.

Dlamini said more people are becoming aware of the risks of unprotected sex, but people still wait too long to find out if they are HIV-positive.

“People come when they feel sick,” he said.

The HIV rates and medical limitations affect the country’s military force, Geller said. While HIV tests are required upon entering the Swazi military, follow-up testing is voluntary.

Because of a lack of standardized and well-analyzed data, it is unclear how many of Swaziland’s military members are HIV-positive, Geller said.

“Getting data is the first thing. Knowing what to do with it is the second,” Geller said.

HIV/AIDS in Swaziland

With an estimated 39 percent of the adult population infected by HIV/AIDS, according to the World Health Organization, the New Jersey-sized nation has the highest HIV rate in the world.

At the military clinic in Mbabane, peer-to-peer counseling programs are now being conducted regularly in the hope of getting troops to protect themselves.

Because of a lack of standardized and well-analyzed data, it is unclear how many of Swaziland’s military members are HIV-positive, said Col. Schuyler Geller, command surgeon for U.S. Africa Command.