Rethinking Swaziland’s                                                                                       here are eigh...
RETHINKING SWAZILAND’S HIV/AIDS EPIDEMIC


estimated to be just 31.3 years – the lowest    Swazis engage in subsistence ag...
RETHINKING SWAZILAND’S HIV/AIDS EPIDEMIC

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Rethinking swaziland's hiv aids epidemic - the need for urgent interventions

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  • I want to thank Dr okoro for the herbal HIV medicine he gave to me and my daughter, i was suffering from HIV when i gave birth to my daughter and that was how my daughter got the sickness indirect from me, but to God be the glory that i am heal with the herbal medicine that Dr.okoro gave to me when i contacted him. i want to use this medium to tell everyone that the solution to our sickness has come, so i will like you to contact this great healer on his email address:Drokorotemple@gmail.com with him all your pains will be gone, i am really happy today that i and my daughter are cured of HIV, we are now hiv negative after the use of his medicine,my doctor confirm it. once more i say a big thank to you Dr okoro for healing hands upon my life and my daughter, i say may God continue to bless you abundantly and give you more power to keep helping those that want your help in their lives. contact him now on his email. :Drokorotemple@gmail.com or call him on his phone number on :+2348051785597,
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  • I was suffering hardship from HIV/AIDS since 9yrs now, and i happen to have 2 kids for my husband, and now we cannot proceed to have another kids all because of my disease and now i have do all what a human like i and my husband can do just to get my disease healed, i have went to several places to seek for help not even one person could ever help, until i melt a comment on the daily news paper that was commented by Miss Marilyn about how this powerful traditional doctor help her get cured of the disease (HIV-AIDS) ' my fellow beloved' i firstly taugh having a help from a spiritual traditional healer was a wrong idea, but i think of these, will i continue to stress on these disease all day when i have someone to help me save my life?' so i gather all my faiths and put in all interest to contact him through his Email address at dr.ihundehivaidscure@gmail.com , so after i have mailed him of helping get my disease cured, i respond to me fast as possible that i should not be afraid, that he is a truthful and powerful doctor which i firstly claimed him to be. So after all set has been done, he promise me that i will be healed but on a condition that i provide him some items and obeyed all his oracle said. I did all by accepting his oracolous fact and only to see that the following week Dr ihunde mail me on my mail box that my work is successfully done with his powers, i was first shocked and later arise to be the happiest woman on earth after i have concluded my final test on the hospital by my doctor that i am now HIV- Negative. My papers for check are with me and now i am happy and glad for his miraculous help and power.
    With these i must to everyone who might seek for any help, either for HIV cure or much more to contact him now at these following email now,
    Email:dr.ihundehivaidscure@yahoo.com
    ' sir thank you so much for your immediate cure of my disease, i must say for curing my disease, i owe you in return. Thanks and be blessed sir.
    My name is Jane wembli
    His Email address is:
    dr.ihundehivaidscure@yahoo.com
    hello world,what should i have done if not for the herbal medicine of Dr ihunde? this man come to my rescue me at my point of death where i think that all hope is gone and lost, i saw the advert of this man on the internet share by a man on how he cure his hiv sickness and at first i thought it was a joke and scam cause i thought there is no cure for this sickness cause i have use drugs that was give me in the hospital but it could not solve it, so my little cousin convince me to contact him and give him a trial if he can help me solve my problems, i obey my cousin and contact Dr ihunde, he told me what to do and i kindly did it, after some time i notice positive changes on my body system, after taking the herbal medicine for two months i went for check up my Doctor told me that i am now negative, i strongly believe that is God that is using this man to cure this deadly disease, i want you to contact this man on his email address with full hope and confident by clicking his email address:dr.ihundehivaidscure@gmail.com once more i say a very big thanks to Dr ihunde for curing my hiv sickness
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Rethinking swaziland's hiv aids epidemic - the need for urgent interventions

  1. 1. Rethinking Swaziland’s here are eight ‘Red Countries’* in HIV/AIDS Epidemic T southern Africa, so called because they are shaded dark red on UNAIDS prevalence maps. They represent the epicentre of the HIV/AIDS pandemic. The Need for Urgent Interventions Swaziland has the highest prevalence.1 This epidemic has been characterized by the slow onset of a myriad of co-factors Scott Naysmith, MSc1 that have culminated to create a complex Alan Whiteside, DPhil2 emergency. Rising morbidity and mortali- Amy Whalley, MSc3 ty mean that every sector of Swazi society is struggling to cope. Swaziland is losing large numbers of the most socially and economically active members of its society, ABSTRACT leading to mass orphaning and a decline in agricultural production. This is happening Swaziland’s HIV/AIDS epidemic has been characterized by the slow onset of a myriad of in the context of gender inequality and cli- co-factors culminating in a chronic emergency, burdening every sector of society. mate change, especially drought. Exacerbated by domestic political mismanagement and ill-suited policies of international Paradoxically, Swaziland is classified as a organizations, impacts will remain endemic for generations. lower-middle income country, which means it cannot access certain forms of From near-zero diagnosed HIV infections in 1990, Swaziland now has the highest relative donor support. prevalence in the world. The impacts of infection are withering the human capacity to The challenges of responding to the cri- mount effective and systemic interventions. Indicators of social well-being show a sis are exacerbated by the lack of account- population in distress. Aggravated by gender inequality, drought, agricultural decline and able domestic governance and ill-suited insufficient financial resources, livelihood failure in Swazi households has become policies of international organizations. commonplace – and the situation is deteriorating. Without greater support from the govern- ment and international donors, innovative This article argues that the brutal reality facing the Swazi population is perpetuated by the community-led interventions may be seri- lack of political will of government and conditionalities imposed by international donors. ously undermined. 2 Swaziland’s In the absence of comprehensive government-led programming, many communities have HIV/AIDS epidemic is currently the most initiated interventions. Assisting these vulnerable populations requires sustained advanced in the world; we posit that it international financial commitments. This money would be used to best effect if may be a harbinger for what awaits the accompanied by pressure for domestic political accountability in Swaziland. Such changes other Red Countries. will facilitate country-wide interventions, particularly those at the community level. While The first case of AIDS in Swaziland was Swaziland is the case study, many of the findings are applicable to generalized epidemics diagnosed in 1986. In 1992, when the throughout southern Africa. country’s first antenatal survey was carried out, HIV prevalence among pregnant Key words: HIV/AIDS; Swaziland; humanitarian emergency; international aid; disease women attending antenatal clinics was burden; gender inequality; Southern Africa found to be 3.9%. By 2004, just 14 years later, antenatal prevalence had jumped to an astonishing 42.6%. Overall prevalence in the country is currently estimated near 19%, 3 a figure which, if applied to American and Canadian populations, would mean that more than 56 million Americans and over 6 million Canadians would be HIV-positive.† The increase in mortality has already had measurable and dramatic effects. In 1998, the UN estimated life expectancy in La traduction du résumé se trouve à la fin de l’article. Swaziland at 60 years. In 2004, after tak- 1. Visiting Research Fellow at the Health Economics and HIV/AIDS Research Division, University of ing AIDS into account, life expectancy was KwaZulu-Natal, Durban, South Africa 2. Director of Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, * The ‘Red Countries’ are: Swaziland, Lesotho, Durban, South Africa South Africa, Namibia, Botswana, Zambia, 3. Private consultant Zimbabwe and Mozambique. Correspondence and reprint requests: Scott Naysmith, University of KwaZulu-Natal, J Block, † Based on a prevalence of 18.8% and a population 4th Floor, Westville Campus, Durban 4041 South Africa, Tel: +27 31 260 2592, Fax: +27 31 260 2587, of 301,140,000 in the USA and 32,000,000 in E-mail: naysmiths@ukzn.ac.za Canada. S8 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 99, SUPPLÉMENT 1
  2. 2. RETHINKING SWAZILAND’S HIV/AIDS EPIDEMIC estimated to be just 31.3 years – the lowest Swazis engage in subsistence agriculture,11 International Development Assistance in the world. 4 Government population this is having devastating effects on the (IDA) loans. Some bilateral donors, such projections in 1986 estimated the popula- majority of the people. Malnutrition as the UK’s Department for International tion would grow from about 900,000 in increases the transmissibility of HIV, has- Development (DFID), use these catego- 1986 to 1,203,000 by 2006.5 The 1997 tens the onset of AIDS, and makes individ- rizations to guide their allocation of for- population census recorded 929,718 peo- uals more susceptible to opportunistic eign aid. These ratings are based on a ple in Swaziland. A preliminary result of infections. In 2007, roughly 40% of Swazis country’s Gross National Income (GNI) the 2007 census indicates the population required food aid, yet the government per capita – the total national income has declined to 912,229. 6 Although recently decided to cultivate cassava for divided by the population. As mortality Swaziland is faced with poverty, malnutri- bio-fuel production.12 from AIDS increases, Swaziland’s national tion and drought, AIDS deaths are central Many of the government’s actions con- wealth is divided among fewer Swazis. to understanding this reversal. tinue to be out of sync with the reality Consequently, AIDS deaths may be lead- One consequence of premature adult experienced by the majority of Swazis. The ing to an increase in Swaziland’s GNI per death is the growing number of orphans suppression of trade unions from public capita. We argue that GNI per capita and vulnerable children (OVC). There are assembly13 shows that Swazis are more sub- should not be the measure used to assign an estimated 120,000 OVC in Swaziland, jects than citizens. The 2006 constitution international assistance in the Red a number projected to rise to 200,000 by reaffirms that executive, legislative, and Countries because it is not reflective of 2010.7 Grandparents have largely assumed judiciary authority rest with King Mswati social and structural realities. the role of primary caregivers. As they die, III, who has ruled Swaziland since 1986. Compounding these misleading catego- many of these children are left without In terms of political freedom and civil lib- rizations, the IMF insists that public sector support networks. This threatens inter- erties, Swaziland is on par with Sudan and expenditure be cut and the public service generational transfers of knowledge sur- Zimbabwe.14 Engaged, accountable domes- be reduced in size18 – this at a time when rounding work and family values, and tic leadership is essential for implementing additional human capacity is needed to increases vulnerability to external shocks. holistic interventions to contain the spread respond to the crisis. As the largest Regrettably, the harsh circumstances and impact of HIV/AIDS. It will be employer in Swaziland, the public sector is afflicting a third of Swazi children have increasingly difficult to reverse the deterio- both financially responsible for many come to be seen as normal and inevitable8 rating conditions in Swaziland without dependants and essential to implementing – an abnormal normality reflecting a des- basic human rights of political representa- alleviation efforts. Cutting the public sec- perate society. tion and gender equality. tor could have long-term negative ramifica- Women too suffer disproportionately. Mortality figures now exceed the thresh- tions for Swaziland’s development. Females in Swaziland are economically and olds used by humanitarian agencies to The absence of sustained financial and politically marginalized. They also shoul- determine when a population requires institutional support has not resulted in a der the burden of the epidemic and are immediate emergency interventions. In total absence of action in Swaziland. Despite more vulnerable to infection. Of females every region in Swaziland, the crude mor- inadequate resources, some community-led aged 25-29, 49% are HIV-positive, com- tality rate has exceeded the threshold of initiatives, facilitated in part by the pared to 28% of males in the same cohort.3 1 death per 10,000 persons per day.15 In National Emergency Response Council on The feminization of the epidemic is a the context of development indicators, the HIV/AIDS (NERCHA), are reaching vul- reflection of the low status of women. In Human Development Index rating for nerable populations.2 KaGogo centres, tra- Swaziland, women were only granted full Swaziland shows a steady decline since ditionally used as a place for resolving dis- legal rights in 2006.9 A recent national sur- 2000. From a ranking of 112 among 174 putes, have been transformed into coordi- vey on violence experienced by female chil- countries in 2000,16 Swaziland has fallen to nating centres for wider community inter- dren and youths in Swaziland found that, 141 out of 177 countries in 2007. 17 ventions such as food distribution and of respondents, nearly 66% of females aged Indicators of social well-being clearly assert orphan registration and care. Providing 18-24 had experienced sexual violence and that Swaziland is experiencing an emer- sponsorship to orphans and vulnerable approximately two thirds of 13-24 year old gency – a national disaster driven by individuals for schooling, food and cloth- Swazi females reported being coerced or HIV/AIDS. Shockingly, this has not set off ing costs, the “Young Heroes” initiative forced into their first sexual experience.10 alarm bells in the international community. assists children affected by the epidemic. Despite their marginal status, females are The politics of aid have restricted the Another innovative response has been the the primary caregivers of both children and external funding that is available to revitalization of the Indlunkhulu fields, a the sick. When they die from AIDS, cop- Swaziland, and consequently international traditional practice where a Chief allocates ing strategies become increasingly desper- assistance has been limited. Swaziland’s land for the community to grow food for ate. rating by the World Bank as a “lower- vulnerable members in the chiefdom. Livelihood failure has become common- middle income” country means that the Community-led initiatives are most effec- place in Swaziland. Consecutive years of Kingdom cannot access the financial tive when supported by domestic and drought, compounded by the incapacita- resources available to “low income” coun- political resources. tion of infected individuals, have led to tries by the International Monetary Fund The most recent UNAIDS report is a falling agricultural production. As 70% of (IMF), including non-concessional welcome flicker of hope in containing the MAY – JUNE 2008 CANADIAN JOURNAL OF PUBLIC HEALTH S9
  3. 3. RETHINKING SWAZILAND’S HIV/AIDS EPIDEMIC (CASP): Final Draft. Mbabane, Swaziland, May global spread of the disease.1 The fact that REFERENCES 2005. world prevalence estimates have been 12. UN Office for the Coordination of 1. UNAIDS. AIDS Epidemic Update 2007. Humanitarian Affairs. Swaziland: Food or scaled down, however, should not encour- Geneva, Switzerland: Joint United Nations Biofuel Seems to be the Question. IRIN. age complacency. The situation in south- Programme on HIV/AIDS (UNAIDS) and the Available online at: http://www.irinnews.org World Health Organization (WHO), December (Accessed October 25, 2007). ern Africa has not improved. 2007. 13. Zvomuya P. Swaziland’s Constitutional Crisis. We do not know the full impacts that 2. Helping Ourselves: Community Responses to Mail and Guardian. Available online at: AIDS in Swaziland. UNAIDS Best Practice HIV/AIDS will have in the Kingdom. We Collection. Geneva, Switzerland: Joint United http://www.mg.co.za (Accessed November 25, 2007). do know that policies must be recast to Nations Programme on AIDS (UNAIDS), June 14. Puddington A. Freedom in the World 2007: recognize the state of emergency facing 2006. Freedom Stagnation Amid Pushback Against 3. Government of Swaziland, Demographic Health Democracy. Freedom in Africa 2007. Freedom hundreds of thousands of Swazis now. The Survey, 2007. House, 2007. aftershocks of HIV/AIDS will reverberate 4. UNDP Human Development Report 2006. New 15. Whiteside A, Whalley A, (Scott Naysmith editor). York, NY: United Nations Development Reviewing ‘Emergencies’ for Swaziland: Shifting the throughout every sector of Swazi society Programme, 2006. Paradigm in a New Era. Health Economics and threatening human development, econom- 5. Swaziland Population Projections (1986-2016). HIV/AIDS Research Division (HEARD) and the ic growth, cultural inheritance and the nat- Population Projections: Volume 5. Mbabane, National Emergency Response Council on Swaziland: Central Statistical Office, 1986. HIV/AIDS (NERCHA). Durban, South Africa ural environment for generations. The fact 6. Swaziland Population and Housing Census and Mbabane, Swaziland, 2007. that hundreds of thousands of Swazi chil- (2007): Provisional Results. Mbabane, Swaziland: 16. UNDP Human Development Report 2000. New Central Statistical Office, 2007. York: United Nations Development Programme, dren will grow up without parents presents 7. Government of Swaziland. National Plan of 2000. a problem without precedent. Combined Action for Orphans and Vulnerable Children 2006- 17. UNDP Human Development Report with drought, an inefficient public sector 2010. Mbabane: Government of the Kingdom of 2007/2008. New York: United Nations Swaziland, 2006. Development Programme, 2007. and political mismanagement, the situa- 8. Zwane, Teettee. No need for aid in SD – agen- 18. UN Office for the Coordination of tion in Swaziland is devastating. cies. The Swazi Observer Available online at: Humanitarian Affairs. Swaziland: IMF Urges http://www.observer.org.sz (Accessed November Economic Reforms. IRIN Available online at: Swaziland is experiencing an 23, 2007). http://www.irinnews.org/Report.aspx?ReportId= HIV/AIDS-induced complex emergency 9. Government of Swaziland. The National 70824 (Accessed March 20, 2007). Constitution of the Kingdom of Swaziland, that is unparalleled. Severe epidemics in 2006. 19. UNAIDS. Quality and Coverage of HIV Sentinel Surveillance with a Brief History of the other countries did not reach the level of 10. National Survey on Violence Experienced by HIV/AIDS Epidemic. Paper presented at crisis present in Swaziland. Uganda’s Female Children and Youths in Swaziland. Workshop on HIV/AIDS and Adult Mortality in Violence Against Children in Swaziland: Developing Countries. New York, 8-13 prevalence peaked near 14%19 and has now October, 2007. Mbabane, Swaziland: Center for September, 2003;6. fallen below 10%,1 and Botswana has been Disease Control and Prevention and Swaziland 20. WHO. Epidemiological Fact Sheets on United Nations Children’s Fund, 2007;19, 17. HIV/AIDS and Sexually Transmitted Infections: able to respond by rolling out treatment.20 11. Food and Agriculture Organization (FAO) of the Botswana, 2006 Update. Geneva, Switzerland: This is not to minimize the devastating United Nations and the Government of the World Health Organization, 2006. and continued impacts of HIV/AIDS in Kingdom of Swaziland (TCP/SWA/2907). Comprehensive Agricultural Sector Policy those countries, but to highlight that Swaziland is facing the most severe and RÉSUMÉ complex HIV/AIDS epidemic to date. Au Swaziland, l’épidémie de sida se caractérise par la lente apparition d’une multitude de Urgent interventions are needed. cofacteurs qui ont mené à un état d’urgence chronique et compliquent l’existence de toutes les Mitigating long-term effects will require couches de la société. Exacerbées par la mauvaise gestion politique interne et par les politiques sustained financial commitments from the malavisées des organisations internationales, les répercussions de l’épidémie se feront sentir pendant plusieurs générations. international community. This money would be used to best effect in supporting Alors qu’on ne diagnostiquait presque aucune infection à VIH au Swaziland en 1990, le pays the work of civil society and NERCHA, affiche maintenant la prévalence relative la plus élevée au monde. L’infection mine la capacité des Swazis de monter des mesures d’intervention efficaces et systémiques. Selon les indicateurs du and pressuring the government to increase bien-être social, la population est en détresse. Sous le poids combiné des inégalités entre les sexes, political accountability. Community-led de la sécheresse, du déclin de l’agriculture et de la pénurie de ressources financières, les ménages responses have, of necessity, endeavoured n’arrivent plus à assurer leur subsistance, et la situation ne cesse de se détériorer. to address the needs of vulnerable popula- Dans cet article, nous faisons valoir que la réalité brutale à laquelle la population swazie est tions throughout the country. While the confrontée est perpétuée par le manque de volonté politique du gouvernement et les conditions case of Swaziland has been highlighted, imposées par les donateurs internationaux. En l’absence de programmes gouvernementaux intégrés, de nombreuses communautés amorcent leurs propres interventions. Pour aider ces populations many of these findings are applicable to vulnérables, il faut des engagements financiers internationaux soutenus. Et pour qu’on en fasse une generalized epidemics throughout southern utilisation optimale, les fonds doivent être accompagnés d’appels à la responsabilisation politique Africa. The positive benefits of community interne. De tels changements faciliteront les interventions nationales, surtout les projets à l’échelle communautaire. Nous nous sommes concentrés sur le cas du Swaziland, mais bon nombre de nos initiatives throughout the Red Countries constatations s’appliquent aux épidémies généralisées en Afrique australe. would be dramatically augmented with greater institutional and financial support Mots clés : VIH/sida; Swaziland; urgence humanitaire; aide internationale; charge de morbidité; inégalités entre les sexes; Afrique australe from domestic and international sources. S10 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 99, SUPPLÉMENT 1

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