In Swaziland, HIV hides in plain sight

Read the obituaries in Swaziland, and you will discover that many people here die from unspecified “lingering illnesses”.

Attend funerals, and you may hear that tuberculosis, dysentery, diaorrhea — even flu — are also proving exceptionally lethal.

Virtually no-one, it seems, is dying of Aids. This is despite the fact that an HIV prevalence of 38,8% has given Swaziland the highest Aids infection rate in the world.

The shame that causes people to blame curable diseases rather than Aids for the deaths of their relatives and friends points to a curtain being drawn over the pandemic in this Southern African country.

But while some might take comfort from the silence that often surrounds Aids, others see only too clearly that it is standing in the way of efforts to prevent the spread of HIV and to deal with the consequences of Aids.

“People have been told that having Aids is the worst thing in the world, and being HIV-positive is just the same because it leads to Aids. People treat people with HIV the way lepers were treated centuries ago. They are shunned and insulted,” says Amos Dlamini, a 26-year-old factory worker who belongs to an Aids support organisation.

“This is why, despite all our best efforts, only a handful of Swazis have come out to admit they are HIV-positive. Even I am afraid, because of the effect it would have on my family,” he adds.

Traditional beliefs conspire with shame to deepen the denial about HIV, in that the deaths of people who succumb to Aids-related diseases are often blamed on witchcraft. This deception is easily maintained in a country where autopsies are rare, and people who don’t have concrete proof of Aids are content to believe their relatives and associates died of something else.

“If no one is HIV-positive, you are safe and you can continue to disdain the use of a condom and sleep with multiple partners, until one day you notice a skin lesion and say, ‘Oh! Someone is bewitching me’,” says Dlamini.

His words are echoed by another Aids activist: “Most people can say they have never met a person who is HIV-positive, even though they interact with friends, family members and co-workers every day who are HIV-positive. It’s such a secret that denial becomes easy.”

A court case currently underway in Swaziland provides another illustration of this denial. It involves the trial of a teenage girl who was arrested for using insulting language during an argument with a neighbour. In the heat of the moment, the girl had accused the neighbour and her husband of having Aids.

“It is true that I am sick together with my husband, but I also do not know the disease that I have,” the complainant told the court. Her willingness to embark on a trial rather than have a blood test speaks volumes of the lengths that Swazis will go to avoid confronting Aids.

Health officials say this culture of denial is rooted in conservative attitudes that make Swazis reluctant to openly discuss matters related to sex.

They also point out that the first Aids prevention campaigns, launched in the 1990s, were counter productive because they suggested that only promiscuous people could contract the disease. A bid to get Swazis to use condoms to prevent HIV transmission did not meet with much success, and was condemned by traditional leaders.

Now that the pandemic has spread far beyond those sectors of the population that were initially thought to be at risk, Swaziland is grappling with a host of Aids-related problems — not least the burgeoning number of orphans. The United Nations Children’s Fund estimates that the country presently has 69 000 Aids orphans. By 2010, that figure will rise to 120 000. (Swaziland’s total population numbers just under a million.)

While orphans have traditionally been taken care of by family members, this social safety net has been strained to breaking point by the dramatic increase in children who require care. In some cases, the net has unraveled completely.

As HIV typically claims people in their most productive years, various sectors of the economy are also feeling the weight of the pandemic. Take agriculture.

Food production has declined, because farmers and farm workers are dying as a result of Aids. “There are fewer people left to plough, plant and harvest the fields,” says an agriculture ministry field officer.

With adults gone, elderly grandparents and young children are left to continue with crop cultivation. They lack the physical strength and — in the case of children — skills, to do so effectively.

Drought has also played a part in reducing yields. However, the agriculture ministry and the UN World Food Programme, which presently supplies a quarter of the population with food aid, say food production will remain below normal levels for a generation — even with sufficient rain.

HIV has cut a swathe through other countries in Southern Africa, the region worst-affected by the pandemic. South Africa currently has the highest number of people who are living with HIV — about 5,3-million. According to the Joint UN Programme on HIV/Aids, seven of the nine African countries where life expectancy has dropped below 40 years are in Southern Africa.

As with Swaziland, South Africa and other states in the region are confronted with denial about Aids. If Swazi health officials succeed in convincing people like Sylvia Mngomezulu, an office worker, that HIV poses a real and present danger, perhaps their experiences will be of use elsewhere in Southern Africa.

“In the country most affected by Aids, why can’t you find Aids anywhere?” she asked during an interview with IPS in the capital, Mbabane. “If so many people have Aids here, where are they?” — IPS

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James Hall
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