Even though economic growth is substantial and social service delivery — while not as fast as we want — is reaching millions, Aids will continue to kill hundreds of thousands in South Africa, burdening families and orphaning children.
Recent research in Swaziland presents a picture that is disastrous and deteriorating. The Swazi people are suffering from a long-term emergency, aggravated by domestic political ineptitude and inaction and the misinformed policies of international organisations. Our research shows Aids is the tipping point and this has implications across the Southern African Development Community.
In 1992 the first Swazi HIV prevalence survey found that 3,9% of women attending antenatal clinics were infected. By 2004 this had risen to 42,6%, the highest in the world. There are biases in antenatal data and so the 2006 Demographic and Health Survey, which included more population testing, was welcomed as an additional source of information. The news was not good. It was estimated that 220 000 people, 19% of the population, are infected. If this prevalence were applied to South Africa and the United States, then nine million South Africans and 56-million Americans would be infected.
Quality of life has declined steadily, echoing the rise of infection. The United Nations reports that from 1999 to 2004 maternal deaths increased from 230 to 370 per 100 000 births. Aids kills half of the children dying under the age of five. Swazi citizens born in 1993 could expect to live 60 years; today Swaziland has the lowest life expectancy in the world at just 31,3 years. The epidemic is shredding the structure of Swazi society.
Families are torn apart as breadwinners fall ill and die and grandparents take on the care of their sick children and orphaned grandchildren. There are already 130 000 orphans and vulnerable children, a number projected to increase to 200 000 by 2010. As elderly careÂÂgivers die, the oldest children take over without a support network. Sadly, Swazis have come to see the circumstances afflicting a third of their nation’s children as ordinary and inevitable — an “abnormal normality” that reflects a society with few options.
Many Swazi households are forced to cope with livelihood failure, caused by drought, falling agricultural production and a declining GDP. The number of Swazis “skipping meals” has increased; poor nutrition hastens the onset of Aids and puts individuals at greater risk of infection. In 2007 40% of all Swazis require food aid, yet the government recently decided to cultivate cassava crops for bio-fuel production.
As the largest employer in Swaziland, the public sector is financially responsible for a majority of dependants and is essential to implementing alleviation efforts. With one in four employees in this sector infected and policemen, teachers and civil servants succumbing to Aids, public services are in jeopardy.
Swazi women and girls shoulder the burden of the disease and are the most vulnerable to infection. A shocking 49% of women aged between 25 and 29 are HIV-positive, reflecting the low status of women. The legal status of women surpassed that of a “minor” only in 2006. The recent National Survey on Violence Experienced by Female Children and Youths in Swaziland finds that “two-thirds of women are beaten and abused”, with six of every 10 Swazi females being coerced or “forced into their first sexual experience”.
The 2006 Constitution reaffirmed that executive, legislative and judiciary authority rests with the king (Mswati III), who has ruled Swaziland since 1986. Aids activists argue that some cultural traditions, in particular commodifying females, are at the heart of the epidemic.
The international donor community is not helping. The International Monetary Fund insists on public sector expenditure being cut and the public service be reduced in size: this at a time when additional human capacity is needed to respond to the crisis. Repaying debt — accumulated in part by the extravagance of a minority — perpetuates the cycle of poverty and disease among Swaziland’s majority.
Swaziland’s rating by the World Bank as a “low-middle income” country means that the impoverished kingdom cannot access the financial resources available to “low-income” countries. This rating is based on a country’s GDP, with no account taken of its social and structural realities. By the time Swaziland’s GDP has fallen sufficiently to access “low-income” funding, it will be too late for pre-emptive interventions.
Signs of hope flicker in Swaziland: NGOs, faith-based and community-based organisations are working to form a coherent response to the epidemic. The National Emergency Council on HIV/Aids coordinates activities to avoid duplication, identifies those people most in need and works with many of the nation’s traditional chiefs. Here too financial and human capacity falls short of demand. We hope that this devastating research provides the wake-up call needed.
Elements of Swaziland’s situation apply to other Southern African counties, especially Lesotho, Namibia, Zimbabwe and Zambia. These generalised epidemics, resulting in chronic emergencies, will continue to threaten human development, economic growth, cultural inheritance and the natural environment for many generations. The case of Swaziland — magnified by poor leadership and the politics of aid — bodes ill for the future of Southern Africa, where the shocks of HIV/Aids will remain endemic long after a cure for the virus is found.
Professor Alan Whiteside is the director of the health economics and HIV/Aids research division (Heard) at the University of KwaZulu-Natal. Scott Naysmith is a visiting research fellow at Heard. This commentary is based on research accessible at: http://www.heard.org.za/research/ResearchReports/2007/Reviewing%20Emergencies%20For%20Swaziland_Report.pdf