2. RETHINKING SWAZILANDâS HIV/AIDS EPIDEMIC
estimated to be just 31.3 years â 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 UKâs 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 countryâs Gross National Income (GNI)
the 2007 census indicates the population required food aid, yet the government per capita â 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, Swazilandâs national
tion and drought, AIDS deaths are central Many of the governmentâs 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 Swazilandâs 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 â 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
â 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 Swazilandâs 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 â 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 âYoung Heroesâ 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. Swazilandâs land for the community to grow food for
ate. rating by the World Bank as a âlower- vulnerable members in the chiefdom.
Livelihood failure has become common- middle incomeâ 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 âlow incomeâ 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 â JUNE 2008 CANADIAN JOURNAL OF PUBLIC HEALTH S9