The small, southern African kingdom of Swaziland is roughly the same size as Wales. It is blessed with a variety of landscapes, including mountains, savannah and rainforests – natural beauty that belies the significant economic and social problems the country faces, writes Lilian Anekwe
People in Swaziland have an average life expectancy of 32 years, the shortest in the world, and many live in poverty as 60 per cent of the population exist on less than £1 a day.
Intrinsically linked with these problems is the fact that Swaziland has the highest prevalence of HIV infection in the world. Twenty-six in every 100 people, aged 15 to 49, in Swaziland is HIV positive. If the UK had the same HIV prevalence rate as Swaziland, it would have 11 million infected adults.
The spread of HIV in Swaziland has created a current problem that will continue to affect the country for generations. According to figures from the Swazi government, about 23 per cent of children are orphans, most as a result of the HIV epidemic.
The spread of HIV across the country had become so pervasive that the United Nations Development Program warned in 2004 that, if it continued unaddressed, the “longer-term existence of Swaziland as a country will be seriously threatened”.
But a report by the Child’s Rights International Network, a charity that promotes children’s rights, says there are many sources of hope despite the country’s problems. It says the “doomsday scenario” predicted in the 2004 UN report has thankfully failed to materialise, thanks to efforts by the Swazi government, charities and activists, both in Swaziland and globally.
If the UK had the same HIV prevalence rate as Swaziland, it would have 11 million infected adults
“Any country that faced the burden of problems that Swaziland has faced would be stressed. Swaziland has been able to cope even with limited resources, such as a manpower shortage due to HIV mortality. But we all have much more to do,” says Jama Gulaid, UNICEF’s country representative for Swaziland.
Swaziland has been one of Africa’s more successful countries in its preventing mother-to-child transmission (PMTCT) outreach efforts, overcoming challenges in a country that has a largely rural population where accessing healthcare is difficult for many women.
“Forty seven per cent of Swazi children who die do so of HIV-related causes. Prioritising an end to mother-to-child transmission of HIV and working with the government on this has been a big part of our activities,” says Dr Gulaid.
Now more than 90 per cent of HIV-positive pregnant women receive antiretroviral drugs to prevent vertical transmission from mother to child. And there are encouraging moves to implement health policies designed to try to address issues, including legislation targeting the protection of children, particularly orphaned and vulnerable children, age-specific sexuality education and health promotion in schools.
Sex with widows is a risk
Sexual cleansing is an African practice where, if a man dies of Aids, his widow is “purified” sexually by having intercourse with the deceased’s male relative or a village peer.
But as the widow is likely to also be HIV-positive, the infection will probably spread as condoms are not routinely used.
Africa is a very large and highly diverse continent, home to hundreds of distinct cultures. A practice that is traditionally widespread in one area may be completely unheard of elsewhere. But widow cleansing has been documented in Uganda, Mozambique, Kenya and Zambia.
Laura Craggs, programme and information officer at an international HIV/Aids charity AVERT, says it is also practised in Malawi. “It is a cultural challenge our partners face in their work as they push to raise awareness of the rights of women and girls among the local population,” she says.
AVERT campaigns to make behaviour and practices safer while respecting local culture, through relatively small changes in cultural practices, such as switching to alternative rituals that carry a lower risk of HIV transmission.
But research in Zambia, where some communities cleanse widows with herbal remedies instead of a sexual intercourse, show this alternative can be seen as shameful for the widow, as it brings into question her health and can be stigmatising.
Dr Gitau Mbaru, senior adviser on HIV and health systems at the Aids Alliance, says high-risk cultural practices must be challenged by working closely with members of communities where they occur.
“Risk perception tends to be very culturally ingrained. We have to challenge why people think it’s culturally acceptable,” he says. “The best way to address this is through the communities themselves because they understand their own cultural problems. We really need to focus on some cultural challenges and social interventions.”