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Swaziland: AIDS in Context
AfricaFocus Bulletin
Apr 22, 2004 (040422)
(Reposted from sources cited below)
Editor's Note
"Swaziland now holds the dubious title of [having] the highest
[HIV] prevalence level in the world. ... [It] is a vivid microcosm
of all the similarly afflicted countries of Southern Africa. At the
grass roots, where it counts, there's a superhuman determination to
bring the pandemic to heel, and to overcome the tremendous assault
on the human condition." - Stephen Lewis, UN Special Envoy for
HIV/AIDS in Africa
Lewis highlights innovative national Swazi plans, supported by the
World Health Organization, for stepping up response to the
pandemic. But Swaziland is also representative of other countries
in that in practice implementation is still painfully slow. And
other obstacles, ranging from U.S. congressional delays on trade
legislation to Swaziland's own unresolved issues of democracy and
women's rights, may still overwhelm the positive momentum of
national efforts.
This AfricaFocus Bulletin presents excerpts from Lewis's remarks
after a recent visit to Swaziland. It also contains selections from
several feature articles on AIDS, trade, and democracy from the
UN's IRIN service, one of the few sources providing regular
coverage of Swaziland. Several additional links are included for
additional background on each topic.
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For additional country-specific background and links, see
http://www.africafocus.org/country/swaziland.php
For other country pages, visit:
http://www.africafocus.org/country/countries.php
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Stephen Lewis, UN Secretary-General's Special Envoy for HIV/AIDS in
Africa
Notes for Press Briefing on Swaziland, United Nations, New York
March 31, 2004
[Excerpts. For full text see
http://allafrica.com/stories/200404060161.html]
Swaziland now holds the dubious title of [having] the highest prevalence
rate [of HIV among pre-natal women] in the world (38.6%). ...
... When I visited Mbabane hospital three years ago, 60% to 70% of
the beds were occupied by AIDS-related cases; now, it's over 90%.
...
And there's one other inescapable aspect of Swaziland, flowing
directly from the pandemic, from the huge numbers of infected
women: the orphans; orphans absolutely everywhere. I've just never
seen anything quite like it. Child-headed households proliferate;
fully ten per cent of the households are 'sibling families' ...
Swaziland estimates it will have 120,000 orphans by the year 2010,
somewhere between ten and fifteen per cent of the total population
,,,
... Swaziland is a vivid microcosm of all the similarly-afflicted
countries of Southern Africa. At the grass roots, where it counts,
there's a superhuman determination to bring the pandemic to heel,
and to overcome the tremendous assault on the human condition. I'm
not romanticizing: in the midst of the worst the world has to
offer, the people of Swaziland simply refuse to succumb, and
they're fighting back with every means available.
In three areas in particular, the response is inspired.
First, Swaziland intends to put between 4,000 and 4,500 people into
antiretroviral treatment by the end of this year (there are about
1,500 in treatment now); 10,000 to 13,000 by the end of next year.
That will represent almost 50% of those who are eligible for
treatment, a much higher ratio than most other countries. Can they
pull it off? The answer would appear to be yes, because the
National Emergency Response Council on HIV/AIDS (NERCHA) is
extraordinarily impressive, well-led and single-minded. More, it
has devised a computer tracking system for drugs and adherence and
side-effects, available to physicians in the public and private
sector to follow patients, while sealed in absolute
confidentiality. I saw the entire apparatus, watched a full
simulation, and it may well be that Swaziland has fashioned a
brilliant technology that can be emulated by other countries. ...
One of the reasons Swaziland is moving so effectively on treatment
is because of the presence of a team of experts from the World
Health Organization, who have helped with every aspect of
implementation, including infrastructure and capacity. This is
exactly what is meant by putting three million people into
treatment by 2005 or "3 by 5". It's not that WHO will do the
treatment itself; far from it: WHO will make it possible for
everyone else to do the treatment and get to the goal.
It is therefore a matter of continuing concern that the seed money
WHO needs --- 200 million dollars over this year and next to do
this indispensable, life-saving work--- is still not forthcoming.
...
Second --- and this is the exciting item --- in order to deal with
the vast numbers of orphans, NERCHA is proposing to establish a
cadre of ten thousand women to act as a kind of surrogate parent
for the children. These are women who have families of their own,
still do all of the tasks related to those families, still care for
the others who are vulnerable in their villages, but on top of all
of that, will somehow find several hours of the day to feed and
support the orphans.
It's a classic example of how women sustain African society,
usually unheralded and uncompensated. What really amounts to
conscripted labour, is described as 'voluntary'.
Well, NERCHA is blazing an amazing trail. In its latest submission
to the Global Fund, NERCHA is asking that the ten thousand women be
paid for the specific work they will undertake with the orphans.
Predictably, it's a very modest stipend --- roughly $40 a month ---
but it's a stipend. And it's not ad hoc or quixotic. It's
explicitly in recognition of the additional work over and above all
the other work that is normally done. It will be monitored
carefully, and the money will be paid.
So the fascinating question is: what happens to the proposal when
it hits the Global Fund? If it's thrown out by the Review
Committee, or the Board, there should be a public uproar that
shakes the Fund to its foundations. It would make a mockery of the
struggle for gender equality. If it is approved, it will set an
astonishing precedent: suddenly, one international organization
will finally have recognized the value of women's unpaid work in an
environment where that work is appallingly difficult and
challenging, and where no one else would consider doing it.
Third, again given the surfeit of orphans, schooling and feeding
are vital. In Swaziland, you have the predicament characteristic of
many other countries: school fees prevent school attendance. In
response, NERCHA and UNICEF and WFP, working with powerful local
chiefs, have fashioned a truly imaginative initiative, serving as
a model in a number of communities. The communities are offered a
grant (through UNICEF) to be used as they see fit (including school
fees, but sometimes teachers or materials or refurbishing of
classrooms), and the entire purpose is to get kids back into
school. Tens of thousands of children are currently out of school.
It's working. The children are returning in large numbers; WFP
feeds them a couple of meals a day; school gardens are planted to
give the children some agricultural experience and to enhance the
diet; it's organized around "Neighbourhood Care Points" - points in
a chiefdom where villagers gather for the purpose of attending to
children, and NERCHA is overseeing the construction of a number of
Social Centres to serve as a focal point for all community and
orphan activity. It's quite the model, and it's giving joy and hope
to a lot of orphan kids.
Swaziland: Innovative Approaches to HIV/Aids
UN Integrated Regional Information Networks
http://www.irinnews.org
April 2, 2004
Mbabane
Swaziland's AIDS prevention and mitigation efforts will be given
significant backing this year, now that the National Emergency
Committee on HIV/AIDS (NERCHA), which distributes government,
private sector and Global Fund monies to health care groups, is
fully set up and funded.
"The process of assessment begun a year ago by the Global Fund, of
our financial management, human resources, procurement, monetary
and evaluation procedures, has found our house is now in order. We
are now getting down to serious business," Dr Derek von Wissell,
director of NERCHA, said in an interview with PlusNews.
When the committee was set up by act of parliament two years ago,
R13 million (US $2 million) in funding was set aside by the health
ministry, but because of "political reasons", according to von
Wissell, only R1 million ($154,000) was spent, despite Swaziland
burgeoning AIDS crisis.
At the time, the tiny kingdom had the world's second highest HIV
infection rate; today, the country leads the world in the
percentage of HIV positive adults at 38.6 percent. Yet, R12 million
was carried over to last year, to which government added R20
million ($3 million), for an operating budget of R32 million ($5
million) for NERCHA's first year.
NERCHA Takes Shape
"We only really started spending in the fourth quarter of 2003. In
hindsight, we could have been more pro-active. We were overly
conservative when we started, because we didn't know what the
procurement process was - how long it would take to get monies from
the Global Fund," said von Wissell.
"I think we are going to see significant interventions, and a
number of innovative projects. These may only be visible by the end
of this year and the beginning of 2005. But 2004 is a year of
implementation," he said. ...
Swaziland has only 1,000 hospital beds in the entire country, and
90 percent of these are occupied by AIDS patients. Hospitals are
sending AIDS sufferers home to be attended by loved ones and
caregivers, but supplies for medical treatment are unaffordable in
a country where two-thirds of the people live below the poverty
line, and the AIDS patient was often the breadwinner.
NERCHA's contribution to a solution was typical of the way the
committee works. On-site research was conducted, and all
stakeholders - government ministries, local and national
traditional authorities, health care NGOs, and people living with
HIV/AIDS - were consulted.
Fifty-five shipping containers were purchased from transport
companies, and one was placed in each of the country's local
parliamentary constituencies. Doors and windows were cut, shelves
were fitted, and the "supply depots" were stocked with rubber
gloves and other materials required for home-based care.
"Immediately, we received complaints that the supply depots were
too far away for some people - who before had nothing! But their
point was taken, and now a depot will be installed in each
chiefdom," said von Wissell. Swaziland has about 350 chiefdoms. ,,,
A shortage of health care personnel, particularly nurses, will be
addressed by a NERCHA-funded study seeking solutions for the
Ministry of Health.
The normal annual attrition rate for Swaziland's 3,000 nurses is
100 to 150 a year. One hundred new nurses are trained yearly at
government hospitals in Mbabane and Manzini. Of the class of 2003,
however, 43 new nurses departed for more lucrative jobs in other
countries. Meanwhile, 300 nurses, or 10 percent of the nation's
total, succumbed to AIDS this past year.
Behaviour change required to reduce HIV infections by ending unsafe
sexual practices remains a dilemma in need of a solution.
"Information alone does not lead to behavioural change. The fact
that people know something is not a motivator. Most Swazis know the
basic information about AIDS - we have to find out why people act
the way they do," von Wissell said.
In the end, it may be the sheer virulence of the AIDS disease that
will jar people into changing their behaviour.
"Behaviour change has happened in other countries where AIDS has
struck. It can happen here," said von Wissell.
For a comprehensive background document on AIDS in Swaziland, see
the March 2003 report by Alan Whiteside, "What is Driving the
HIV/AIDS epidemic in Swaziland, and what can we do about it?." It
is available at:
http://www.nercha.org.sz/2003whiteside_report.html
and
on the website of the Southern African Regional Poverty Network at:
http://www.sarpn.org.za/documents/d0000706/index.php
For a news report on a 2002 UNDP study on "Gender-Focused
Responses to HIV/AIDS in Swaziland," see
http://www.irinnews.org/report.asp?ReportID=30243
Issues raised in this report, and acknowledged in the Whiteside
study above, are among critical issues that have still to make it
to the top of the public agenda in Swaziland.
Swaziland: Textile Industry Under Threat Over Agoa Rule
UN Integrated Regional Information Networks
http://www.irinnews.org
March 31, 2004
Mbabane
Swaziland's flourishing textile industry is experiencing a crisis,
caused by delays in US legislation that would extend a deadline in
the African Growth and Opportunities Act (AGOA), and enable Swazi
exports to continue entering the market duty-free.
"Already, about one thousand garments workers out of 28,000
employed nationally have lost their jobs because of the uncertainty
over AGOA. Each worker supports 10 dependants," said Sipho Mamba,
Secretary-General of the Swaziland Manufacturing and Allied Workers
Union.
According to the Ministry of Enterprise and Employment, a quarter
of the population is either directly or indirectly dependent on
factories that export under AGOA.
Exported garments manufactured in African countries from raw
materials made in other countries - mainly in Asia - have been
accepted under AGOA. However, under current rules this preferential
status expires on 30 September, and no Swazi apparel exporter had
received an order for delivery after August, the garment exporters'
association warned.
A bill introduced last November in the US Senate would extend AGOA
benefits until 2015, and for the next four years permit raw
materials to be imported from non-AGOA countries. Another bill,
introduced to Congress in the same month, would extend AGOA to 2020
and allow "third party" fabrics for a further three years. But both
pieces of legislation have stalled.
Swaziland's association of garment manufacturers met on Wednesday
with Prime Minister Themba Dlamini to press for government action
on AGOA. The business community has reportedly been frustrated by
government's lack of initiative on the issue.
"As employers, we are doing everything possible to avert the
possible disaster which might befall the country," Robert Maxwell,
secretary-general of the Swaziland Exporters Association said in a
statement.
Because US retailers place orders six months in advance and are now
ordering their fall fashion lines, if the AGOA legislation is not
passed in two weeks, Swazi garment factories will lose business.
Already some orders have been cancelled, resulting in layoffs.
"Once we lose customers, it will be hard to get them back. If the
delay in AGOA legislation is temporary, we can reopen and rehire
workers in six months. If it is permanent, there won't be an
Asian-owned garment factory still here next year," said the manager
of one Asian-owned garment factory in the Matsapha Industrial
Estate near the central commercial city, Manzini.
"The uncertainty about the future of AGOA is already having a
negative impact on AGOA as the [Bush] administration's primary
initiative to boost African economic growth and development. We
understand that several major US buyers have already shifted orders
to Asia in anticipation of the September 30 expiration date,"
Florizelle Lister, assistant United States trade representative for
Africa, said in testimony to the Senate Foreign Relations Committee
last week.
One source familiar with the AGOA legislation said election year
politicking in the US might be responsible for the delay in the
trade scheme's renewal. "Loss of American jobs through outsourcing
to other countries is a campaign issue. Trade benefits to Africa
may be seen as detrimental to US garment workers."
Swaziland needs a time extension on its ability to use "third
country" raw materials in its AGOA exports, to give the country
time to set up clothing factories.
There are two other issues darkening Swaziland's export prospects:
the country's monarchical system of government goes against the
philosophical grain of AGOA, which seeks to encourage democracy by
fostering trade, and its human rights record. Both these issues
will be featured in an annual review of all AGOA-eligible countries
undertaken by the US State Department in June.
The strong South African rand, to which the Swazi currency, the
lilangeni, is pegged, has also made Swazi exports less competitive.
"Our products are twice as expensive as they were two years ago,
because of the strengthening rand. This erases the advantage of our
goods going into the US without duty taxes," said the manager of
one garment factory.
Additional sources: For background on current AGOA program, visit
the official U.S. AGOA site at
http://www.agoa.gov For information on new legislation and additional background, see
http://allafrica.com/agoa and http://www.agoa.info
See in particular the February 2004 report by Aisha Bahadur on
"AGOA and Sweatshops in the Apparel Sector" and the April 2004
study by Paul Brenton and Takako Ikezuki of the World Bank on the
impact of AGOA. Both are available under Research Documents" on the
http://www.agoa.info site.
Swaziland: Rights Groups Forced to Hold Protest Outside Kingdom
UN Integrated Regional Information Networks
http://www.irinnews.org
April 20, 2004
Mbabane
A human rights rally will be held outside Swaziland, after security
forces blocked a planned gathering at the weekend by pro-democracy
groups who intended to condemn the government's draft constitution.
"We will now restage [the event] in another country that recognises
human rights," said Kislon Shongwe, an official with the banned
political party, People's United Democratic Movement. South Africa
or Mozambique were being considered.
The human rights day commemoration was co-sponsored by the
Swaziland Agricultural and Plantation Allied Workers Union
(SAPAWU), a member of the Swaziland Democratic Alliance - an
umbrella body of human rights, labour groups, as well as banned
political parties - and the National Constitutional Assembly (NCA),
a civil society organisation that is challenging the
palace-sponsored draft constitution.
"This is a remembrance of the struggles the people of Swaziland
have been through since the unlawful repeal of the Independence
Constitution of 1968, which was unconstitutionally abrogated by His
Majesty King Sobhuza II in 1973, denying the nation its fundamental
rights and freedoms," SAPAWU said in full-page newspaper
advertisements placed the day before the event was to have taken
place in the eastern agricultural town of Big Bend.
The union and NCA said government censorship of the state media had
compelled them to purchase advertising space to deliver their
message.
A spokesman said the Swazi police did not permit the human rights
event to go ahead because gatherings of a political nature are
banned in the kingdom. Organised political opposition to royal rule
is also forbidden by royal decree.
Government sources said the event was viewed as an attempt to
embarrass King Mswati on the eve of his 36th birthday celebrations
on Monday.
Organisers denied the allegation and said the celebration, which
was normally held in October, had been scheduled for the week of 12
April because it was the anniversary of the abrogation of the
country's constitution, and the beginning of a national state of
emergency, now in its 31st year.
They declared 12 April as African Human Rights Day in Swaziland and
said it would be commemorated annually.
In 2000, pro-democracy groups met in the Mpumalanga province of
South Africa after the Swazi government banned political meetings.
The convention produced the "Nelspruit Declaration", calling for
the peaceful transformation of government from a monarchy to a
democracy.
The NCA had intended to announce its plan of instituting court
action to block the new draft constitution at the human rights day
event.
King Mswati has said he would decree the new constitution this
year, but in November 2002 the Court of Appeal ruled that the king
had no power to decree laws. The government then said it would
ignore the Appeal Court ruling on the king's powers, after which
the Court of Appeal bench resigned in protest. Swaziland's highest
court has not functioned since.
The NCA intends challenging the draft constitution on the basis of
the 2002 Court of Appeal ruling.
Additional sources: The UN's IRIN covers Swaziland regularly. The
best way to access background reports from earlier years is not
through IRIN's own interface, but to use a google search for:
Swaziland site:irinnews.org
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a particular focus on U.S. and international policies. AfricaFocus
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