AIDS in Swaziland

A young girl tests out a new seesaw on a playground built by the Elizabeth Glaser Pediatric AIDS Foundation at the Mkhulamini Clinic in Swaziland
A young girl tests out a new seesaw on a playground built by the Elizabeth Glaser Pediatric AIDS Foundation at the Mkhulamini Clinic in Swaziland (Wikimedia Commons)

The 13th International AIDS conference in Durban, South Africa, focused attention on southern Africa, a region reeling from the impact of the HIV/AIDS pandemic. No country in the region has been spared, even little Swaziland. The highland kingdom, surrounded by South Africa., was a British protectorate for 100 years, but it has been an independent monarchy since 1969. It has a population of only a million people, and the death toll there is rising.

Producer: Ginger da Silva

Broadcast: July 11, 2000


Radio Netherlands, the Dutch International Service, presents “A Good Life” with Ginger da Silva.

This problem is very grave for Swaziland because Swaziland is a very small country of just about one million people. This disease spreads like wildfire. If efforts are not made to move really quickly and stop the spread of the virus, it can wipe out our country.

Hello. The 13th International AIDS conference this week has focused attention on southern Africa, a region reeling from the impact of the HIV/AIDS pandemic. No country in the region has been spared, even little Swaziland. The highland kingdom is surrounded by South Africa. It was a British protectorate for 100 years but has been an independent monarchy since 1969. It has a population of only a million people, and the death toll there is rising.

Much of the spread of this epidemic is growing out of historical and economic circumstances that in many respects were imposed on Swaziland.

Alan Brody is the recently-appointed UNICEF representative to Swaziland.

People were living traditional, rural kinds of lives with institutions that in the old days, this disease ever would have gotten a foothold in Swaziland. There were breakdowns all through the last century, and things like people had tax imposed on them by colonial authorities. They didn’t ask for them to come in the first place. To pay head tax, people had to go to work. This was known. There was no cash in a subsistence economy, and so people went off to work in the mines in South Africa, and served some interests of the global economy. So all of that happened and that brought this problem back in because miners who are off for a year at a time, obviously concepts of marriage and fidelity and so on break down in that circumstance. So we have a breakdown of society. It’s nobody’s fault. The question is what are people going to do to try to solve it?

In a speech to parliament in February 1999, the king of Swaziland, King Mswati II, pulled no punches: he said AIDS was a national disaster, and every Swazi national official should be mobilised in the effort to combat it.

That really set in motion at least a willingness to face it. He asked all the ministers and leaders to talk about this whenever they were talking in public, so it had opened up a process of dialogue and debate about this issue. But still I think people were in shock, and people hadn’t really…there hadn’t been much publicity about the numbers, and people spent 1999…there was a lot of argument about numbers, how many people were really infected. Everybody seemed to have a different number, including UNICEF, and many people were misusing numbers because there aren’t good statistics. But I think towards the end of the year, people began to realise that it’s not an argument about numbers because the numbers…we don’t know whether…some people were saying it’s 30% . Some were saying it’s 50% of the adults, and the reality is that it’s “only” 22%. Well good Lord, only 22%! That sunk into people that whatever the number was exactly, that this is a terrible situation.

National and international organisations were already wrestling with the problem when Alan Brody arrived in Mbabane, the capital, last December. United Nations agencies were there trying to help, as Elisabeth Lwanga, representative for the coordinating agency, UNDP, explains.

As for UNDP, our work is generally more working directly with governments on policies, on planning. Our support in Swaziland has been mainly in efforts to get a national strategic plan put in place, providing support to the government machinery that has been put in place. But because of the uniqueness of this tragedy, we also have found ourselves working in other areas, supporting SASO, the organisation that’s working with people living with HIV and AIDS, assisting hospices, home care for the sick, which is not something traditionally that UNDP should be doing, but we’ve also been going into that as well. But our real focus is on awareness and advocacy.

Many countries have regarded AIDS as simply a disease, another health matter, and placed into under the responsibility of the ministry of health. But in developing countries, the health ministry is often stretched for resources to begin with and ill-equipped to deal with all the other social and economic aspects that accompany this particular disease. In Swaziland, an inter-sectoral crisis management committee has been set up under the office of the deputy prime minister. There’s also a cabinet sub-committee working with the UNDP and UNAIDS, developing a national plan. Elizabeth Lwanga thinks it’s crucial to set up a central plan in order to focus the nation’s efforts.

That resources are not scattered and that resources are not being directed into just one thing and leaving other key things unattended to. That’s why the development of a national strategic plan really is crucial, and in all endeavours, this is highlighted as the most urgent. Fortunately we should be getting the national plan out within, I believe, another week or two. We should have it finalised. GdS: Isn’t this a bit late? This epidemic has been around since ’83, and here we are in the year 2000. It’s a bit late. True, I agree, but then I suppose it’s the way of the world. It doesn’t really matter how much we have learnt from other experiences. We still do not take action the way we should. As an example, now we are all focusing on southern Africa because the crisis now has more or less shifted from eastern Africa maybe to southern Africa, but we are leaving unattended opportunities in western Africa, where the levels are still very low. As far as I’m concerned, we should drowning those countries with advocacy to stop the spread of the virus so that we don’t get into the same kind of epidemic situation.

But do officials, political leaders and even the experts know what to do?

We’re looking. We’re really looking hard to say OK, how do we address this? And we’re talking about a couple of issues. One is how do we reverse this trend that has been rising so quickly, and how do we reduce the number of infections? And that means a fundamental change in behaviour, and that’s the most difficult behaviour to change. It’s the most private, and it’s the most deeply ingrained. It’s instinctual in many ways. It’s different for every person, and nobody likes to talk about it. This is true in every society, in every culture. You know, my own background is in communication. I spent six years – some years ago – studying for a Ph.D. in communication. After that, about six years of hard work and research in what everybody had to say about how you convince and how you persuade people. My conclusion was – and I was partly trained by both my wife and my children in this – that people will do what they want to do. And particularly in sexual behaviour you have this, and unless you can influence what people want to do, you can use fear appeals and all these kind of things, but people deny. I can add a corollary to that: people will hear what they want to hear, selection attention and selective perception. So you have to deal with all of these things.

One organisation that is helping in various aspects of this effort is SASO, a support and advocacy group for people living with the Human Immune Deficiency Virus. Their best known member is Vusi Matsebula, who was the first person in Swaziland to come out publicly and admit that he was HIV positive.

I believe I contracted HIV in 1992 when I met a girl at a party. Then, after five days, the same girl called me on the phone to tell me that I’m going to die. After a while, I heard some of her friends laughing. After that, she dropped the phone. It took me eight months to go for a blood test. That was ’92 July when she called me on the phone. GdS: You must have been very frightened. Did you know anything about HIV? In this country back then, there was little about HIV in the country. The only thing we heard on the radio, papers, TV were countries like Uganda, foreign countries. So it was easy for many of us to think HIV is not in Swaziland. AIDS is not in Swaziland. Back then, we didn’t know about HIV. We only knew about AIDS. So, it took me eight months to go for a test. I went for the blood test, and then they confirmed that I am HIV positive. The way I contracted the disease, it was through ignorance. That was one thing. So with that knowledge, I thought there are many of my friends out there somewhere who have the same attitude about this disease. So I took it upon myself to declare my status for them to see the reality of the disease.

But going public was not an easy or automatic step for Vusi. It was the support and counselling of the people in SASO that gave him the strength to reach out to others.

When I joined the organisation SASO, there is so much I was helped in accepting and coping with my situation. The day I heard about my infection on the phone when the girl called me, I suffered a few weeks after that a pain in my head, such that I opted for a suicide because I thought AIDS was just right at the door. As soon as I met the organisation and through counselling, I was helped to realise that some people can live normal lives, so I began to have the hope that I can make it. It’s another reason why I came out in the open to let the other one who is out there, probably suffering from the same thing, and maybe he’s losing hopes and he’s also opting for committing suicide to say hey, you can live. I’ve lived.

In the past few years, SASO has grown to about 70 members. 11 of those have come out publicly with their status and travelled around the country speaking to school children and church groups. They hope to educate as many people as possible. A few, following Vusi’s example, have come out on national radio and TV, but the reactions they get are often mixed.

The first move was a television programme that we have in this country that is entitled “Let’s talk”. Then, after that, I used the media, I mean the papers, then the radios. Sometimes I’m called here and there to have certain programmes on the radio. GdS: You’ve become quite a celebrity I understand. Thanks a lot. Gds: But what happened in your life when you went public? This must have been quite shocking for many Swazis. Well, to my surprise, a lot of people were telling me, don’t be a jerk. You’ve been always like this. There’s no sign that you are sick. So why go tell us lies like that? So most people didn’t believe my story. GdS: They thought you were just a jerk. Right. Most people thought I’ve got a lot of money from the government to say that they will change their attitudes. Some people said I’m looking for fame. Otherwise, there’s nothing like that. There are a few of those people who encouraged me. They said I’m very grateful of your declaring in the open because now I realise that I have to change my way of living. I can realise that this thing really exists. There were those people. But the most were denying it. GdS: Still denying it. What about your family and friends? I would say that my family has been a great support, and I believe that my living positively, and my confidence comes from my family, mostly from the support they are giving me because before I came out in the open, I told my mother. My mother was a single mother, and my sister and my late brother. Many of the fears people living with HIV out there who are scared to openly speak out is that my family will reject me. My friends will reject me. But I didn’t get that. Instead I got people coming to me to search for more information about the whole thing. GdS: Did you have a job? Yes, at that time, I had a job. Before I came into the open, it was my duty to my colleagues and tell them. I first went to my supervisor who has a very great support. I want to take it outside but I want to take it outside leaving my colleagues before. So I did tell them. The reaction to them was just like you are lying. GdS: We know you’re healthy. We see you working. Yeah, we see you. There’s nothing wrong with you. So why do you tell like this? Most of them, they didn’t like the fact that I am taking it out in the open. They were so very protective. GdS: There are also some people who believe that if you are sick, you are somehow bewitched. Yes, there is something like that. In fact, most people are in that sense of denial. Whenever someone come across maybe death or sickness, they think of being bewitched.

The speed with which the infection rate rose in Swaziland was like a witch’s curse. Measured by blood sampling at neonatal clinics, at the beginning of the decade, the incidence of HIV was quite low, but by 1994, it had jumped to around 16%. Four years later among the pregnant women attending these clinics, the proportion who were HIV positive had risen to 32%. By 1999, the people who had been infected in the earlier period – from ’92 to ’94 – began dying in large numbers. Today, the papers are filled with obituary notices of young people who have died quote after a long illness.

What I found coming in is that many of my colleagues in the international side who had been here over the past five years, people in the donor community and others, were quite cynical. Nothing can be done. Why? Because they had been trying for five years, probably doing their best and nobody was listening. And so their conclusion was it’s hopeless. And I think if anything I see part of my own role coming in as a newcomer here is trying to remove that sense of hopelessness and cynicism because I think the situation has changed fundamentally. People are listening, and everybody I’ve met is not just listening. They hear, and they want to know, and they’re saying help us. We don’t know what to do about this. Help us figure out what to do. My own sense, even before I came, because I worked before in Africa and I worked in villages when I was young as a Peace Corps volunteer, I think the answers are in the villages. You have to get into the way people think, and you have to build on that. You cannot approach this negatively. You cannot come and tell people, well you are dying because you are all sinners and so on. That’s not the case. HIV spreads without relevance. It’s affecting everyone: the sinners and the sinless. In UNICEF, we are worrying about the huge number of infants who are getting infected. Most of the mothers who are infected, they’re infected through no fault of their own.

But many people still think the negative or shock approach is appropriate. Vusi feels it just makes things worse for both infected and uninfected people.

There are obstacles we need to encounter before we fight the spread of HIV. That is one fear, the fear of the unknown. Most people fear maybe to touch someone who is HIV, and the fear again, I do say it was more because of the way the problem was introduced in the country. We only know about AIDS, the last stage of the problem. The statement that we heard on the radio, the TV, the papers was that AIDS kills. If you catch AIDS you die. The pictures that we saw were of people very skinny, who when you see you really say the person will last maybe a day, and then the person is dead. Instead of getting the information, we had to shun away from every information pertaining to HIV and AIDS. We disassociated ourselves with AIDS. GdS: It was too scary. It was too scary. So that is one of the fears. Someone in the high authority in this country once said people who have been discovered to be HIV should be branded. GdS: Branded? Branded. GdS: Like cows. Like cows so that it will help to lessen the spread. When a partner decides to go out with somebody, let’s say Vusi living with HIV, before we do anything, the person will ask me to take my ?? out. That’s crazy. Instead, it’s like putting petrol over fire. GdS: It certainly doesn’t decrease the fear and people will be afraid to talk about it. Yes, yes. That’s making the problem worse. So I would say stigma in the country is too high. I’m still living today because we are still finding these posters that are talking about don’t catch AIDS, avoid AIDS. We are longing for posters that will say you’re not alone. I’m still your brother, even if you are HIV. We need more posters that will hit a message to a lot of those people that are there having HIV to realise that I am not alone.

Alan Brody of UNICEF is convinced that it’s possible to be both positive and effective. He and others have been working on a comprehensive new approach. The king recently travelled to the U.S. and Geneva to consult with AIDS experts and U.N. officials, and his commitment to the cause is essential. Dr. Brody believes that if the Swazi model succeeds, it could inspire other countries too.

In Swaziland, it’s a very close-knit community. It’s a country of just under a million people. It’s a single ethnic group although it’s brought together a number of different clans and so on, but it’s very close-knit, homogenous in many ways. There’s a tremendous respect – I’ve found at least among a great majority of the population – for the king and the queen mother, and especially in the rural areas. The traditional system and the chieftancy system, the chiefs, they have a lot of authority. Nothing happens without their blessing in the rural areas. And they’re under a system and the system…the traditional system is very strong in Swaziland. In fact, there’s no split between the traditional system of governance and the modern one. The king is the head of state, and this is unusual in Africa. So that system appears to me to have tremendous potentials to really grapple with this problem. One because of the credibility in that system and to involve the men and the chiefs. Too many of the messages have been directed to women: protect yourself and assist your man to use a condom. This doesn’t work. They don’t have the power. So addressing the message from credible sources, from influential sources to the men themselves and putting it in terms of this is a national emergency, and this requires courage. This requires bravery. Be a Swazi warrior and always wear your shield when you are going into battle.

What they are preparing is an ambitious plan. Ultimately it will have the chiefs going to every household in the land to ensure that the message of protection gets across. The revered queen mother herself started the ball rolling by naming 60 prominent men and women who are to form a national steering committee for an effort called ?? or bring up the children in the proper way. The project is starting to generate a lot of creative ideas.

?? is a special consultant to the queen mother. She has been preparing for ?? She’s also the only licensed gynaecologist in all of Swaziland. Dr. Delamine was the first to raise an alarm that the sexual abuse of young girls is on the increase along with the HIV/AIDS epidemic. Alan Brody from UNICEF took me to meet her one Saturday night in her living room, together with a friend, she was rehearsing songs they had been writing for the school girls of Swaziland to sing to the Queen Mother.

GdS: Tell me what the words are, what the words mean. The first one: your majesty, please help us remind them to bring us up. Remind them that the future of this country is us. The children are the future of the Swazi nation. So in this song the children are thanking for reminding the adults to bring them up. And they are telling her to remind them we are the future of this country. And they seem to have forgotten it because who is bringing us up. Who is fighting for us? Who is talking for us? Who is teaching us? Who is feeding us? Who is giving us shelter? Generally these are the children who are saying finally, grandma, you have seen that something is wrong. They’ve forgotten their job. GdS: It’s a very strong song, very strong lyrics. It is. We actually…the idea is that the children themselves should be the ones that sing the songs, that ask the questions because the way we have gone about this is that we have so confused our children, they don’t know what we are supposed to do, what they are supposed to do and what the parents are supposed to do. So they are getting conflicting vibes. GdS: And the parents are confused too, I gather. The parents are more confused. We’ll have more lyrics about the confusion of parents, the lost culture, and finding themselves in the middle because they find themselves in a situation where they’ve got one tenth of British culture, and  they’ve forgotten all the Swazi culture. GdS: What are the elements of the traditional culture that would help prevent AIDS from spreading? In reading some 50 and 60-year-old books about Swazi culture, I found that they had traditions that recognised that boys and girls needed to…they did have relations together, but they didn’t have sexual relations. Or, it depends on your definition of sexual relations. We have very wide ones nowadays, but what do they call them? Penetrative sexual relations, if we can put it that way. In the Swazi culture they actually had institutions for educating adolescents. Boys were educated. Girls were educated in how to relate to each other and preserve virginity up to the time of marriage. It’s a very strong traditional value. Ironically, this was broken down when a lot of missionary work began. To missionaries looking from outside, they said looking at these boys and girls and the way they were having sexual relations of a sort. That’s very immoral, and they stopped that. But they had the opposite effect than they intended because what happened subsequently was without that kind of training by introduction of a sort of very moralistic but puritanical viewpoints about talking about sex, the youth kind of ending up without any guidance at all. GdS: But is it really realistic to think of going back to virginity? It’s realistic in the sense that it’s an attempt to make the children realise that what they are doing is wrong. The other thing is that if you are teaching the girls to behave themselves and you give them good reasons, such as behaving yourself because children tend to copy. The children are not doing anything strange. They are doing what the parents do. The children simply follow in their footsteps. It doesn’t matter what you tell them to do. They watch and see she’s only saying this because… GdS: So the song is really a call from the children to the parents to do their duty. Yeah. Just get up and do your duty. Just like it’s a call from the her majesty. Her majesty is saying to the Swazi parents, I’ve been watching you. The grandmother of the family in Swaziland is the custodian of the family culture, of the morals, of the behaviour, of everything. This is what ?? is about. GdS: Are you trying to revert back to a previous culture? Rivers don’t run backwards. You cannot. But what you can do is to draw on positive things from the traditional culture and particularly draw on the pride. When you negatively with any human being – if you raise children you know this – when you’re negative with your children, telling them don’t do this, don’t do that. It doesn’t work. You have to give them pride and a positive sense of identity. I think drawing on traditions allows you as a nation to create pride and a positive sense of identity.

Alan Brody of UNICEF and ?? of Mbabane. It’s time to leave Swaziland and close off this edition of A Good Life. Technical operations today were by Paul Brouwer. I’m Ginger da Silva, and I’ll be back again next week. Tune into A Good Life in seven days’ time. Till then, stay well.