The Elephant

I know I don’t mention my work much in these blogs, but it has now been over 7 months since I left Aussie shores, so I figure it’s probably high time I convinced you that my life here is much more than an extended holiday.

So, why am I here?

Swaziland has the highest HIV rates in the world.  Almost 26% of the population are infected, with almost of half (49%) of women aged 25-29 harbouring the “killing disease”.  The impact of this gigantic elephant in the room cannot be understated.

  • In 1997, an average Swazi could expect to live to 60.  In 2004, this had dropped to 31.4.
  • One third of the country’s children have been orphaned by the disease, and 43% of households now harbour orphans.
  • HIV and AIDS is the primary killer of children under 5, accounting for 47% of all deaths.
  • More than half the hospital beds are occupied by people with HIV-related illnesses, and two thirds of deaths in the country are due to AIDS.

All of this eventually prompted King Mswati III to re-introduce umcwasho, the tradition of abstaining from sex for five years, and banning sex with girls under 18.  However, he broke it himself after four years by taking a 17 year-old wife to add to his collection.  He was, however, the first Southern African leader to get tested for the disease, and has strongly encouraged others to test, yet he has also discouraged Male Circumcision, which has the potential to reduce infection by 60%.

A raft of other factors contribute to the rapid spread of HIV, of which only a few are listed here.

  • 69% live below the poverty line with 37% living in extreme poverty.  However, the country is classed as middle-income due to the huge wealth secured by the country’s few elite, which also makes it ineligible for various forms of international assistance.
  • 79% of the population live in rural areas, predominantly on subsistence farming.   In 2007, 40% of the population relied on food aid, with the malnourished, of course, being more susceptible to HIV and more likely to progress to AIDS.
  • Health care tries, but struggles to meet the country’s needs.  While 80% of the population live within 8km of a health facility (which, in itself, not an easy walk for a sick grandmother), 12% of nursing posts and 33% of medical professional posts were vacant in 2005. Attrition rate among health care workers stands at 7.9% annually.
  • By 2007, only 36% of women and 17% of men aged 15-49 had been tested for HIV and knew the results.  Only 28% of those needing Anti-Retroviral Therapy are receiving it.
  • Swaziland is a polygamous country, legally and culturally.  However, the introduction of Christianity has led to a decline in polygamy and a rise in in more ‘informal’ relations outside marriage.  93% of men admit to being unfaithful or having multiple concurrent partners in the last year.
  • Sexual debut is starting younger (around 16 years), and 10% of young people say their first sexual partner was at least 10 years older than them.  22.6% of people aged 15-19 are already on the childbearing road.
  • Women are, by far, the most susceptible and hardest hit by HIV.  Two thirds of women experience sexual abuse at some point in their lives and marital rape is disturbingly common and accepted.  Until recently, married women were legally classified as minors under the guardianship of their husbands and in-laws, which means they were unable to own land, and could not own a passport or take a loan without their husband’s permission.

Depressed yet?

Fortunately, there are a few shining lights in this darkened tunnel. Recent figures show that the incidence rate for HIV is dropping, ever so slowly but in the right direction none-the-less.  In recent years, Swaziland adopted a new constitution that (theoretically) gave women equal rights.  Then, of course, there are organisations such as mine (Gone Rural boMake) who are working closely with women, not necessarily on HIV directly, but by targeting the social determinants of health.

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