Trip notes 2: Swaziland's AIDS crisis

This is the second in a series of posts on my recent visit to South Africa and Swaziland. Part 1 is about South Africa’s fracking dilemma.

The border town of Matsamo is anything but inviting as you wait in the immigration queue on your way into the mountain kingdom of Swaziland.


The day we arrive it is raining heavily. Well-dressed workers stream across the border from Swaziland into South Africa where the jobs are more plentiful. We appear to be the only tourists going the other way. A rusty, buckled sign welcomes you to Swaziland beyond which lies, on one side of the road, a row of tin shacks.

The roof of the building on the other side of the road has long since fallen in, and the walls threaten to follow at any moment. A skinny cow stands in the middle of the road disrupting the traffic.

In the immigration room a vending machine dispenses free condoms, but the supply has run out. It’s that last feature of Matsamo that is perhaps most symbolic of Swaziland’s problems. Consider the following statistics about Swaziland:

– Prevalence of HIV as a percentage of the population aged 15-49 is 25.9%

– Life expectancy is 48.7 years

Inept AIDS response

Swaziland responded to the first cases of AIDS in the country back in the mid 1980s, by all accounts, with earnest good intentions. But as the infections took hold and AIDS spread through the population  the country’s efforts to control it were shown up to be ineffective at best, incompetent and irresponsible at worst.

In 1999, Swaziland’s King, Mswati III, declared AIDS a national disaster. But the King, who took the throne in 1986, has presided over shocking corruption, nepotism and reckless spending of the country’s meagre funds. In 2008, some of his 13 wives went on a  lavish shopping trip to Las Vegas – while two-thirds of the population live in abject poverty. The king has banned journalists from taking photos of his luxury cars, unimpressed by the bad press this generates aboard, where he likes to travel in style to wine and dine with world leaders.

Mswati’s reign is characterised by all the usual traits of tinpot dictatorships, but his sins are worse because of the extent of the AIDS epidemic. The AIDS charity Avert has this to say of Mswati III:

Swaziland’s King has been criticised for his “blatant disregard” for the factors contributing to the AIDS epidemic in his country and living a lavish lifestyle, while his country is in such a dire situation. When the King chartered a plane to take his 13 wives on an international shopping trip in 2008, hundreds of Swazi women protested, shouting “we need to keep that money for ARVs!”.78 79 In 2010 Prince Mangaliso, chairman of the king’s advisory council, claimed pharmaceutical companies were exaggerating the HIV/AIDS epidemic to “keep their businesses afloat”.80

It appears that stronger action from King Mswati and his government is needed in order to dramatically cut HIV transmission rates in one of the world’s worst AIDS epidemics.

Currently there are widespread programmes within the country – ranging from free condom distribution to HIV testing, that are funded by UNAID and other agencies. But entrenched cultural norms are hindering success. People would rather not know that they have HIV than have to face up to it and condom use is disliked among sexually active males. A drive to circumcise tens of thousands of Swazi boys could help reduce the rate of HIV infection, but coverage will have to increase significantly.

Two-thirds of Swaziland’s population lives in abject poverty

Poverty exacerbates crisis

The AIDS problem has been exacerbated by hard economic times hitting the country. Most of Swaziland’s 1.2 million people are either subsistence farmers, work in the sugar cane or forestry sectors or low-paying textile industry

The country’s capital Mbabane exudes a semblance of normalcy – it looks much like any small provincial centre you’d see in South Africa, and when we passed through, a fair amount of building construction was underway.

But the economy is not in good shape, according to the International Monetary Fund:

Swaziland’s financial problems stem from a sudden fall in revenue payments from the Southern African Customs Union but critics of the regime also blame poor economic management and widespread corruption because of the power wielded by Mswati and his inner circle.

In a country where two-thirds of the population live in poverty and one in four adults are HIV-positive, it is extremely vulnerable to the financial squeeze which has had a large impact on basic health and education services.

It has been more than a year since the IMF first advised Africa’s last absolute monarchy to slash its public wage Bill and overhaul its poorly managed economy.

Asian money is starting to flow into Swaziland – as it is in other parts of the country, with Taiwanese investors set to build factories and create jobs for up to 3,000 Swazis.
The country’s economic woes make a direct contribution to the AIDs crisis. While anti retroviral drugs, which keep HIV sufferers alive longer are widely available in Swaziland, their efficacy relies on patients having enough food to take the drugs with. Research from around Africa shows that HIV sufferers who are also struggling to find enough to eat won’t get the protection from antiretrovirals they need.

In a study in Northeastern Uganda, consuming only one meal per day and being dependent on caregivers for food were risk factors for ARV non-adherence [21]. In Zambia, the belief that ARVs must be taken with food led individuals to skip doses when they could not access enough to eat [18]. Lack of food was also among the key barriers to ARV adherence in a qualitative study from South Africa

Malabsorption can occur if antiretroviral agents are taken improperly with regard to meals or if they are taken with certain other drugs or herbal remedies. Some commonly prescribed drugs can cause dangerous drug toxicities if they are taken by patients who are also taking certain antiretroviral medications.

The Guardian adds:

A UN survey of 1,334 households in November 2011 suggested that one in four were worse off as a result of shocks such as rising food prices and loss of work. This resulted in reduced food consumption, with some families skipping meals for an entire day.

The report showed households with HIV-positive members were at greater risk and relied more on cheaper meals or skipped meals altogether. A Swazi MP claimed he had encountered impoverished patients mixing cow dung with water to fill their stomachs in order to be able to take ARVs.

Despite their seemingly overwhelming problems, the Swazis I met were friendly and generous. On the outskirts of Mbabane, we stopped at a crafts market to pick up some souvenirs. It had been raining for days, so the traders hadn’t seen many tourists through. They met us eagerly displaying their carved statues of elephants and lions and beautifully illustrated earthenware. I got back onto our tour bus with a bag full of trinkets that probably cost me $20 all up. In Swaziland, that’s the equivalent of three weeks’ wages for many.

A crafts trader at Mbabane, Swaziland

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