Integrated Regional Information Networks - December 31, 2002

The small southern African kingdom of Swaziland has the worst HIV infection rate in the world, according to a new ministry of health report, and the government is turning to NGOs and international health organisations to help handle the crisis.

The report has estimated that 38.6 percent of Swazi adults are HIV positive, up from 34.2 percent at the beginning of 2002.

Both figures were based on surveys of women at government antenatal clinics, extrapolated in a manner that health experts said was a reliable indication of the general population. But the earlier findings was the result of tests done in 2000, while the current 38.6 percent figure was based on results from last year.

"Both statistics are a year out of date by the time of their release," a health ministry source told IRIN.

The seemingly out of control rise in HIV infections has been blamed variously on gender inequality that denies women, who are legal minors, a say in having children, to an insensitive feudal leadership that feels no urgency in safeguarding the health of the peasant majority. Swaziland is ruled by sub-Saharan Africa's last absolute monarch. Despite King Mswati III's declaration of AIDS as a "national crisis", little additional government funding has been allocated to combating the disease.

"To put it bluntly, in a monarchy, everyone is considered dispensable but the royal rulers," a political activist told IRIN.

Palace sources scoff at the notion that Mswati is insensitive to the HIV/AIDS crisis, despite reported extravagant spending in 2002 on cars and homes for the royal household. "The king is the king of all people," Prince Mfanisibili told IRIN.

Controversy has surrounded the delayed release of the new HIV statistics. A draft was in circulation among health organisations, government offices and foreign envoys for months. The health ministry has still not officially released the report, but has let it seep out without comment.

"The health ministry does not want Swaziland to take the position of being Africa's leader in HIV infections," a health care professional alleged.

No matter how dire Swazi HIV/AIDS statistics have been, government officials took comfort in the fact that Botswana's infection rate was historically higher.

But the new findings have changed the picture, particularly in the light of Botswana's more active efforts in HIV/AIDS prevention and treatment.

The Swazi government's major initiative this year was the launch of the National Emergency Response Committee on HIV and AIDS (NERCHA). The committee's purpose has been the distribution of government and donor funds to health NGOs and other groups active in anti-AIDS initiatives.

But critics point out that Swaziland has yet to formulate a national HIV/AIDS policy. Civil society groups have instead stepped into the breach.

"Knowing that even a 38.6 percent infection rate for HIV may already be an out of date figure can be overwhelming, but it inspires those of us in the AIDS mediation field to work harder," Rudolph Maziya, the national coordinator for the Alliance of Mayors' Initiative to Combat AIDS at the Local Level (AMICAALL), told IRIN.

AMICAALL was founded by Swazi mayors who sought funding and technical support for community programmes aimed at tackling HIV/AIDS. In 2002 a full contingent of community coordinators took up duties in the main urban centres of this conservative kingdom.

"The coordinators are assisting individuals who have original ideas for AIDS projects to submit proposals and find funding," Sebenzile Ginindza, the community coordinator for the capital Mbabane, told IRIN.

Projects given the green light thus far have been hospices for AIDS patients, gardens to generate income for AIDS orphans while addressing the nation's food shortages, and employment opportunities for people living with HIV in a country with a 40 percent unemployment rate.

AMICAALL programmes have been directed at towns, which as a result of rural migration, are absorbing an increasing percentage of Swaziland's one million population.

UN Children's Fund representative Alan Brody told IRIN that the new HIV statistics were "just a projection of the misery to come. People who acquired HIV seven to 10 years ago are at the end of the gestation period, and are now developing AIDS". He said that 20,000 Swazis were developing AIDS each year.

"It's a vicious cycle," said AIDS counsellor Sipho Ndwandwe. "The more we are in denial about AIDS, the more people who should be cautious are reckless, and the disease spreads. Because people refuse to believe how widespread AIDS really is, they shun known AIDS sufferers, and treat them as isolated, dangerous individuals."

Private and non-governmental relief organisations fill some of the gaps, but the need far outstrips the availability of services. "Swaziland has a few hospices here and there, but nothing uniform, and nothing that can meet the number of AIDS patients in the country," said Thuli Dladla, an official with NERCHA.

Total government capital expenditure for all national health needs in 2002/03 was budgeted at US $4.1 million.

Visit IRIN's PlusNews Swaziland HIV/AIDS Country Brief at: http://www.irinnews.org/AIDS/swaziland.asp

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