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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


AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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