New reality requires new strategy in southern Africa

Published: 27 May 2003 0:00 CET

John Sparrow in Evusweni, Swaziland

Chief Delezi Masilela did the unthinkable. He stood up in his rural community in central Swaziland and said he was HIV positive.

It sent a shudder through the homesteads of Evusweni and his family counselled him to be silent. They said he was bringing shame upon them, and one of his wives soon left him.

The traditional chief, who already suffers from tuberculosis, could have expected it. Although he lives in a country with the second-highest prevalence of HIV/AIDS in the world, the stigma around it is so great the disease is kept in the shadows.

Officially, almost 40 per cent of Swazi adults are said to be infected, based on findings among pregnant women more than a year ago. The true picture is probably worse.

With prevalence climbing, the Red Cross fears that in parts of southern Africa the figure could soon be upwards of 50 per cent.

But as things stand, few of the 20,000 Swazis expected to be infected this year will ever be open about it. They are simply too afraid.

A health ministry survey has shown that while people are willing to care for HIV-infected relatives, most ostracise others living with the virus. Information campaigns ensure there is widespread general awareness but AIDS isn’t something ordinary people talk about.

And behind the veil of secrecy, the ministry found, risk-taking behaviour has not diminished, either. Given the prevalence of the virus, the prognosis is grim for this kingdom of 970,000 people.

Seeing more and more people dying around him, Chief Masilela made his stand. He had to break the silence.

The impact of AIDS on agriculture, the poverty left in its wake, the plight of children orphaned and women widowed had left him fearful. Unless people speak up and face up to the spread of HIV, he believes, his community is doomed. “If things don’t change, it will just die off,” he says.

The chief's fears are shared by the Red Cross. The threat to communities such as his is reflected in an emergency appeal launched today by the International Federation. Seeking 13.6 million Swiss francs (US$ 10.3 million), it will extend Red Cross National Society operations in Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland, Zambia and Zimbabwe.

The appeal sets out new strategy based on an integrated community-level response. The interaction of HIV/AIDS, failed health care, poverty and food insecurity has created an unprecedented disaster conventional intervention cannot contain, it says.

Without fresh approaches a dramatic fall in life expectancy, a decimation of the workforce and agricultural production, and the destitution of whole communities are inevitable.

The appeal depicts the erosion of community fabric, with HIV/AIDS the driving force. Poor and worsening access to health care, the accelerated spread of tuberculosis, malaria and other disease, a widespread shortage of safe water and sanitation, uncontrolled urbanization, and ineffective agriculture are among the aggravating factors, it says.

It calls for a response in which these inter-related ills are no longer dealt with separately. A comprehensive package of measures is needed, it says, to curb a patchwork of problems feeding and exploiting each other.

Masilela sees the evidence around him. He spells out what AIDS does to farming. “The people who are dying should be out there ploughing and planting the fields,” he says. "Swazi culture is such that when a farmer dies others in the community step in, help work the land. But even they have died. There is no one to assist anymore.” Land lies idle as a consequence.

Failed harvests prompted a global response of food aid to avert starvation in southern Africa, but now, as harvests improve in parts of the region, aid is being scaled down. The threat of famine has, for now, receded but food insecurity has not.

The chief is particularly concerned for women and orphans plunged into chronic poverty by the loss of husbands and parents. Women are disproportionately affected by AIDS. It is they who nurse the sick, they who form more than 50 per cent of the infected, and they who, as widows, are left to feed, educate and agonize over the future of their soon-to-be-orphaned children.

Busisiwe, a 37-year-old mother of five whose husband died of AIDS a year and a half ago, is one of them. On her homestead, Masilela leads the way through high green maize, part of the coming harvest, but the impression it gives is misleading.

Busisiwe is struggling to keep her children fed. Unable to afford seed or work her fields properly, she leased them to neighbours for a share of the crop. But even after this year’s promising harvest she will retain but a few bags of maize.

She is eating into them already. Short of food, she is cutting and grinding the unripe crop, and those bags will be depleted further. Her children’s school fees are in arrears and when harvest comes she must sell some maize to pay them, or the children will be excluded.

Something else has concerned her lately: her own health and strength is waning. She has TB and awaits the outcome of a Red Cross HIV test. Soon she could face a mother’s greatest fear: who will care for her children.

Already southern Africa counts 3.2 million children orphaned by AIDS, many of them in child-headed households, where tomorrow’s meal is not guaranteed and youngsters drop out of school because they, too, cannot afford the fees.

Only when the denial of AIDS is dispensed with can communities start to look for solutions.

Chief Masilela is working on food security. He has already persuaded the elders to set aside land for orphans, and advocates communal farming and crop sharing to help infected and ailing people. Outside help with such schemes would be welcome.

Humanitarian thinking and analysis must change, the Federation appeal says, warning that donor and governmental policy could soon lag behind the emerging challenges. A new paradigm is needed, and the Federation is calling for “a consortium of partners with special interests and capacities” to intervene now to contain the crisis and develop medium and long-term strategy to return communities to normality.

Delezi Masilela’s quest to change his community’s mindset is part of the same equation. The removal of stigma is but one step. Cultural standards and practices in a traditionally polygamous society present other critical challenges. Multiple sexual partners are the norm in Swaziland, casual sex is highly prevalent and premarital sex starts young.

These habits can be traced to a time when life expectancy was low and infant mortality high. Then they were a question of survival. Today they mean the spread of HIV and the reversal of development.

Masilela’s voice can be likened to a prophet’s crying in the wilderness. There are signs that some people are listening. To others what he says is heresy.

He acquired the virus, he says, when he inherited a late brother’s wife, who has herself passed away. He suggests that HIV testing should today precede the traditional practice. Given Swazi reluctance to be tested, and the fear of the stigma it might bring, it is a less than palatable notion.

But AIDS has changed the face of disaster in Africa. Everyone must change with it. Unless they do, warns the Federation, the apocalypse of AIDS will very soon be unstoppable.

Related links:

Southern Africa Food Crisis
News story: Swaziland stalked by an "alliance of ills"
Reducing the impact of HIV/AIDS
Make a donation