Abstract
Swaziland’s HIV/AIDS epidemic has been characterized by the slow onset of a myriad of co-factors culminating in a chronic emergency, burdening every sector of society. Exacerbated by domestic political mismanagement and ill-suited policies of international organizations, impacts will remain endemic for generations.
From near-zero diagnosed HIV infections in 1990, Swaziland now has the highest relative prevalence in the world. The impacts of infection are withering the human capacity to mount effective and systemic interventions. Indicators of social well-being show a population in distress. Aggravated by gender inequality, drought, agricultural decline and insufficient financial resources, livelihood failure in Swazi households has become commonplace–and the situation is deteriorating.
This article argues that the brutal reality facing the Swazi population is perpetuated by the lack of political will of government and conditionalities imposed by international donors. In the absence of comprehensive government-led programming, many communities have initiated interventions. Assisting these vulnerable populations requires sustained international financial commitments. This money would be used to best effect if accompanied by pressure for domestic political accountability in Swaziland. Such changes will facilitate country-wide interventions, particularly those at the community level. While Swaziland is the case study, many of the findings are applicable to generalized epidemics throughout southern Africa.
Key words: HIV/AIDS, Swaziland, humanitarian emergency, international aid, disease burden, gender inequality, Southern Africa
Résumé
Au Swaziland, l’épidémie de sida se caractérise par la lente apparition d’une multitude de cofacteurs qui ont mené à un état d’urgence chronique et compliquent l’existence de toutes les couches de la société. Exacerbées par la mauvaise gestion politique interne et par les politiques malavisées des organisations internationales, les répercussions de l’épidémie se feront sentir pendant plusieurs générations.
Alors qu’on ne diagnostiquait presque aucune infection à VIH au Swaziland en 1990, le pays affiche maintenant la prévalence relative la plus élevée au monde. L’infection mine la capacité des Swazis de monter des mesures d’intervention efficaces et systémiques. Selon les indicateurs du bien-être social, la population est en détresse. Sous le poids combiné des inégalités entre les sexes, de la sécheresse, du déclin de l’agriculture et de la pénurie de ressources financières, les ménages n’arrivent plus à assurer leur subsistance, et la situation ne cesse de se détériorer.
Dans cet article, nous faisons valoir que la réalité brutale à laquelle la population swazie est confrontée est perpétuée par le manque de volonté politique du gouvernement et les conditions imposées par les donateurs internationaux. En l’absence de programmes gouvernementaux intégrés, de nombreuses communautés amorcent leurs propres interventions. Pour aider ces populations vulnérables, il faut des engagements financiers internationaux soutenus. Et pour qu’on en fasse une utilisation optimale, les fonds doivent être accompagnés d’appels à la responsabilisation politique interne. De tels changements faciliteront les interventions nationales, surtout les projets à l’échelle communautaire. Nous nous sommes concentrés sur le cas du Swaziland, mais bon nombre de nos constatations s’appliquent aux épidémies généralisées en Afrique australe.
Mots clés: VIH/sida, Swaziland, urgence humanitaire, aide internationale, charge de morbidité, inégalités entre les sexes, Afrique australe
References
- 1.UNAIDS. AIDS Epidemic Update 2007. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO); 2007. [Google Scholar]
- 2.Helping Ourselves: Community Responses to AIDS in Swaziland. UNAIDS Best Practice Collection. Geneva, Switzerland: Joint United Nations Programme on AIDS (UNAIDS); 2006. [Google Scholar]
- 3.Government of Swaziland . Demographic Health Survey. 2007. [Google Scholar]
- 4.UNDP Human Development Report 2006. New York, NY: United Nations Development Programme. 2006. [Google Scholar]
- 5.Swaziland Population Projections 1986–2016. Population Projections. Mbabane, Swaziland: Central Statistical Office; 1986. [Google Scholar]
- 6.Swaziland PopulationHousing Census . Provisional Results. Mbabane, Swaziland: Central Statistical Office; 2007. [Google Scholar]
- 7.Government of Swaziland. National Plan of Action for Orphans and Vulnerable Children 2006–2010. Mbabane: Government of the Kingdom of Swaziland; 2006. [Google Scholar]
- 8.Zwane Teettee. No need for aid in SD–agencies. 2007. [Google Scholar]
- 9.Government of Swaziland. The National Constitution of the Kingdom of Swaziland. 2006. [Google Scholar]
- 10.National Survey on Violence Experienced by Female ChildrenYouths in Swaziland. Violence Against Children in Swaziland. 2007. [Google Scholar]
- 11.FoodAgriculture Organization FAO of the United Nationsthe Government of the Kingdom of Swaziland TCP/SWA/2907. Comprehensive Agricultural Sector Policy (CASP): Final Draft. Mbabane: Swaziland; 2005. [Google Scholar]
- 12.UN Office for the Coordination of Humanitarian Affairs. IRIN. Swaziland: Food or Biofuel Seems to be the Question; 2007. [Google Scholar]
- 13.Zvomuya P. Mail and Guardian. 2007. Swaziland’s Constitutional Crisis. [Google Scholar]
- 14.Puddington A. Freedom in the World 2007: Freedom Stagnation Amid Pushback Against Democracy. 2007. [Google Scholar]
- 15.Whiteside A, Whalley A, (Scott Naysmith editor). Reviewing ‘Emergencies’ for Swaziland: Shifting the Paradigm in a New Era. Health Economics and HIV/AIDS Research Division (HEARD) and the National Emergency Response Council on HIV/AIDS (NERCHA). Durban, South Africa and Mbabane, Swaziland, 2007.
- 16.UNDP Human Development Report 2000. New York: United Nations Development Programme. 2000. [Google Scholar]
- 17.UNDP Human Development Report 2007/2008. New York: United Nations Development Programme. 2007. [Google Scholar]
- 18.UN Office for the Coordination of Humanitarian Affairs. Swaziland: IMF Urges Economic Reforms. IRIN. 2007. [Google Scholar]
- 19.UNAIDS. Quality and Coverage of HIV Sentinel Surveillance with a Brief History of the HIV/AIDS Epidemic; 2003. [Google Scholar]
- 20.WHO. Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: Botswana, 2006 Update. Geneva, Switzerland: World Health Organization; 2006. [Google Scholar]