Swaziland's deadly cycle of hunger and Aids
By James Hall

Swaziland, the tiny Southern African kingdom with one of the world's
most severe AIDS problems, has begun to confront the reality that the
epidemic is no longer just a medical problem, but one that is
wreaking economic and social devastation that threatens national
survival.

"There is a ghastly synergy at work with HIV/AIDS in Swaziland," says
Dr John Kunene, principal secretary at the Ministry of Health and
Social Welfare. "Like a row of falling dominoes, the impact on one
area strikes another area. The result is more poverty at a time when
poverty eradication is a national priority, and less food production
during the middle of a drought and food security crisis."

The United Nations AIDS programme says the epidemic in Swaziland "has
assumed devastating proportions."

"National HIV prevalence in Swaziland has matched that found in
Botswana (the country with the highest HIV prevalence rate in the
world), at almost 39%. Just a decade earlier in Swaziland, it had
stood at 4%," a UNAIDS report notes. It says HIV prevalence among
pregnant women is at almost 40% in Gaberone (Botswana) and Manzini
(Swaziland).

Swaziland shows no sign of decline in HIV prevalence, the report
adds.

Two-thirds of Swazis live in chronic poverty, and the AIDS epidemic
is reversing poverty alleviation efforts by the government and by
international humanitarian groups.

"The goals were to make Swaziland self-sufficient in food production,
end poverty, provide universal health care and education for all
children. Each of these goals has suffered a significant setback
because of AIDS," says AIDS activist Joyce Khumalo.

Life expectancy for a Swazi was once projected to be 57 years by this
year. But AIDS has brought it down to a mere 39 years – less than it
was during colonial times, before a nationwide system of hospitals
and clinics was established.

`The impact of an ailing workforce strikes particularly hard in
agriculture, just when drought grips the country for the third
consecutive year. Over a fourth of the population in this nation of
less than a million people is currently surviving on food assistance
from aid agencies, led by the UN World Food Programme and the
International Red Cross'

The life that is lived is increasingly impoverished. With AIDS
sweeping the industrial and agricultural workforce, Gross Domestic
Product will rise only 1.7% this year, according to the Central Bank
of Swaziland – down from the 3.4% growth recorded three years ago and
half the 3% annual rise the bank says is needed to raise living
standards.

The impact of an ailing workforce strikes particularly hard in
agriculture, just when drought grips the country for the third
consecutive year. Over a fourth of the population in this nation of
less than a million people is currently surviving on food assistance
from aid agencies, led by the UN World Food Programme and the
International Red Cross.

"I think it's clear to everybody by now that you can't separate food
from AIDS," says Sarah Laughton, WFP emergency coordinator in
Swaziland.

Laughton says food scarcity is likely to continue even if good rains
return, and the WFP is shifting from emergency relief to ensuring
that families affected by AIDS have enough to eat. Insufficient food
harms HIV positive people who need proper nutrition to forestall the
onset of AIDS, and poor nutrition hastens the progression of HIV
infection to AIDS, wasting and death.

Another problem is that adequate provision of food is also a
necessary condition for the success of efforts to treat people living
with HIV/AIDS.

Experts point to the interdependency of nutrition treatment with Anti-
Retroviral (ARV) drugs, which have made HIV/AIDS a manageable
disease. ARV programmes, they say, need to be integrated with
nutrition services, something that the government of neighbouring
South Africa, for instance, plans to do.

However, even the best-intentioned projects can be unsuccessful if
the realities of hunger and livelihood issues are not taken into
account. In Zambia, which too faces famine, people with HIV/AIDS were
handed out ARV drugs with 5kg bags of nutritious soy food last year.
But the project collapsed when entire families were found sharing the
food – AIDS patients refused to eat the food if their families went
hungry.

In Swaziland, beginning this year the first ARV drugs are slowly
finding their way to patients. Distribution plans are being expanded,
while nurses and caregivers are being trained in administering the
drugs.

But the link between proper nutrition and the successful
administering of ARVs has not been officially acknowledged by
government, and there are no formal food distribution efforts to
accompany the dispensing of ARVs.

Individual NGOs do recognise the link, however, and they do what they
can within their mandates. Shelia, an Mbabane secretary who joined
the support group the Swaziland AIDS Support Organisation (SASO) when
she learned she was HIV positive two years ago said, "SASO counsels
us in proper lifestyle, which includes nutrition. We receive vitamin
supplements, and sometimes poorer members receive food assistance."

Pregnant, lactating and HIV-positive women receive food supplements
through a UN Children's Fund programme, with food coming from the
WFP. "The mothers receive a high-nutrition formula concentrated in a
soya blend supplement," says WFP's Laughton.

Such NGO efforts can do little to mitigate widespread hunger.

"Swaziland is suffering its fifth consecutive year of declining
harvests, and it is due to more than drought. There are fewer adults
to plant and weed crops, and bring in the harvests. Fewer fields are
being planted, and so there is less food," Laughton says.

Commercial farms, producing sugarcane and citrus fruits for export,
are faring better than others because they can hire migrant workers
from neighbouring countries like Mozambique. But small family-farms
are suffering. Eighty percent of Swazis live as peasant farmers on
communal land under palace-appointed chiefs. With no irrigation or
mechanized operations, they depend on rain and manpower to grow their
subsistence crops.

At least 10,000 households are now headed by children under 18 years
of age, who lack the physical ability and expertise to grow the crops
on which they and their siblings depend for survival. "It will take
years for an adult population of farmers to return," says Laughton.

By that time, there may be no land for the children to live on:
inheritance laws do not cover the four out of five Swazis who live on
communal land, where the rule is that if a field is unproductive for
two cropping seasons, the chief may give it away to others, including
developers.

— The writer noted for his analyses, histories and films featuring
the kingdom.

— Panos Features