World AIDS Day: Swaziland Edition

I arrived at the Baylor clinic at 9:00 in the morning, knowing full well that although the event was supposed to start at 8:30, it would be at least half an hour until it started. We had set up the giant tent the day before to protect the attendees from the hot summer sun, but it turned out to be a Seattle day- cold and damp, with a dark overcast. The problem with mountain climates is that you can never trust the weather forecast.

I was there for the World AIDS day commemoration event. Even though World AIDS day wasn’t until next Tuesday, there are so many NGOs that work with health that they have to space their events throughout the week to avoid conflicting with each other. The audience for our event was a good mix of Baylor patients, including the youth who participated in the Teen Club support groups, and the doctors, board members, and other stakeholders within Baylor College of Medicine – Swaziland.

The commemoration started with a prayer and a church hymnal from the master of ceremonies, which I’ve come to expect at any public ceremony in Swaziland. Next, the formidable executive director Ms. Hlatshwayo gave the opening remarks. She celebrated Baylor’s role in reducing the mother to child transmission rate to 2 percent, while emphasizing the importance of talking about HIV with peers to reduce stigma.

Then, the Teens from the Teen Clubs gathered in the front to perform an instructional skit about HIV, told from the perspective of the HIV virus itself. “My name is HIV. The only thing I’m afraid of is people who take care of themselves,” said the plucky Swazi youngster who played the role of the virus. Following the skit, a group of Swazi women wearing traditional Swazi dress danced and chanted in siSwati.

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The next couple of hours continued in the same way, with speeches about the state of HIV in Swaziland interposed by various performances from Teen Club youth. While the speeches were optimistic, they also emphasized the enormous scale of the problem. And with good reason: The HIV/AIDS crisis is one of the most significant facts of life in Swaziland today. The disease has ravaged the population, dropping the life expectancy from 63 years at the beginning of the epidemic to 48 years at its height in 2008.

Even worse, the most socially disadvantaged populations within Swaziland have been at the highest risk of the disease. The percentage of women living with HIV/AIDS today is around 31 percent, compared with 20 percent of men, and this disparity becomes more pronounced in lower socio-economic brackets. While the mother to child transmission has dropped to below 2% today, before the intervention of NGOs percent of the child population infected through mother to child transmission was startlingly high. A particularly tragic result of the epidemic is that nearly half of Swazi children now fall into the Orphans and Vulnerable Children category, a significant portion themselves infected.

These are immediate, tragic human impacts. Often overlooked, however, is the less quantifiable damage the disease has dealt to the social fabric of Swazi society. One of the staples of Swazi society has been its traditionalism, largely due to the fact that Swaziland is a tiny, homogenous country (84% of its population are ethnic Swazi) that reverted to absolute monarchy during its decolonial transition in the late 1960s. Along with other powerful social institutions such as Zionist churches (which blend Christianity and indigenous worship), the monarchy has strategically maintained its stronghold by reinstating old rituals of Swazi society as performances of national solidarity.

The Umhlanga ceremony, which features a Reed Dance performed by a parade of (topless) Swazi girls, is probably the most well-known of these rituals. The true origins of Umhlanga are speculative, because they rely heavily on oral accounts, but African historians believe that Umhlanga became a much more central Swazi tradition after the resurgence of the monarchy. The ceremony is widely understood to be a celebration of virginity since only childless, unmarried girls can take part; more dubiously, it has been speculated to be a market for the King to choose his next wife from (in truth, this has probably only happened with two of the kings 14 wives).

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The Princess at Umhlanga

While chastity has become a central theme of the ceremony in recent years, Umhlanga was originally designed to provide tribute labor to the Queen mother. But, as with many other institutions, the ceremony has been forced to contend with the presence of HIV/AIDS. By 2001, the force of HIV/AIDS in Swaziland was too concussive to ignore. In response, King Mswati III issued a call for Umcwasho, a full ban on sex among unmarried virgins for 5 years. This policy was consistent with the traditional values of older Swazis, and therefore was met apparently without opposition from the public institutions (though it was considerably less popular among the Swazi teens).

Highly visible and well-attended, the Umhlanga ceremony became one of the public battlegrounds for the fight against HIV/AIDS, where the young women were trained to be the soldiers for the cause. An HIV/AIDS education campaign began within the ceremony itself, and the girls were taught new chants about the dangers of HIV/AIDS. Like the chant reproduced below, many of these chants reinforced conservative ideologies of sexuality and gender.

(Lead singer)Inyandzaleyo Malangeni!
(Chorus) Nawe ingakutfola iAIDS
(Lead singer) Hlala ngentfombi Ntfombatana!
(Chorus) Nawe ingakutfola iAIDS
(Lead singer) i- AIDS ibhokile lonyaka.
(Chorus) Nawe ingakutfola iAIDS

(Lead singer) Beware Malangeni!
(Chorus) You too will be caught by AIDS
(Lead singer) Sit like a lady, girl!
(Chorus) You too will be caught by AIDS
(Lead singer) AIDS is widespread this year

(Chorus) You too will be caught by AIDS

Of course, while abstinence campaigns work in a perfect world, in practice they have very little positive effect on sexual habits, and actually tend to be detrimental because they deter the use of condoms and other low-risk sexual practices. More damningly, since girls in gender unequal societies tend to have very little bargaining power (and Swaziland is no exception), the decision to have sex, and the way to have it, largely resides with the man in heterosexual relationships. Accordingly, abstinence programs aimed at women usually fail to target the root of the problem.

This became apparent in Swaziland when the rates of HIV/AIDS continued to climb during the Umcwasho period, and by the end of Umcwasho in late 2005, government policy was starting to become more responsive to public health campaigns. It is unclear what caused the change in policy- I suspect a combination of conditional development/aid dollars and the obvious failures of the abstinence programs- but the fact remains the government allowed a variety of non-state actors to implement HIV/AIDS responses.

The period between 2006 and 2008 saw the implementation of the second phase of the National Emergency Response Council for HIV and AIDS (NERCHA), the umbrella organization of the national response to HIV/AIDS. This phase was much more proactive than the previous phase, and funneled UNAIDS money towards UNAIDS approved health care sectors.

Meanwhile, prominent NGOs had begun to work within Swaziland. Notable among these are Young Heroes, ICAP, and BIPAI (the organization I’ve been working with). I have trouble keeping track of the alphabet soup of NGOs working in Swaziland today, and I have no doubt that the influx of white expats (like myself?) and their (our) Western values is another part of the disruptive core of HIV/AIDS.

Abstinence is still a large part of the social response to AIDS, especially in the churches which most Swazis attend on a weekly basis, but contraceptive use, free public testing, and other public health approaches are widely acceptable practices, albeit with considerable variance in urban vs. rural areas. This protean response is exemplified by the ABC (“Abstain, Be faithful, Condomize”) slogan that is widely advertised in Swaziland.

All in all, it is hard to overstate the impact of HIV/AIDS in Swaziland. For now, it is a defining feature of life in Swaziland, as recognizable as minibuses, chicken and pap restaurants, and colorful ceremonial dress. And it has redefined how Swazis view their relationship with their significant others, with their friends, with their bodies, with their king, and with God.

I’ll conclude with a quote from the keynote speaker at the world AIDS day event that sums my article up quite beautifully. “Because of AIDS we have a new relationship with God. We are discovering that we are kind, confident, empowered, and spiritual.”

 

 

 

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