A new report says 42-percent of pregnant women in Swaziland are infected with the AIDS virus, HIV. That's a three percent increase in the last two years. However, despite the increase, the figures may actually reflect some good news.
Professor Alan Whiteside, of South Africa's KwaZulu-Natal University, has spent many years studying HIV/AIDS in Swaziland. He says that the increase in HIV prevalence among pregnant women was not unexpected.
"The increase in HIV prevalence from 2006 to 2008 is not a great surprise. The reason why it's not a huge surprise is because it could be seen as a success. What it could mean is that there are more people surviving because we know that they've rolled out anti-retroviral therapy. So, the pool of people that you're sampling has more HIV positive people in it," he says.
Many other African countries have received a lot more attention about HIV/AIDS than Swaziland, so the extent of the epidemic there is unknown to many.
"Swaziland does have the worst HIV epidemic in the world. And I think there are a number of contributing factors. First of all, there's the history of the country. It is an isolated country. It's had migrant workers going in and out of it for many years. There are particular gender questions in the country around the role of women and how they're perceived by men. There's a question of concurrent partnering (polygamy), which is a major issue. Swazis don't circumcise," he says.
Whiteside describes Swaziland as a "perfect storm of many issues coming together to create the worst epidemic in the world."
Swaziland King Mswati the Third is believed to have at least 13 wives. Asked how that might affect how women are perceived, Whiteside says, "This is a problem that we face in that you do have polygamy, which is accepted and respected. What we've had until recently is a view of women as being there primarily for men. What I have to say is that legislation in the country has recently changed and the challenge is to change the mindset of the people. And maybe the king has a role in leading this change of mindset."
Whiteside is currently writing a book on HIV/AIDS in Swaziland and is co-author of the book: AIDS in the 21st Century. He says that many countries with similar HIV/AIDS problems have "macho societies. That has to change."
However, behavior change is often difficult and slow. "We tend to want to prescribe what a country should do. And we forget that it is less than 80 years since women were given the vote in the UK. So, there are major changes in gender relations in the West (that) we want to happen in a few years. Indeed, it's a matter of life that they do happen in a few short years across Africa," he says.
The KwaZulu-Natal university professor says empowering women would go a long way toward lowering HIV prevalence rates. "I would be giving grants…particularly to women and to grandmothers because we know that they spend the money wisely for the most part. They would feed and educate their children, grandchildren and the orphans in their communities," he says.
Swaziland has a large AIDS orphan population for a country of its size. "According to government data, they believe that there are about 225,000 children who've been orphaned. And this is in a population of less than a million. So, it's fairly catastrophic," he says.
However, there has been a large government and community-based response to the problem, as well as an influx of donor aid. Money from the US PEPFAR program, for example, is used to help Swazi orphans.
circumcision is being promoted as a way to reduce the spread of HIV. Studies
have shown that removing the foreskin of the penis eliminates a possible reservoir
for the AIDS virus. "Circumcision is not a tradition there, but there are a
number of initiatives that are rolling out circumcision and the demand is very,
very high. So, what we're seeing is that men are changing their view of this
and society is changing their view of it," he says.
Whiteside says that there are a number
of factors preventing Swaziland from being more in the HIV/AIDS spotlight.
"it's a tiny, little forgotten country, very sadly. The population of less than
a million… It's ruled by a king. So the global community looks on it as not
being typical. And the other and worse problem is that in terms of the World
Bank definition, Swaziland is seen as a lower middle income country. In other
words, the perception is that it's doing ok. But it isn't doing ok. AIDS is
cutting a swath through the population," he says.