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SWAZILAND: Focus on social impact of AIDS

[This report does not necessarily reflect the views of the United Nations]

MBABANE, 22 February (PLUSNEWS) - "Panic breeding" is the inelegant term given to a response by some Swazis to an AIDS epidemic that is decimating the population of the small Southern Africa kingdom. The impulse to make-up for AIDS deaths by having more babies is exacerbating both the health crisis and the kingdom's ongoing problem with overpopulation.

"People are reacting hysterically to the swath of AIDS deaths that are cutting through the population. Every weekend brings a traffic jam of funerals for young and middle-aged people who die of mysterious 'lingering illnesses', as the newspaper death notices say," explained Alicia Khumalo, a nurse at Raleigh Fitkin Memorial Hospital, the main medical facility in the commercial town of Manzini, Swaziland's most populous urban centre.

"The reaction has been a return to the thinking from the days of low life expectancies, before modern health services: Have lots of babies as survival insurance."

Martin Dlamini, editor and columnist with the Times of Swaziland, noted: "It does not help that government after all these years does not have a population police or an AIDS policy, even though these crises are the worst problems facing us. Without any direction, people take matters into their own hands."

The influential Times of Swaziland columnist James Dlamini, who succumbed to an unnamed wasting disease in 1995 in a country where, then as now, it is taboo for an HIV positive person to admit to their condition, coined the term "panic breeding". He observed that AIDS was providing a new impetus for procreation in a country that at the time had one of the world's highest population growth rates - 3.6 percent per year.

When Britain assumed custody of the territory of Swaziland, about 84,000 Swazis occupied the country. "Independence brought development in the health sector, an expansion of rural clinics, and a rise in life expectancy to 65 years for women and 58 years for men by 1991," said Dr John Kunene, deputy director of health services in the ministry of health.

The population grew 200 percent in the thirty years following independence, and nearly reached the one-million mark when the results of the most recent comprehensive census, taken in 1997, were announced. But by 1997, AIDS, a disease no one spoke about but everyone seemed to acknowledge, was reversing 50 years' worth of social progress.

Last year saw the release of a landmark HIV Sentinel Sero-surveillance Report, one of the first efforts to document with credible data the extent of AIDS in Swaziland, and its effect on population growth. The report, assembled by the Swaziland National AIDS/STDS Programme, found that 34.2 percent of pregnant Swazi women were HIV positive. Half of Swazis with sexually transmitted diseases had AIDS, and 78.6 percent of tuberculosis patients were HIV-positive. Female patients had "significantly higher" HIV rates than males, the study showed.

Fear of AIDS inhibits people from admitting their condition. "I don't want to have a lonely funeral, because my relatives would not come if they learned I have AIDS. They think they can catch it from my corpse," an AIDS patient admitted in an interview.

A projection by the UN children's agency UNICEF estimated that up to one out of three Swazis are HIV-positive (the health ministry prefers a more "conservative" figure, and claims 20.5 percent of the population is infected with HIV). But only 5,600 cases of AIDS from 1987 to 2001 were officially reported to the Swaziland National AIDS Programme office in Mbabane, due largely to government's confidentiality law that forbids a patient's AIDS status from being released without the patient's consent.

However, during the same period, admissions at government hospitals spiralled upward, more than doubling from 1992 to 1996. Deaths among inpatients rose from 318 in 1992 to 2,320 in 1996.

"A large proportion is considered to be linked to HIV infection," said the Sentinel Sero-survelliance report. In 1998, HIV testing of inpatients found 50 percent were infected. Among inpatients aged 20 to 29 years, 65 percent were infected.

Few Swazis are aware of these statistics, but no family has not buried its share of loved ones who, relatives acknowledge in secret, have died of the disease referred to colloquially as "the thing that cuts you down completely" - a disease known to be incurable.

"Swazis can read the handwriting on the wall, they see the destruction AIDS is bringing, and some feel the only way out is 'panic breeding'," said a source at the health ministry.

Historically, the impulse among Swazis has been to procreate, initially in an effort to secure possession of their territory against more populous tribes and encroaching European colonialists.

There is also a socio-economic factor. Swaziland is a peasant society where 80 percent of the population permanently live in single-family homesteads under chiefs, raising subsistence crops, when they are lucky. Government statistics show that 65.5 percent of the population live below the poverty line.

"The traditional farm is labour intensive," said Sipho Mngomezulu, a field officer with the agriculture ministry. "That is why Swaziland has always had such a high population growth rate, because all the farmers raise sons and daughters to work the land."

In an unfortunate twist of fate, when the full impact of AIDS struck, the agriculture ministry was seeing its first successes in transforming small family farms into commercial enterprises through grants and low-interest loans for irrigation and equipment to raise cash crops for market. Community cooperatives allowed farmers to combine their land resources to raise sugar cane, cut flowers and other crops for the export market, particularly the European Union and Taiwan as facilitated by trade agreements.

At the same time, the Family Life Association and other population-control groups were spreading the message that large families increased poverty rather than ensured prosperity. The message went out that in the modern world, children meant a financial obligation toward schooling, clothing and medical expenses. Polygamy, a marital institution created to ensure maximum population growth at a time of high infant mortality and low life expectancies, is still legal in Swaziland, but is practiced less frequently.

"Modern girls are not going to live barefoot and pregnant in a mud hut with other wives," said Beauty Dlamini, a Manzini saleswoman. There are still traditional weddings, but multiple wives are too expensive for most guys."

The progress in changing attitudes toward procreation seen in recent years has been largely wiped out by people's desire to breed their way out of the destruction wrought by AIDS. A source at the Family Life Association lamented: "Babies born with HIV have caused infant deaths to rise, and life expectancy is down to pre-independence levels. All of us in the population control field have striven very, very hard to get the population growth figure down, and this is in fact being accomplished, but not the way we would want it. We have AIDS to 'thank' for the drop."

Swaziland's population, which was growing at 3.6 percent annually a decade ago, is now growing at 2.9 percent. Birth control does not account for the drop. Deaths do. Government hospitals report no let up in the number of births.

"Swazis feel that because of AIDS, they have no choice but to have more babies. HIV testing is not mandatory, so most women do not know they are infected. Without precautions their babies may die tragically, and do," said nurse Khumalo.

UNICEF estimates that at least 10,000 orphans will be created each year in this small country after the children's parents die of AIDS.

"People must be taught that having more babies is not the answer to AIDS," said AIDS activist Pholile Dlamini. "Avoiding HIV is the only way. We must teach prevention, not procreation."

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