PRESS CONFERENCE ON HIV/AIDS IN SWAZILAND

PRESS CONFERENCE ON HIV/AIDS IN SWAZILAND

A senior United Nations official today said that for the Kingdom of Swaziland, the written logo of its existence had been expressed on the cover of most recent Joint UN Programme on HIV/AIDS (UNAIDS) HIV prevalence report:  “A Nation at War with AIDS”.

Stephen Lewis, the Secretary-General's Special Envoy for HIV/AIDS in Africa, told correspondents at a Headquarters press conference that the inexorable sweep of the virus there had been calamitous, with HIV prevalence rates having jumped 900 per cent since 1994.  Swaziland now held the dubious title of having the “highest prevalence rate in the world”.  Just back from Swaziland, he described a grim picture of the devastation wrought by the virus, and asked, “What is to become of this lovely little country?”

With a World Health Organization (WHO) initiative to provide anti-retroviral treatment for 3 million people with HIV/AIDS by 2005 -– the “3 by 5 initiative” -- running into a roadblock for lack of funding, and with prevalence rates hovering around 40 per cent, he wondered how a tiny country like Swaziland could cope.  “You can see the virus on people’s faces in the street ... in a crowd ... on the faces of rural villagers”, he said.

“It was a difficult trip because the sense of death is so pervasive”, he continued.  Likening a visit to the female medical wing of Mbabane GeneralHospital to “scene out of Kafka”, he said appallingly ill women filled every cot in the ward, and when the ward was inevitably filled to capacity, women who were just as sick had to be placed on the floor -- under each cot.  Some 87 per cent of pregnant women attending antenatal care centres were under the age of 30, and    67 per cent under 25.  The virus was tearing apart the very heart of the country, he added.

On top of all that, large parts of Swaziland were facing very serious food shortages -– major corps had failed for the past over three years and significant droughts had left farmlands parched and all but worthless.  And, as with many South African countries, Swaziland’s drought had been fiercely complicated by the reality of HIV/AIDS, because so many farmers had died or were ill, it was simply impossible to maintain agricultural production, and household food security declined.  “Everywhere you go adults and children beg you for food”, he said.  While the donor community had been reluctant to provide the financial resources to subdue the pandemic, “most of us have an excess of food”.

The other inescapable aspect of Swaziland’s existence, which flowed directly from the pandemic, was the huge number of orphans –- many of whom were infected.  “Orphans everywhere”, he said, “I’ve just never seen anything like it.”  Child-headed households proliferated, in what one Cabinet member had called an “explosion” of so-called “sibling families” being held together by children as young as eight years old.  “Of course, that’s not a family”, Mr. Lewis said.  “It is a brutal rupture of the family constellation where every child is vulnerable and at risk, and no child has a childhood.”

Swaziland estimated that it would have 120,000 orphans by 2010, somewhere between 10 and 15 per cent of the total population.  He reiterated that many of

those children were or would be HIV positive.  “I’d like take the entire political leadership of the G-8 and plunk them down in Swaziland for a week –- not for a day but a week –- and see if they’d ever be the same again”, he said.  Maybe Oprah [Winfrey] or Bono [of U2] could orchestrate such a move, but if it happened, “you can be darn sure that attitudes of western governments would change”, he said.  “No human being could be impervious to what is happening to these children.”

But even facing the worst the world had to offer, the people of Swaziland were refusing to succumb.  “You gotta love the people of this country”, who were struggling mightily at the grass-roots level against “what must feel like Armageddon”, he said.  And while not romanticizing realities on the ground, he added that the people were fighting back with every means available.  Swaziland intended to put 4,000 to 4,500 people into anti-retroviral treatment by the end of the year and from 10,000 to 13,000 by the end of next year.  That number, roughly 50 per cent of those eligible for treatment, was unusually high for an African country.

Asked could Swaziland pull it off, Mr. Lewis said the answer would appear to be yes, largely because the National Emergency Response Council on HIV/AIDS (NERCHA) was “extraordinarily impressive, well-led and single-minded”.  More, it had devised a computer-tracking system for drugs, treatment adherence rates and side effects, so that physicians could follow patients, all with absolute confidentiality.  “I saw the entire apparatus and watched a full simulation”, he said, stressing that “it may be that Swaziland has fashioned a brilliant technology that can be emulated by other countries”.

The country was also making strides on treatment because of the presence of a team of WHO experts who had helped with every aspect of implementation, including infrastructure and capacity-building.  That was exactly what was meant by putting 3 million people into treatment by 2005, he said -- not that WHO would actually undertake treatments itself, but that it would make it possible for everyone else to do the treatments and get to the goal.  It was, therefore, a matter of continuing concern that the seed money that the agency needed -- $200 million over the next two years -– was still not forthcoming.  That amount was barely one tenth of 1 per cent of what would be needed to rebuild Iraq and Afghanistan over the same period, he added.

This was the second time this month he had called a press conference to draw worldwide attention to the 3 by 5 initiative, he said, vowing to “just keep hammering away” until donor governments understood that if the goal of putting 3 million people into treatment by next year was not reached, “it’s on their heads”.  And every person not reached, which would undoubtedly represent a life lost, would also be on their heads.  “Let it be said in advance that he United Nations family and the World Health Organization will be blameless”, he said.  The WHO could make the target if it had the seed money.  “Surely some western country amongst the cornucopia of wealth and power can find the dollars.”

He went on to say that an exciting development had sprung out of Swaziland’s efforts to cope with its astonishing numbers of orphans.  The NERCHA was proposing to establish a cadre of 10,000 women who would, in effect, look after those orphans.  They would still look after their own families, care for the sick and continue assuming the burden of care in their communities.  The United Nations had raised the notion of paying them, finally breaking the “monolithic resistance” to paying women for work that was unacknowledged, but indispensable.  Incredibly

enough, NERCHA decided to include a request for a small stipend for the women in their latest request to the Global Fund for HIV/AIDS, Tuberculosis and Malaria.

“We appealed to them to stop the unabated sexism surrounding this disease”, he said.  If the Fund’s Board turned down the request, it would be lambasted by many for resisting gender equality.  If it agreed to the measure, that would set an important precedent for other countries in the future.

When asked why his message, so passionately delivered, seemed not to be getting through, Mr. Lewis said it was his feeling and belief that the United Nations should keep raising the issue.  The donor community had indeed been “heartbreakingly intransigent” since the beginning of the pandemic, but there appeared to be a little more money and recognition now.  There was some light at the end of the tunnel, but “a faint and fragmentary one”.  The United Kingdom had given some $7 million to the 3 by 5 initiative, and Spain and Sweden were thinking seriously of donating.  He knew of no other contributions.

Answering a question on the Swazi monarchy, he acknowledged that the country had yet to experience significant constitutional reform.  Some of the policies and practices of the King were highly contentious -– from polygamy to proposed extravagant expenditures for private planes and palaces.  He had met with the King for some time, he said, but added that he wasn’t going to pretend that he had raised difficult issues in the context of his visit.  Still, the two had held a very frank conversation, and Mr. Lewis believed the King understood that donors were restive about Swaziland’s political and economic priorities, particularly in the face of such a devastating pandemic.

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