Collaboration: A viable strategy in combating the HIV/AIDS crisis in Swaziland

Collaboration: A viable strategy in combating the HIV/AIDS crisis in Swaziland

Shokahle R. Dlamini, Institute of Distance Education(IDE) - University of Swaziland

Abstract
HIV/AIDS is a threat in national development worldwide. Research has indicated that societies carrying the heaviest burden of HIV/AIDS are the poor developing societies of the world. The link between poverty and HIV/AIDS is well established. Unfortunately, if developing nations are faced with the endless problem of HIV/AIDS, they stand a very limited chance of achieving the millennium goals by 2015.That being the case, the health crisis besetting developing nations in Sub- Saharan Africa should be given the seriousness it deserves in order to achieve the millennium gaols. HIV/AIDS could only be effectively dealt with if action is carried out on numerous fronts, including the educational front. Unfortunately, Swaziland, a developing kingdom on the South Eastern part of the African continent, only has one university which cannot enrol all qualifying candidates. The limited resources at the University of Swaziland make Open and Distance learning the only way forward if we want to educate thousands of Swazis on HIV/AIDS.

This paper discusses factors fuelling HIV infection in Swaziland. It shows how multi-sectoral collaboration could be used to solve the problem of HIV/AIDS. As that happens, the paper further describes the role which Open and Distance learning could play in combating HIV/AIDS.

In one of the homes of people living with HIV/AIDS in Swaziland, AIDS had claimed the lives of three out of a family of five. The only two still alive were a three year old girl and her mother who was intermittently ill and physically unable to find food, cook or bath herself. The 3 year old girl practically assumed all household chores: the ill bed-ridden mother would tell the child to light the fireplace and move the cooking pot back and forth for her to stir as the child looked on. She would then tell her to wake her up once the food was cooked and bring the food by the bedside…To the mother the child was the only care giver…To the community worker taking the child away meant removing the only care giver for the mother and separating the child from her remaining family member (Swaziland Government 2006, p.50).

After all separating the mother from the child would not change the fact that the mother was about to die of HIV/AIDS. Nothing could be done to remove the virus from the blood of this woman. But a lot had been done to keep Swazis out of danger of contracting the HIV. Despite all the efforts, many families in Swaziland have lost their loved ones to HIV/AIDS. Consequently, ailing family members are left to be looked after by young girl children in whose hands some of them end up dying.

To paint a clear picture of what Swaziland has been doing to combat HIV/AIDS since 1987, one needs to provide a historical account of Swaziland's response to the HIV/AIDS pandemic. The first HIV case in Swaziland was reported in 1986. In 1987 the first HIV/AIDS victim died. Since then, ` Both the Swaziland Government and the Non Governmental Organisations (NGOs) have worked tirelessly to educate the nation in an attempt to combat HIV/AIDS' ( Dlamini 2003, p. 34).For instance, in 1987, the Swaziland Government, with the assistance of the World Health Organization (WHO) established the National AIDS Prevention and Control Programme (NAPCP). This programme was later renamed the Swaziland National AIDS Programme (SNAP).This programme deals with issues of epidemiology, surveillance, education and prevention. In 1992 the first “national survey of women attending Ante- Natal Clinics (ANC) was carried out, and HIV prevalence in this group was found to be 3.9 percent. In 1994 the prevalence rate was 16.1 percent. Since then, surveys have been carried out every two years.'(National Emergency Response Committee on HIV/AIDS 2003, p.4). A decade later in 2004, the infection rate had gone up to 42.6 percent (9th Sentinel Serosurveillance Report 2004, p.7). This shows that HIV infection is relentlessly growing despite efforts to curb its spread.

In 1998, an HIV policy was developed and approved by cabinet. According to the report by NERCHA and UNAIDS, this policy focuses on the three components which are prevention, care and support and impact mitigation (2003, p.4) In February, 1999, His Majesty King Mswati III declared HIV/AIDS a national disaster and he further called upon every member of the Swazi nation to take HIV/AIDS as his or her responsibility . The response to the HIV pandemic goes beyond government. According to Dlamini, `NGOs involved in this are the Schools health and population Education (SHAPE), the Family Life association of Swaziland (FLAS) and the AIDS Information and Support Centre (TASK)'(2003, p.34). In 2001, the National emergency Response Committee on HIV/AIDS (NERCHA) was created. Its focus is on prevention, care, research and mitigation.

In 2002, the Government of Swaziland increased her efforts to fight HIV/AIDS when the Ministry of Education (MOE) began to involve itself in educating learners through the Schools Curriculum. This was done in order to complement and enhance the current curriculum in primary and secondary schools by providing basic information on HIV/AIDS that will facilitate behaviour change among the school going youth. This move was a milestone in the prevention of new infections among school going children. Unfortunately, this intervention only catered for school going children who are only a very tiny fraction of the total number of the Swazi youth. Considering all these efforts, it becomes obvious that Swaziland has neither ignored nor underestimated the gravity of HIV/AIDS since the first AIDS related death in 1987. Contrary to this, Swaziland has the highest HIV prevalence in the whole world. The question here is what exactly is the problem with Swaziland? To answer this question one needs to look at gender relations in this patriarchal kingdom.

Swaziland is a small kingdom with an area of only 17, 363 square kilometres. It is found on the South Eastern part of Africa. This country's population is estimated to 1.6 million (National Census Office 2006). Of this number, over 68 percent are below 24 years, a clear indication that Swaziland's population is youthful. Swaziland is one of the poor African states with more than 60 percent of the population living below the poverty line. Such an economic scenario has been brought about by an increasing rate of unemployment and the devastating effects of HIV/AIDS.

Swaziland is a patriarchal kingdom. ` In a patriarchal kingdom like Swaziland, the minority status of women, to a large extent regulates the relationship between men and women in general and that between husband and wife in particular'( Dlamini 2005, p.70). Kanduza states that `Patriarchy manifests itself in Swazi society in ordaining the perpetual minority of women' (2002, p.4). This perpetual minority contributes towards increasing the vulnerability of Swazi women to HIV infection by hindering women from adopting the ABC approach to HIV prevention. Put differently, `While clearly there is a role for ABC in HIV prevention, this approach presupposes the ability to exercise rights- a condition not realized by many girls and young women for whom ABC has turn out to be ineffective' (Sexual Health Exchange 2004, p. 5).Furthermore, Dlamini observed that the institution of patriarchy allows Swazi men to have things their own way both in the public and in the private domains. They even coerce women and girls into sexual activity (2005, p.71). This clearly shows that while ABC can contribute immensely in reducing new HIV infections, it is very difficult for girls and women in patriarchal societies to make good use of this strategy.

Girls are married off in their teens…Recent studies in Africa indicate that young married women are at high risk of HIV infection than their unmarried peers. Husbands of young married women tend to be older and more sexually experienced, and therefore, more likely to be infected than unmarried or younger male counterparts (Sexual Health Exchange 2004, p. 5).

In addition to that, poverty in Swaziland forces a number of young women to exchange sex for survival. A soldier interviewed by Hall concurred with this when he said that soldiers at Matsapha have no difficulty finding people to sleep with because women would come to the barracks after failing to find employment in the Matsapha industrial site. These women come to sleep with the soldiers for dinner (Mamba 2002, p.19).

While a majority of girls and women are unemployed and poor, the male dominance in the country allows men greater access to paid work and material wealth. Thus they control the money and the resultant power. Sexual Health Exchange reveals that men consider involvement with girls as a demonstration of economic power (2004, p.10). Male promiscuity in Swaziland is celebrated as (bunganwa), being a stud, while women are expected to be faithful, a test which if they fail could lead to being dumped, divorced or killed. Women are expected to be submissive and accept their promiscuous husbands whose behaviour places them at risk of becoming infected with HIV (Swaziland government 2006, pp.8-9).

Another cultural practice that increases the risk of contracting HIV among Swazi women is (lilobolo) or the payment of bride wealth. (Lilobolo) is a very old cultural practice in Swaziland where cattle from the groom's family are transferred to the bride's family for the loss of the bride's presence and her services in her parental home. Booth adds that it ensures the legitimacy of her children and their lineage (1985, p.112). Ndwandwe gives a more clearer function of (lilobolo) when saying, through (lilobolo) a woman was not bought, what was bought were the children a woman reproduced. Lilobolo allowed a man to attain ownership of the children the woman produced (Ndwandwe, H 1999, pers. comm.26 August). Like Ndwandwe, Barnet and Whiteside have noted that in some parts of South Africa they say children are what we give (ilobolo) ( bride wealth) for ( 2002, p.21).In other words the payment of (lilobolo) deprives married women the right to decide whether to have children or not. That means that even if a woman knows that she is HIV positive, she is compelled by the institution of (lilobolo) to fall pregnant and put her life at risk and further endanger the life of the unborn child. (Lilobolo) does not only deprive Swazi women of their reproductive rights, it further transforms them into some movable property that can change hands in the event of the death of a husband (Dlamini 2005, p.74). This practice is called wife inheritance. Wife inheritance occurs when a male relative, usually a brother of a deceased husband, takes the widow as a wife often in what amounts to forced marriage. The widow has to become the brother's wife even if her husband may have died of AIDS and she is HIV positive or if the new husband is (Dlamini 2005, pp.74-75).

For a very long time the sole responsibility of making people healthy has rested on the shoulders of medical doctors. But the prevalence of incurable diseases like AIDS has enabled humanity to discover that curative medicine is not the only solution to all our health problems. Talking about this, Khan argues, `Society has given the doctor entirely justified praise for having carried out his task with extra-ordinary devotion' (WHF 1983, p.251). But Khan further wonders if the doctor has succeeded in reducing morbidity and mortality. The prevalence of AIDS shows that he has not. Curative medicine offers a temporary solution if it is not accompanied by preventative measures. Hubley notes, The introduction of the concept of primary health care by the World Health Assembly in the Russian city of Alma-Ata in 1978 was a direct result of the failure of curative hospital based systems of health care (1993, p.7).

One of the implications of primary health care is that health is no longer an exclusive preserve of medical doctors and other practitioners in the ministries of health. Health is everybody's business. For instance communities have to be actively involved in the planning and implementation of their own health care and other development programmes. Unfortunately no community could fully participate in this without being equipped with relevant skills. So community education by skilled and deserving people should be the starting point. In Bidwell's words:

Unfortunately in most developing nations, health education has not been taken seriously until the beginning of the 1990s when the concept of community health workers began. In Swaziland these are called Rural Health Motivators (RHMs). Their main responsibility in Swaziland is to teach communities on causes of diseases and the importance of hygiene. They are given a three months course in advance in order to enable them to execute their duty. Matrons who are not health educators are responsible for their training and supervision. There are only eight health educators in this country. Of this number four are in the four different districts of Swaziland. The remaining four are stationed in the health education unit of the Ministry of Health and Social Welfare. The Regional health educators, as they are called, only go to communities during times of outbreaks of certain diseases like cholera in the summer season. The major aim of their visits at such times is just to assess the situation and give brief lectures on the causes and prevention of the diseases. This means that the responsibility of health education is left entirely in the hands of ill trained RHMs.

It is obvious that if the Swaziland government could shift emphasis from curative to preventative measures that include health education; the HIV/AIDS scenario in Swaziland could take a favourable turn to human development. It is this shift from curative hospital based system to community-based systems whose emphasis is on prevention, which makes collaboration the only viable solution especially in poor developing nations of the world. In this new system every member of society has a role to play in influencing behaviour change. Professional researchers, for instance, can play a profound role in health promotion and health education through their research. They only need to keep in mind the fact that research for its own sake is a futile exercise. All research endeavourers ought to aim at influencing behaviour or policy. This is one concrete outcome of research, which could bring about positive social transformation. In other words, our research should not be done only for academic proposes. We should make sure that it is useful to policy markers and even to the general populace. Research is not only about knowledge creation. It is also about positive social change. So research results need to be disseminated not only to colleagues and students in universities, but also to communities so that community members could use them to improve their lives. Policy makers also need findings from our research to formulate policies that would meet the developmental needs of communities. We should be seen to be exerting pressure on policy makers through research. As researchers, we are advocates of the disadvantaged communities. Therefore, we ought to use our research results to lobby in order to influence policy. For instance, we may need to invite legislators to forums such as this, for them to receive research results from the researchers.

Since legislators are the direct representatives of the people who voted them into office, they have a responsibility to address their constituents' needs on the floor of national parliaments (UNAIDS, 2003:28). In parliament legislators can spearhead laws that reinforce the rights of marginalized people like women and girls who because of lack of rights cannot make good use of the ABC approach. Community members also need to be responsive to the health promotion messages provided by health educators and RHMs.

This paper has discussed some of the circumstances under which women live and has shown how such circumstances facilitate the spread of HIV infection in Swaziland the most important problem cited is inequality among sexes. On the other hand, the importance of women in the perpetual existence of states could not be over emphasized. Women are important both for their productive and reproductive capabilities without which national economies could crumble and humanity could cease to exist (Dlamini 2005, p.68). So to deal with the problem of low social status of women in Swaziland, the Institute of Distance Education (IDE) needs to introduce Gender Studies in its Humanities program to address Gender perceptions about the role of women and girls in relation to men and boys. This course could empower female students to be assertive. Male students could learn to respect women and to value their productive and reproductive roles.

Poverty and unemployment are some of the factors facilitating high HIV prevalence in Swaziland. IDE in collaboration with relevant stake-holders could play a role in alleviating poverty by equipping the Swazi youth, especially women, with skills required by the market. This could improve women's employment opportunities thus providing them with economic independence and enabling them to make their own decisions without relying on men.

There is limited coverage of HIV and AIDS lessons on life skills education (Swaziland government 2006, p.22).The information provided in the primary and secondary curricula only caters for the youth in schools. In addition to this, the Ministry of Health educates the nation on HIV issues through the Swaziland Information and Broadcasting Service and selected television programmes. But unfortunately, not all Swazis own radios and television sets. This therefore raises the need for IDE to offer to community leaders, short HIV/AIDS courses that would run for two weeks to six months. The community leaders would in turn pass on this knowledge to their fellow community members. Another challenge facing the struggle against HIV/AIDS in Swaziland is the inadequacy of human resource. We shall all remember the fact that HIV/AIDS is a new phenomenon in the health circles. That being the case, most of our experienced medical practitioners have not been trained to deal with the pandemic. IDE could extend the frontiers of their knowledge by providing courses which they would take while keeping their jobs. There is a desire among some of them to have access on training on HIV/AIDS issues. This is shown by the increasing number of Swazi nurses who enroll in the Republic of South African universities as part time students in courses such as Disaster Management, Nursing, Nursing Management, Counseling, Gender Studies and many more. Unfortunately, not all practitioners with this desire could afford to enroll in neighboring universities. Those who cannot are obviously looking forward to the University of Swaziland to save their situation. This is a challenge to IDE.

In conclusion it should be emphasized that in order for Swaziland to combat HIV/AIDS, there has to be a collaborative action beginning from the grass root level. This collaborative action should include enacting laws that will enhance the social status of Swazi women thus enabling them to make good use of the ABC strategy for HIV prevention. To do this, Legislators rely on research results which academics produce. In addition to that, this collaboration should include the provision of courses designed by IDE to inform the nation on HIV/AIDS, the provision by IDE of courses that will capacitate health practitioners on how best to deal with the HIV pandemic, and the provision of courses that will increase the employment opportunities of the Swazi youth especially female students in order to reduce poverty and put an end to their dependence on men.