AIDS smothers African kingdom

THE BALTIMORE SUN

MBABANE, Swaziland -- When lawmakers in this mountain kingdom met this year to respond to the country's AIDS crisis, they proposed some peculiar solutions: HIV-positive citizens should be branded, one parliamentarian suggested. Another favored locking them away in concentration camps. Still another thought sterilization was best.

In the end, the Swaziland parliament agreed to ban miniskirts in schools, arguing that it would reduce sexual relations between teachers and students.

The measures evoked laughter from many citizens, living in a nation sandwiched between South Africa and Mozambique. But the proposals were also a sign of desperation, AIDS activists here say, as this tradition-minded country ruled by a monarch comes to terms with an epidemic clouded in mystery, misunderstanding and shame.

The health statistics are staggering for a country with a population less than a fifth of Maryland's:

In a society of just under 1 million people, about 22 percent of the population is believed to have human immunodeficiency virus, the virus that causes acquired immune deficiency syndrome. About 40 percent of all pregnant women are HIV-positive; 15 percent of all newborn babies carry HIV. About 35,000 children have been orphaned because their parents have died of AIDS. The government predicts that in the next 10 years more than 200,000 people -- one in five citizens -- will have died as a result of HIV/AIDS. And by 2005 life expectancy will have dropped to age 38 from age 59.

Swaziland ranks with Zambia, Zimbabwe, Botswana, Namibia and South Africa as one of the nations with the highest rate of infection. Yet compared to these other countries, Swaziland has yet to fully appreciate the problem.

Each week, dozens of families bury their loved ones without acknowledging what struck them down. The pages of the national newspaper the Swazi News are filled with the obituaries of 20- to 30-year-olds that offer no cause of death other than "a long illness."'The number of deaths is rising. I think the government is in shock, in a panic," said Vusi Matsebula, who embodies the dreadful consequence of the country's silence.

Eight years ago, Matsebula said, he met a young woman at a party and spent the night with her. A week later, she telephoned him to deliver awful news with about as much emotion as if she were forecasting the weather. "Vusi, you are going to die," he remembered her saying. "You now have AIDS. You got it from me." He remembered her giggling and then hanging up.

"To me, it was a joke," Matsebula said. "I didn't know anything." In Swaziland, "there was nothing ever said about the disease." But a blood test confirmed the woman's prediction: He was HIV-positive. For Matsebula, then a 22-year-old with plans to attend college, it marked the beginning of his membership in a sort of underground.

"People in this country are very much afraid to talk about AIDS or to accept that relatives -- mothers, fathers, sons and daughters -- are dying from AIDS," said Christabel Motsa, chairwoman of the government's newly formed crisis committee on disease. "This kind of denial caused a slow response to the disease. Why people are in denial I don't think is clear to anyone."

Tradition blamed for spread

Health officials blame the country's ties to tradition as a cause for the rapid spread of HIV here. Southern Africa's only remaining kingdom, Swaziland is ruled by 32-year-old monarch, King Mswati III, also known as the lion king. He has seven wives.

Many men in rural areas follow his example by practicing polygamy or having multiple partners, leading to the spread of HIV. Swazi culture also remains mistrustful of Western ideas of medicine. Contraceptives are frowned upon by much of the population, making the problem worse.

"We believe so much in traditional healing that whether you are educated or not, when you are sick the first stop is the traditional healer, not the clinic or the hospital," Motsa said. By the time the ill seek help from a physician, their health is so poor, they cannot be helped.

Matsebula, now 30, is a rarity in Swaziland for his willingness to speak openly about his condition. He walks down the streets of Swaziland's sleepy capital, Mbabane, with a T-shirt emblazoned with giant block letters that say "HIV POSITIVE," catching stares from people passing by.

Swaziland has had no public figure announce he was HIV-positive, to encourge people to discuss AIDS. The government's ad campaigns to raise AIDS awareness are meek and ineffective, critics say. So Matsebula speaks about his illness with school groups and on radio and television, trying to push the secret of AIDS into the open.

When he was infected, in 1992, AIDS was still considered to be a white man's disease or a prostitute's disease. Family members suffering from AIDS were unwilling to tell their own families what was happening to them. "The way it was introduced made people turn a deaf ear to the disease," he said. No contact with a white man meant there was no need to worry.

Matsebula's inability to share his fear about his condition troubled him. He felt ill, lost weight. At night he started to have throbbing headaches. He considered suicide. But he decided to live. He joined a fledgling AIDS support group, which held secret night meetings to avoid public harassment. At first, Matsebula would always walk home alone from the meetings out of fear that someone would find out he belonged to the group.

Then, in 1996, he began to reach out to his family. He could not gather the courage to tell his mother so his sister did it for him.

"I never cried," his mother said. "I pretended as if everything was normal. But I never slept the whole night. I lay awake thinking about his funeral." Today, she is one of the founding members of a group of parents with sons and daughters who are HIV-positive.

Dying in silence

Few people in Swaziland have taken Matsebula's journey. Most people die from AIDS in silence.

Martha Motsa, a nurse with a Salvation Army clinic in Mbabane, meets these victims every day during her rounds at the clinic and during home visits. On a recent morning, Motsa drove her pickup truck into the outskirts of Mbabane to a small tin-roofed house surrounded by calla lilies.

Inside, Gabsine Ncongwane, 35, was dying of AIDS. She had learned she was HIV-positive in 1998, and her life began to unravel. When her boss found out she was HIV-positive, she lost her job as a clerk at a shop in Mbabane. Now she stays at home with her mother, brother and nephew.

But she has been afraid to share her secret with her friends. "Because of the stigma, they won't give me support," she said.

She lives from one day to the next, in and out of hospitals. Her family is too poor to pay for medication to treat the sores, rashes and raging headaches that confine her to bed many days. Her efforts to get government assistance have failed.

Motsa provides what medication she can, but the increasing number of AIDS patients spreads her resources thin. She makes about a dozen house calls a week and sees more patients at the clinic. She suspects there are more AIDS patients who are not comfortable asking for help.

The government has only awakened to the problem in the past two years. In 1999 King Mswati first declared HIV/AIDS to be a national disaster and started pushing for an aggressive response to the epidemic. This summer, the king urged his people to practice responsible sexual behavior and to get tested for HIV as he and his seven wives have done.

Yet many of these suggestions were undercut by proposals from Swaziland's lawmakers to confront the crisis. First they put forward a motion directing the ministry of health and social welfare to sterilize all HIV-infected residents.

Later, an aide to the Swazi king proposed creating camps to keep HIV/AIDS sufferers from the public. According to reports in the local press, Tfohlongwane Dlamini, chairman of the kingdom's powerful national council, described HIV-infected people as "bad potatoes" who had to be cordoned off from the general population or "all will go rotten."

Both motions failed, but the parliament did approve a motion asking the Ministry of Education to ban miniskirts in schools in an effort to stop sexual relations between teachers and their students.

"They have raised their skirts so high they can't move without exposing themselves," complained Sen. Majahenkhava Dlamini.

Dlamini's proposal has been met with criticism from the health officials and the Ministry of Education, which is expected to enforce the law.

A. P. Mkhonza, principal secretary of the Ministry of Education, considers the skirt ban strange in a country where young woman parade through town bare-breasted dressed in tiny reed skirts during the annual National Reed Dance. "It was an easy solution. They don't want to debate the real cause of HIV," she said.

Motsa, leader of the crisis committee on AIDS, fears the lawmakers' odd proposals will undercut the work of her group, which is about to release a five-year plan to deal with the AIDS crisis.

"It's hurting our cause a great deal. It has been embarrassing for His Majesty, who has been going for support. It has retarded our programs. It has been very negative and something that we really didn't need," Motsa said. Yet the parliamentary proposals reflect the attitude here toward AIDS.

"Deep down, 70 percent of the population doesn't quite understand what is going on. The parliament mirrors society," Motsa said.

The cornerstone of the nation's five-year plan is to focus AIDS prevention and education on traditional leaders, who offer the strongest and most direct link to the people. But that approach will be difficult because the traditional leaders have been responsible for furthering misunderstanding of the epidemic, she said.

Already, Swazi chiefs have been tapped to help identify orphans of AIDS victim and to help them find new homes. If they can be educated about AIDS, Motsa says, the people will follow.

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