30 November 2010

Living with HIV in Swaziland

Swaziland has the world’s highest prevalence of HIV and more than a quarter aged between 15 and 49 are infected. And those who disclose their status are severly stigmatised.


One year ago, in the small southern African kingdom of Swaziland, 25-year-old Zanele Mamba was living on the edge. She and her husband, Mfanzile Dlamini, were HIV-positive and had already lost two babies to Aids.

They lived in a one-room hut in Mkhulamini, 50 kilometres east of the capital Mbabane, surviving on subsistence farming and Dlaminis meagre salary as a night watchman. Dlaminis family, who owned the land they lived on, constantly harassed the couple about their HIV status.

Mfanziles family would say horrible things to him," said Mamba. I kept telling him, “Don’t worry about it. Don’t go to them. But then they came to our house and continued with the verbal abuse.”

The couple lived for their 14-month-old daughter, Phiwa, who was HIV-negative, thanks to the prevention services Mamba received at a local clinic. Dlamini and Mamba also had access to government- supplied anti-Aids medicine, which allowed them to stay relatively healthy.

No longer welcome

The situation worsened as the year wore on. Dlaminis treatment failed and he became too ill to work. In June 2010, he died. Mamba realised she was no longer welcome in her home.

The Dlamini family took everything she had. They took the chickens. They took her clothes.

“It was a sign saying, ‘Just move. We don’t want you here’. So I decided to pack up and leave.”

On the day of her husband’s funeral, Mamba took her daughter and left. She was six months pregnant with her fourth child.

Swaziland has the world’s highest prevalence of HIV, the virus that causes Aids. More than a quarter of Swazis aged between 15 and 49 are infected, yet people who disclose their status are often severely stigmatised.

Stabbed by father

Phumzile, who asked that her surname not be used, was stabbed by her husband after they both tested HIV-positive. He blamed her for bringing the disease into their home.

He said he was going to cut my throat and kill himself because he can’t stand the humiliation of telling people that he himself is HIV- positive. I think he thought I was dead because I was bleeding profusely."

Phumzile left to live with her parents and lost all her possessions. She eventually recovered from her injuries and now works at a government hospital, counselling other women who test positive for HIV.

According to Zandile Nhleko, community linkages officer for the Elizabeth Glaser Paediatric Aids Foundation in Swaziland, HIV stigma is still entrenched in rural parts of Swaziland, where more than 75% of Swazis live.

People in urban areas have more access to information they have the internet, they go out more," Nhleko said.

Still high levels of stigma

Yet access to information alone hasn't done enough to overcome stigma, as still-high levels of prejudice among health workers and government officials testify.

Nhleko says she has seen nurses refuse to share dishes and food with colleagues who are HIV-positive.

Last year, a Swazi parliamentarian caused outrage when he proposed branding the buttocks of every Swazi who tests positive for HIV.

Lack of leadership

King Mswati III, Swazilands absolute monarch, has 13 wives - despite multiple concurrent sexual partners increasing the risk of infection with HIV.

In 2001, he banned girls under 18 from having sex in an effort to curb the spread of the virus. Soon after, he married a 17-year-old girl.

To date, not a single Swazi political leader has openly disclosed his or her HIV status. And yet, as World Aids Day approaches again, there are glimmers of hope.

Zanele Mamba is now living with her mother, Alice Mamba, in rural Lubombo region.

Alice, 48, makes no secret of the fact that she is HIV-positive. Several of their neighbours have also disclosed their status, suggesting that efforts by non-government organisations to educate Swazis are working and stigma has eased, at least in this particular community.

“I am very very happy here,” says Zanele, who gave birth in September to a baby boy, Nkosingphile (‘gift from god’), who has tested HIV-negative thus far.

Alice feels that people with HIV should take responsibility for defeating stigma in Swaziland.

People living with HIV should not hide their HIV status, but they should just disclose and tell everybody about HIV," she said.

“It’s very important for everybody to know that if you have HIV you are still a human being." Says Zanele

(Sapa,  Heather Mason, November 2010)


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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