SEATTLE — Swaziland, with a population of 1.343 million, has the lowest life expectancy in the world at 52 years. Over 30 percent of adults aged 18-49 are infected with HIV. Girls and young women make up 74 percent of new HIV infections among adolescents. An estimated 40 percent of pregnant women are infected with HIV. AIDS is the leading cause of death of children under age five. These statistics outline the desperate need to improve health in Swaziland.
Exploring the causes – poverty and gender bias
In Swaziland, 63 percent of the population lives below the national poverty line. Gender bias is high. While the link between poverty and gender bias has been proven time and again in studies throughout the world, the combination has contributed to an additional dimension in Swaziland – unnaturally high rates of HIV infection and AIDS.
When women are continuously perceived as second- or sub-class, their education, health and general human rights are endangered. While sexual crimes are technically illegal in Swaziland, Country Reports on Human Rights Practices indicates that perpetrators often receive minimal or no punishment. Violence and sexual violence against women are common, while perpetrators using protection against sexually transmitted diseases is not. Additionally, poverty and desperation contribute to a prevalence of transactional sex (sex acts in exchange for money, goods and services) and a heavily populated sex worker industry. The patriarchal region’s traditions still include polygamy, marriage to girls as young as age 14 and subordination of women to their husbands. And, as Country Reports points out, customary or traditional law frequently supersedes constitutional law in crimes against women and children.
Amazingly, good news is emerging in Swaziland, one small victory at a time. To improve health in Swaziland, aid organizations are working toward healthier behaviors, healthier attitudes and healthier care facilities.
DREAMS of ending gender bias
Formed to address gender bias and the subsequent staggering number of girls and women infected with HIV in Swaziland and nine other countries in sub-Saharan Africa, DREAMS envisions an Africa comprised of Determined, Resilient, Empowered, AIDS-free, Mentored and Safe women. DREAMS operates with the support of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and The Bill and Melinda Gates Foundation, among others, and approaches the need for changed behaviors and societal norms in regard to women and girls with evidence-based methods. The organization aims to alter the trajectory of the lives of women and girls, thereby altering the spread of HIV and AIDS throughout the region.
HC3 Swaziland and DREAMS
Under the DREAMS initiative, the Health Communication Capacity Collaborative (HC3) contributed to the empowerment of women in Swaziland by forming clubs focusing on financial literacy and its link to HIV. HC3 worked with community leaders to address gender-based violence, calling on chiefs and their wives, school and religious leaders and other influential citizens for their acknowledgment of the bias and vulnerability of girls and women, and for their support to battle it. HC3 also worked with health providers to reduce discrimination against sex workers. In partnership with the Family Life Association of Swaziland (FLAS), HC3 set up mobile services for HIV testing, counseling and referrals to clinics more sensitive to demographics susceptible to discrimination. In addition, HC3 worked with the Royal Swazi Police through meeting and training sessions to implement change in discriminatory attitudes.
Swaziland Health, HIV/AIDS and TB Project
The World Bank contributes $20 million of the $41 million Swaziland Health, HIV/AIDS and TB Project. At its core, this project focuses on strengthening the health infrastructure of Swaziland. Initiated in 2010, the project displays reliable indicators of achievement as it progresses toward its intended completion date in 2018. For instance, among the project goals to improve health in Swaziland is increasing the number of health facilities that provide five key services: modern methods of family planning, postnatal care, management of sexually transmitted infections (STI) and HIV, immunization and growth monitoring in children. The number of facilities has increased from 56 in 2010 to 68 in 2017, toward the goal of 75 in 2018.
The project includes a goal of 1,442 nurses or midwives receiving training from project-supported institutions. From an initial number of 581 in 2010, the project surpassed its goal in 2017 with 1,959 enrollees. Also in 2017, the number of pregnant women receiving prenatal care during a visit to a provider reached 107,863 women – increasing from a mere 13,963 women in 2010. The goal at the project’s completion is 132,186 women.
Doctors Without Borders administer ARV
After Doctors Without Borders implemented a “test and start” strategy to improve health in Swaziland, over 1,700 people were administered antiretroviral treatment (ARV) after testing positive for HIV. Twelve months later, the virus was suppressed in 82 percent of patients. In October 2017, the “test and start” strategy became the national standard of HIV care as adopted by the Ministry of Health.
Solutions are seldom simple in matters of health, poverty and gender bias. But as aid organizations recognize the link between all three issues in Swaziland, attitudes can change, trajectories can be altered and a nation can finally progress.
– Jaymie Greenway