Fighting a deadly epidemic — and history
Eswatini is battling the world’s most serious HIV/AIDS problem. Long-standing sexual behaviours and beliefs stand in the way, including those of the South African country’s king
MANZINI, ESWATINI The seven-year-old girl was gravely ill.
Weak, coughing and struggling to walk, she was suffering in her father’s home, nestled in the barren hills of this south African kingdom.
When she met the girl, Nonhlanhla Dlamini says she was not surprised to find that the child had been infected with HIV, the virus that causes AIDS.
“The child cried … She said she wanted to kill herself,” Dlamini said. “She was so young.”
The 53-year-old trauma counsellor and advocate recalls gazing into the child’s listless eyes and feeling a familiar pang of grief. But she was also not surprised to learn how the child contracted the disease.
The girl had been infected by the man responsible for protecting her. Her father, a police officer, had repeatedly raped her, causing a gaping rectovaginal fistula and transmitting HIV.
“By the time the case got to court, she was so sick … and she couldn’t be treated in time,” Dlamini said.
The girl died. The father was not found guilty of any crime. The power of ancient traditions appears to have made his action acceptable among his peers.
Even with determined efforts to curb the epidemic, AIDS is the leading cause of death in Eswatini, a tiny, impoverished kingdom between South Africa and Mozambique previously known as Swaziland.
Eswatini has attacked the virus vigorously. The country of 1.2 million has exceeded targets on HIVtreatment coverage and prevention of mother-to-child transmission, according to United Nations monitoring. Internationally funded clinics offer free access to testing and to antiretroviral medications that can keep people infected with HIV healthy for decades.
But the country still has the highest prevalence rate of HIV in the world. Almost one in three Swazi adults are living with the virus compared to one in five adults in the next most afflicted countries: Lesotho, Botswana and South Africa.
And young women are in the greatest danger. Swazi women aged 15 to 24 are at least three times more likely to contract the virus as males in the same age group. They die from AIDS twice as often.
The causes for this tragedy are almost as clear as the numbers. Ancient mores and traditions protect and at times encourage dangerous sexual activities, including widespread sexual violence and incest, which is mostly kept hidden.
According to United Nations reports, one in three Swazi girls experiences sexual violence before age 18 and almost 20 per cent of women say that they have been abused in the past 12 months. Although women’s advocates say that most incidents of rape are not reported, the country has the fourth highest rate of reported rape in the world.
Mostly, victims and families of victims do not turn in the men who commit these rapes.
“They don’t see (rape or) incest as a criminal offence,” said Diamini, director of the Swazi Women Action Group Against Abuse (SWAGAA), a non-government organization trying to confront incest, rape and inequity.
“More than 85 per cent of the violence happens at home,” Dlamini told the Star at her Manzini office.
“It’s not strangers. It’s the people at home … where the children are supposed to be safe.”
At the heart of the tragedies that Dlamini sees are cultural beliefs that thwart the efforts to fight HIV/ AIDS.
Many Swazis retain beliefs in ancestral spirits and consult witch doctors, who normalize cultural practices that put women and girls at high risk of HIV: Some Swazi men believe that having sex with a virgin will protect them from getting sick with AIDS or give them special powers. This drives some fathers to take their daughters’ virginity when they are young, before another man rapes them, several Swazis told the Star. For others, a father raping his daughters is a family custom to secure a male heir to the homestead.
Most sexual assault victims that SWAGAA supports are children, and 90 per cent are victims of incest — usually by fathers, grandfathers or uncles, Dlamini said.
More than a third of Swazi women believe that rape is a normal part of being a woman, according to Vimbai Kapurura, director of Women Unlimited Eswatini.
This is why most sexual assaults are uncovered by accident, said Xolile Mazibuko, 45, a case management officer at SWAGAA. In one recent case, she was called to support a girl who arrived at school with her uniform torn, after an assault that morning by her father. Mazibuko learned that the girl’s four older sisters were habitually raped, too, but they didn’t want Mazibuko to report it. They seemed to consider it a rite of passage.
“The sisters reprimanded the younger one … saying that they had been through it and what was her problem?” Mazibuko said.
Dlamini, Kapurura, Mazibuko and other advocates say they hear stories like that every day.
A grandmother, Lucy Gama, takes care of her 12 orphaned grandchildren in a shack on a rolling ridge in the nearby Hhohho mountains. Gama’s son, his two wives and her daughter died agonizingly of AIDS, she told the Star, her eyes glazing with tears.
The 60-year-old weaves grass placemats in the bright colours of hope that she carries for her family. She tends to a thriving garden of maize to sustain them. But she worries her grandchildren might carry HIV and die young too.
“Boom dead. Boom another dead. Boom again dead,” she said, in a mix of English and Siswati, the language of the Swazi people, her etched face contorting with painful memories.
“So many people are dying around me.”
Young women die of AIDS at least twice as often as young men because they are too afraid of their abusers to be tested or treated, said Joe Aryee, a Ghanaian pastor who has lived for 23 years in Eswatini and supports the country’s most vulnerable children.
“Sexual assault is a common family secret,” Aryee said. “There is a stigma to reporting rape, disclosing HIV status and taking medication.”
Dr. Yves Mafulu, 39, a senior medical officer at AIDS Healthcare Foundation Eswatini, a U.S.-based non-profit that provides HIV care, said that he has not seen victims of sexual assault or child abuse in his four years working in the Manzini clinic.
“There is not much notification of such cases,” he said, emphasizing the dire disconnect between the country’s AIDS programs and endemic incest, sexual violence and gender inequity.
If victims don’t report sexual assaults, Mafulu said, they aren’t tested and the virus can progress quickly.
Another contributing factor to the huge presence of HIV/AIDS is a widespread practice found in many cultures, including in North America: polygamy. Eswatini is ruled by totalitarian King Mswati, 55, who rose to power at age 14 and has married 15 women — so far.
One of his wives was a high school girl, Zena Mahlangu. She disappeared without her mother’s knowledge in 2002 when she was selected as a bride after the annual umhlanga, or reed dance ceremony, in which she — then 17 — joined more than 40,000 girls, some as young as 11, in required bare-breasted dancing for the king.
“Zena had plans and dreams,” Mahlangu’s mother, Lindiwe Dlamini, told the Guardian newspaper after her abduction. “Now all those plans and dreams have been cut short.”
Mswati’s father, Sobhuza II, had more than 100 wives and 600 children.
An ancient tribal custom, polygamy is endorsed here for any man who can afford it. Tradition also permits a man to have a sexual relationship with his wife’s younger sister.
Dlamini’s own father was polygamous, as was her husband’s father, she said, but “if we’re serious about curbing HIV/AIDS, then everybody must stick to one partner.”
Swazi women have limited decision-making authority over their well-being, said Cebsile Simelane, a 41-year-old mother of two who lost three sisters to AIDS-related illnesses. Simelane worried about contracting HIV too when her husband, a pastor, began having sex with several other women. But when she raised her concern with her husband, he grew angry and soon left the family home. He never returned.
“I think it was the work of the devil,” Simelane said.
Dlamini said she still cries about some of the brutal cases of violence and rape that she sees. She views the struggle against the culture and superstition that nurture HIV/ AIDS to be an uphill battle.
“The level of violence has gone up,” Dlamini said.
“There are so many children, so many cases.”
In 2004, Dlamini attended a leadership course in the United States, where one elderly American suffragette made her realize that she couldn’t expect men to grant rights to women and children. Women had to fight for themselves.
“No matter how good you may be as a coach, you will never score any goals,” the older woman told her. “You will only be able to score goals if you are in the field.”
Dlamini decided to run in the next federal elections. She was elected in 2008 as one of only seven women in the country’s 55-person assembly.
She helped introduce Eswatini’s Sexual Offences and Domestic Violence Act of 2018 to combat cultural norms that perpetuate violence and discrimination against women. The act criminalized rape and child abuse in the country for the first time.
But the legislation is having little effect, Dlamini said, because it has failed to change the mindsets of police and judges. And many women who have reported abuse now live in fear of retaliation from their abusers.
One of those is Nandi, a mother of two, whose name has been changed for her safety. She has an anxious expression and thinning hair. She fears she will be killed by her attacker.
“Police don’t take our reports seriously,” said Nandi, 31, her eyes brimming with tears.
She was kidnapped and almost killed by a former partner in September. Her wrists were bound with cable, and she was raped, beaten and forced to drink pesticide. Two other men in the residence where she was being held ignored her pleas for help.
After hours of torture, Nandi was able to escape to a hospital and notify police. But instead of arresting her assailant, the police insulted her and accused her of being drunk. Two weeks later her attacker kidnapped her 10-year-old son at knifepoint and stuffed him in the trunk of his car. The boy was freed only when the car crashed into another vehicle. The man was then arrested and quickly released.
“His sister is a police officer,” Nandi said, her voice trembling.
“Being a Swazi woman is really hard.”
It’s hard in part because of endemic poverty in a country where the king owns 60 per cent of the land and controls the economy.
Most Swazis live below the poverty line, according to the World Bank, and two-thirds of young women are unemployed. Women and children are forced to normalize sexual abuse because they have no other choice, said Andrew Chapfika, program manager at Women Unlimited.
Chapfika will never forget teaching children at a primary school to identify and report sexual assault. As he spoke, a seven-year-old girl stood up and asked an impossible question. “So, if I report that my uncle is abusing me, will you take care of me?”
The child recognized the intractable challenge facing the nation, Chapfika said. How can Eswatini protect women and children from HIV/AIDS while men who embrace violence and promiscuity control the country’s wealth and power?
Swazi women need international support, said Meredith Copp, a Canadian humanitarian who been visiting the country for 17 years. Dlamini called her in January, saying that SWAGAA had to downsize due to shrinking resources and lacked even gas money to get crisis case workers to victims.
“Dlamini is desperate for the women of Swaziland and working very hard to find the resources to help,” said Copp, who raised $3,000 in her Cape Breton, N.S., community for SWAGAA this winter.
There are few shelters for victims of domestic violence, not enough social workers and too few education workers to support Swazi women and children, Copp said.
Dlamini is asking to have genderbased violence declared a national crisis because she has come to a conclusion that could apply to many nations, both developing and developed, where people still suffer in the long war between superstition and knowledge in the treatment of disease.
To end these chains of unnecessary tragedies, “the country will need to address difficult questions of who we are and what we believe in,” she said.
“We have to do this work. We have to do it. But it’s very traumatic.”
Sexual assault is a common family secret. There is a stigma to reporting rape, disclosing HIV status and taking medication.
JOE ARYEE PASTOR