NGOs lead in the war against AIDS

As devastating new AIDS statistics are revealing the growing extent of the epidemic in the country, government has virtually conceded its inability to cope with the crisis by setting up a new body to disburse funds to health NGOs already at work on the problem.

The new body is called NERCHA, the National Emergency Resource Committee for HIV and AIDS, organisation director Dr. Derrick von Wissell told AFRICANEWS. Von Wissell, a former finance minister, is respected in government and private circles. "What we don't want is another disaster relief fund looted by people in government," one aid worker with a Catholic charity organization said.

It is no coincidence that NERCHA when pronounced aloud sounds like "nurture." The committee that will channel government and donor funds is badly needed to assist cash-strapped NGOs like The Swaziland AIDS Support Organisation (SASO), which counsels people with HIV and AIDS, and The AIDS Support Centre (TASC), which offers AIDS testing and sends community organizers into every rural pocket of the kingdom with HIV-prevention information.

Weary of pilfered funds from emergency donations, which end up in the pockets of thieving bureaucrats instead of helping their intended beneficiaries, donor nations and international organisations demanded that government set up NERCHA in a credible fashion, with accessible accounts and open books. Dr. von Wissell says, "Every group that comes to us for assistance must provide an accounting mechanism to show how its money is spent. On the basis of such accountability, additional funds will be granted. We are eager to help."

NERCHA's readiness to assist comes at a time when AIDS strengthens its grim stranglehold on the country. The 2002 report put out by the Swaziland National AIDS Project, which works closely with the health ministry, shows that 34.2 per cent of the adult Swazi population is HIV positive, and destined for a premature death from AIDS. Things get worse in concentrated pockets of the population. At the Matsapha Industrial Estate, where the kingdom's manufacturing industries are centered, half the workforce is HIV-positive or has AIDS, according to the Matsapha Chamber of Commerce.

In the central commercial hub, Manzini, Swaziland's most populous urban centre, 55 per cent of women between 20 and 30 years old are HIV-positive, and 44 per cent of women aged between 30 and 40. "Next to possibly Gaberone, Botswana, no other city in the world is more heavily affected by HIV than Manzini," Alan Brody, acting United Nations representative to Swaziland, told AFRICANEWS.

Polygamy is legal in Swaziland. This year, 34 year-old King Mswati took his eighth and ninth wife. The king says he takes a blood test every six months. Among common people, such diligence is not practiced, and through multiple wives an HIV-positive man can spread the virus quickly through a homestead. Traditional marriages, which require expensive cattle dowries, are on the decline, but the polygamous mindset is deeply rooted in the Swazi male psyche. Multiple girlfriends and out of wedlock births are the norm, not the exception.

While population growth has dropped statistically, from 3.6 percent per year a decade ago to 2.9 percent this year, the decrease is entirely due to AIDS deaths. The number of childbirths has not decreased, but increased. The result is another sad phenomenon faced by health NGOS accepting funding from NERCHA. "There will be up to 40,000 children left orphaned each year after their parents both die of AIDS," says Dr. von Wissell. "That is a very high number for a nation of less than a million people."

Health and welfare organisations such as the United Nations Children's Fund (UNICEF) also blame the initial "strategy of fear" used by health groups when AIDS became a problem. The spectre of an incurable deadly disease that was presented in early AIDS information instilled such a fear that Swazis were afraid to know if they were infected. "Part of the problem has been denial," says Hannie Dlamini, president of the Swaziland AIDS Support Organisation. "People are afraid to get tested because they don't want to know if they are going to die. But then they infect other people with HIV. People who are tested won't tell anyone. Even me, I was in deep denial for a year after I learned I was HIV positive."

Just three years ago, operations were suspended at the largest manufacturing plant at Matsapha, a refrigeration factory, when workers downed tools to protest a management report to a newspaper that workers had AIDS. Such refusal to face reality exacerbated the problem.

Early anti-AIDS campaigns were also heavy on a message of personal responsibility, and suggested that people would have themselves to blame if they contracted AIDS. "People who are HIV-positive tend to feel guilty because they think they'll be accused," says Pholile Dlamini, an AIDS activist in Manzini. "So, they keep quiet, and this has led to a veil of secrecy, as it is taboo to talk about AIDS."

Even the health ministry contributed to the deception. For political reasons, to deflect criticism that it was not doing enough to control the crisis, the health ministry until last year insisted that "only" 20.5 percent of the adult population was HIV positive. The result in Swaziland was that non-government organisations like the Salvation Army and the Swaziland Red Cross shifted their resources to attack the AIDS problem. "We did not have many resources to begin with, and this has put a strain on our other activities, like cholera and malaria control, and pre-natal care," says Thandie Kunene of the Salvation Army.

The launch of NERCHA was quickly followed by the first disbursements of government funds to over 20 organisations, including all those mentioned in this article. Health workers found hope from two developments: government's acknowledgement that it is allowing more effective health NGOs to handle the crisis instead of government bureaucracy, and the inflow of cash to groups that need it badly. "This isn't a government giveaway," says Dr. von Wissel. "It is a redistribution of resources."

A new organisation, the Alliance of Mayors Initiative for Community Action against AIDS at the Local Level (AMICAALL) is on the list of groups receiving government assistance. Funded also by the World Health Organisation and the municipalities that the mayors preside over, AMICAALL in turn funds grass-roots projects based upon the ideas of community members.

"Community people are in the best position to know what is needed to combat AIDS in their area," AMICAALL national director Rudolph Maziya told AFRICANEWS. "Their ideas have been many, like income generating projects for people with HIV who can't hold down regular jobs, hospices to care for AIDS patients, and youth recreational facilities where young people can get information about HIV and AIDS prevention."

Other NERCHA funds are going to HIV testing and counseling facilities. "You can't test someone for HIV without counseling them before the test, and after the results come back," says Pholile Dlamini. "If the results are positive, the patient is advised how to live a healthy and productive life. If the results are negative, the person is told how he or she must practice safe sex to stay healthy.

At least one orphanage is receiving assistance from NERCHA, and the concept of a community orphanage has been presented to the mayor's AIDS initiative for funding. After years of denial, Swazis are realizing that AIDS has a long-term hold on the country, and long-term plans like orphan care are necessary. Real optimism has greeted the first cash allocations from NERCHA.

"There is more here than just the hype that surrounds a new venture," said the Times of Swaziland. "The country has matured in its handling of the AIDS crisis, and there is a feeling that this time we may get it right, by having lots of coordinated organisations doing their part with government financial assistance and oversight."

The innovative ideas being raised to tackle AIDS, coming from ordinary community members, also testify to a new found seriousness, and an optimism bred from a desire to "do something" in the face of an almost unspeakable disaster.