Swaziland's HIV rate is the world's highest. More than one-fourth of adults are HIV-positive, and approximately half of the deaths of children under five are virus-related. And, despite governmental efforts, Swazis' grasp of HIV/AIDS information remains poor.
Cultural mores concerning sexuality worsen matters. According to a spokesman for the Swaziland Coalition of Concerned Civic Organizations, "When a western [non-governmental organization] puts out a message about condoms, someone turns up on radio ... and says, 'Don't be silly, our job is to produce children.'"
Although a campaign encouraging adult male circumcision -- funded by the US President's Emergency Plan for AIDS Relief -- fell short of its target, the promotion of infant male circumcision is faring better. Seventy-eight percent of those needing antiretrovirals (ARVs) are now covered, and testing can be conducted domestically.
However, economic crises threaten those gains. A 2011 UN study of 1,334 households notes that one-fourth were negatively impacted by factors including rising food costs and loss of employment. The study also reported households with HIV-positive mothers relied on cheaper food and missed meals.
Ncamsile Mkhwanazi, staff nurse at a clinic in the Gilgal village, said the clinic sees approximately 100 patients weekly, many with HIV. Most patients are women; men are reluctant to be tested.
"HIV medication is getting better because we have drugs, but the people are not using protection, so they are spreading the virus," said Mkhwanazi. She said the message of the circumcision drive was unclear, leading men to believe the procedure prevented, rather than reduced, the risk of female-to-male transmission. Mkwhanazi credits ARVs for lowering death rates, but says food, ARVs, and other medicine stocks are running low.