Swaziland’s HIV/AIDS epidemic has been characterized by the slow onset of a myriad of co-factors culminating in a chronic emergency, burdening every sector of society. Exacerbated by domestic political mismanagement and ill-suited policies of international organizations, impacts will remain endemic for generations. From near-zero diagnosed HIV infections in 1990, Swaziland now has the highest relative prevalence in the world. The impacts of infection are withering the human capacity to mount effective and systemic interventions. Indicators of social well-being show a population in distress. Aggravated by gender inequality, drought, agricultural decline and insufficient financial resources, livelihood failure in Swazi households has become commonplace – and the situation is deteriorating. This article argues that the brutal reality facing the Swazi population is perpetuated by the lack of political will of government and conditionalities imposed by international donors. In the absence of comprehensive government-led programming, many communities have initiated interventions. Assisting these vulnerable populations requires sustained international financial commitments. This money would be used to best effect if accompanied by pressure for domestic political accountability in Swaziland. Such changes will facilitate country-wide interventions, particularly those at the community level. While Swaziland is the case study, many of the findings are applicable to generalized epidemics throughout southern Africa. [Summary available in French].
Canadian Journal of Public Health (2008) 99 (supplement 1: Building HIV and AIDS Competence among Community Organizations in Southern Africa) S8-S10.