Unease is mounting in Swaziland after reports that supplies of antiretrovirals are dangerously low. Resources have never been adequate to tackle the world’s highest HIV infection rate in the tiny kingdom, but in recent months, the cash-poor government and dwindling donor funding have led to increasing panic among people living with HIV.
“Only Two Months Supply of ARVs Left,” headlined the front page of the Swazi Observer recently, quoting an MP's remarks to parliament warning that the country's economic troubles could put people's lives in danger. One in four Swazis between the ages of 15 and 49 is living with HIV - at 26.1 percent, the world's highest prevalence - in a population of about one million.
“Drug droughts are [becoming] common in Swaziland. Hospitals go for months without basic drugs and supplies. But ARVs are different. Like TB drugs, the user cannot miss a day. I can tell you that people are already very concerned,” said Sandile Hlope, a programme officer for a Manzini-based HIV testing and counselling centre.
Swaziland is in the grips of an acute financial crisis. Social services have been cut and public servants are facing looming retrenchments - government is the country's biggest employer. In addition, the Ministry of Agriculture last month reported a 29,000MT shortfall in the annual maize requirement - the country’s staple food - of about 114,000MT.
How long before drugs run out?
Health Minister Benedict Xaba went on government radio last week to assure people that drug supplies would not run out at hospitals, and reaffirmed government’s dedication to spending on national health priorities, despite the cash crunch that has, among other things, grounded government vehicles and halted some non-essential programmes.
More than 64,000 Swazis were receiving ARVs by the end of June, a number expected to climb to about 69,000 by the end of July, according to the Monitoring and Evaluation Unit at the Ministry of Health. However, 200,000 Swazi adults are believed to be HIV-positive.
“The ARV rollout is going well in terms of fulfilling projections,” said Charles Azih, information and data officer for the Swaziland National AIDS Programme (SNAP). “We have no reports of any clinics or supply points running short of ARVs, and no one has come to our office with such news,” he said.
Quantities of ARVs used in Swaziland are ordered on the basis of current use, with projected use factored in, so the supply is always expanding, Azih added.
According to civil society groups, AIDS efforts have already been compromised, and HIV support organizations have had to cut operations and retrench workers because government has not followed up financial commitments with actual funding.
Officials at the National Emergency Response Council on HIV and AIDS (NERCHA) were unwilling to speak on the record to IRIN/Plus News about the financial crisis, but confirmed that programmes to assist people living with HIV and AIDS had been affected or suspended. NERCHA provides vehicles to AIDS organizations, but these cars and trucks were grounded last month.
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“I used to get my ARVs every month, and I got to the clinic on an agriculture department vehicle. But there are no government vehicles on the roads any more and I can’t do this. I walk... 15km. I have to leave my children alone at the homestead," said Thandi Nkambule of Hhelehele, outside the central commercial town Manzini.
Sicelo Dlamini has been accompanying his pregnant wife to the government hospital in the eastern provincial capital Siteki for her pre-natal check-ups. “We are part of the programme for pregnant women who are HIV-positive, to keep the baby from getting infected. But when we got to the hospital there was nothing happening. The nurses were on strike because they hadn’t been paid.”
The Southern African Customs Union (SACU), comprising Botswana, Lesotho, Namibia, South Africa and Swaziland, applies a common set of tariffs and disproportionately distributes the revenue to member states. It has provided an economic lifeline to Lesotho and Swaziland, in particular, which have small impoverished populations, large numbers of HIV-infected people, and few or no natural resources.
SACU revenue accounted for about 66 percent of the Swazi government’s income two years ago. Following a reorganization of customs union receipts, this income was halved and will make up only 32 percent of this year’s budget, which has put severe pressure on the public purse.
Government has requested financial assistance from South Africa, which is obliged to consider the loan to avoid a humanitarian crisis on its doorstep and a flood of economic refugees. But Swazi NGOs, led by the Swaziland Coalition of Concerned Civic Organisations, and constituent organizations belonging to South Africa’s ruling party, the African National Congress, are calling for political reforms to be linked to any financial aid.
Swazi health NGOs fear that not only will the debate likely go on long after the stockpile of ARVs finishes, its resolution one way or the other will not help people living with HIV and AIDS.
“The loan is to pay for civil servants’ salaries and finance capital projects like the new airport. We must turn to our international partners for assistance,” said Vusi Shongwe of the Swaziland National Association of People Living with HIV and AIDS.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions