Resisting condom use as AIDS deaths soar

Resistance to condom use in Swaziland has proved a perplexing failure for the government and health NGOs, a failure whose consequence is apparent in new statistics on the epidemic released by the Joint UN Programme on HIV/AIDS (UNAIDS). "We failed to learn the lesson of recent history that condoms are unpopular. We should have stressed education, abstinence and faithfulness to your partner from the start," Thabsile Dlamini, secretary of the Swaziland Nurses Association, told PlusNews. The UNAIDS report released last week proved depressing reading. In Swaziland "the epidemic has assumed devastating proportions", it said. "National HIV prevalence in Swaziland has matched that found in Botswana, almost 39 percent. Just a decade earlier, it had stood at 4 percent." Like Botswana, which has led the world in HIV infections among its adult population, Swaziland shows no sign of incipient decline in HIV prevalence, the report stated. In the anti-AIDS struggle the focus has increasingly shifted to antiretroviral drugs, which are beginning to become available in Swaziland. But as treatment efforts are stepped up, there is concern that prevention programmes are receiving less attention. "The emphasis is [on] treating the sick, and lengthening the lives of HIV-positive persons. This is good, but there is still a need to prevent infections in the first place," Dlamini said. Despite the AIDS toll, and the years of safe-sex messaging, condom use remains a controversial subject. "Swazis dislike condoms. They are unSwazi," declared Nhlavana Maseko, an influential traditional healer, when the World Health Organisation (WHO) began distributing condoms in the 1990s. One of the country's top traditional leaders, Jim Gama, governor of the royal village Ludzidzini, has also ridiculed condom use as being inconsistent with Swazi manhood on his popular weekly programme on government radio. A snap survey of attitudes carried out at the bus rank in Manzini, the central commercial town and densest population centre in the largely rural kingdom, found respondents using condoms on occasion, but without consistency or with faith in their effectiveness. "I use condoms until I run out, and if they are not available that doesn't stop me from having sex. Condoms are not 100 percent effective," said Mfanakhona Khumalo, 23, a bus driver. Mary Nkambule, 25, a seamstress, was more emphatic. "Condoms are useless," she said. "They cut down on pleasure. They are like eating a sweet with the wrapper on." The founder of the Swaziland AIDS Support Organisation, Hannie Dlamini, caused a stir this month when he broke from the strategy of Swazi health organisations that promote condoms, and publicly condemned condoms at a rally of Christian fundamentalists. "Condoms don't stop AIDS. They don't work. Only faithfulness and abstinence stop AIDS," he declared. Dlamini's remarks, in which he also said that UN agencies have distributed millions of defective condoms, and warned that condom users to "do so at their own risk", were given banner headlines in the Swazi press. The WHO and UNAIDS responded with newspaper adverts condemning the sensational reporting, along with "misinformation and disinformation". "Consistent and correct use of condoms reduces HIV transmission by at least 99 percent in humans. This is not 100 percent, but it is pretty close to it!" said the WHO and UNAIDS statement. Thabsile Dlamini of the nurses' association is among health officials who have observed the failure to popularise consistent condom usage among Swazis, and feels other curbs on sexual activity must be pursued. "AIDS is a moral issue, and the churches are now talking about promiscuity and adultery," she said. But social welfare officials like Esther Kanduza of the Woman's Resource Centre in Mbabane, feel efforts to promote condoms must persist, in light of the doubtful alternative of promoting total sexual abstinence. "Swaziland is a polygamous society where multiple sexual partners are the tradition," she noted. The WHO and UNAIDS statement agreed: "Abstinence is certainly the most perfect behaviour to avoid HIV/AIDS, but experience shows that a small percentage of persons are going to stay abstinent for the remainder of their lives." The statement concluded on a wistful note, tied to the need to continue a policy of condom advocacy. "Wouldn't it be nice to think that by completely abstaining, or by using correctly and consistently a condom, close to 200,000 persons now living with HIV/AIDS in Swaziland would prevent the infection of those who are not infected, or [not] re-infect themselves, and lead normal lives?" Swaziland's current population is approximately 970,000.