Swaziland’s Silent HIV Epidemic

NHLANGANO, Swaziland — The first shock for visitors to Swaziland is how beautiful it is. Most of the year, the high-veld areas sport endless green mountains with scattered homesteads and roaming cows and goats. There is no such thing as a bad view in Swaziland. Nearly every home, outside the few small bustling areas, is the beginning and end to a private hike that can go on for hours. Watering holes and waterfalls tend to be hidden, rather than pointed to by arrows and neon signs, and provide a perfect place to have a romantic picnic or quiet game of Scrabble.

The second shock is the quietness of its HIV epidemic. Swaziland has the highest HIV prevalence in the world, with nearly a fifth of the population infected. The per capita numbers dwarf even other highly affected sub-Saharan countries such as South Africa and Botswana. One might expect HIV to slap you in the face. But there are no buildings collapsed by an HIV earthquake, no towns flooded by an HIV tsunami. No zombie-sick people dripping HIV from their eyeballs. You don’t see obvious signs of it outside of the clinics and hospitals or the privacy of homesteads.

And though it is a subtle emergency, everyone in Swaziland is aware of HIV, and those who were born with the virus have to prepare for a lifetime of being positive. At mass HIV-testing sessions run by the charity Young Heroes and held throughout Swaziland, children stand in a tight formation, shoulder to shoulder in two parallel lines facing one another. A game leader hands a tennis ball to one side, and the children pass it hand to hand behind their backs. Once time is called, the opposite line must guess where the ball is. Only rarely does a smirk or dropped ball give its location away. The ball represents HIV. Anyone can have it, but you will rarely know for certain even with a deep stare at the surface.

A child who learns at an early age that an HIV-positive person normally looks the same as an HIV-negative person can use that knowledge to avoid being infected. She knows that a man who courts her, no matter how healthy he looks, may still have HIV.

Because HIV is primarily passed through heterosexual intercourse in Swaziland, young adults have been the largest infected group, particularly women in their 20s and men in their 30s. Nearly half of Swazis in those age groups are HIV positive. As many have died over the past 20 years, Swaziland has what can understatedly be called an orphan problem. In combination with a crashing economy, a population agitating against the traditional government and royalty, and a ludicrously expensive system of education that makes it nearly impossible for any but the very wealthiest to complete school, Swaziland’s HIV orphans present a frightening problem for the country’s future.

The slow but steady emergency and lifelong time frame of HIV often calls for a lifelong commitment to help, not only with treatment but also with the orphan problem. Near the small, southern city of Nhlangano, there is a family-run farm called Pasture Valley. The farm has timber, a dairy with a few dozen cows, fruit trees, and three greenhouses. Peter and Michelle McCubbin, the couple who own and run Pasture Valley, opened a children’s home on the farm in 2003 and, with the help of two house mothers, now care for 24 orphaned Swazis. The children are as old as 17 and as young as 2. They all go to school, either at the preschool on the farm or at one of the Nhlangano public schools; they all work the farm; they all have food, clothing, soccer balls, books, crayons. If they were born HIV-positive, the house mothers make sure they take their meds every day. They ride a bus to church every Sunday. When you visit, you think you’re seeing the lives the children of Swaziland deserve. You forget these children lost their parents because of HIV, a disease that has been preventable since the 1980s and treatable since the 1990s. You forget that you should be surprised that these 14 boys and 10 girls are happy and healthy and literate.

It’s difficult not to envy the orphans at Pasture Valley, even knowing that they’ve lost their parents. Like most happy children, they are imaginative and giggly. Like everyone in Swaziland, they enjoy jaw-dropping natural beauty from morning until night. Like many Swazis they run with cows and horses and dogs and play soccer. And unlike most Swazi children, they are well-educated and secure in their food, clothing, and shelter. If they have a problem, they have someone to talk to. They get cake on their birthdays and presents on Christmas. They will finish high school bilingual, fluent in English and siSwati. They will have seen lions and elephants and giraffes on field trips. Even those with HIV will live longer lives than their parents and show their own children the beauty of the Kingdom of Swaziland. And maybe when their children grow up, they can tell them about how visitors to their country used to expect an HIV plane crash, or an HIV civil war. But all they saw were green mountains in the high-veld.