Swaziland provides a horrific example of what an HIV epidemic can do to a fragile economy: In the early 1990s, economic growth was posted at about 6 per cent a year. But over the past decade, HIV is estimated to have reduced growth by at least 1.6 per cent, and in recent years as much as 2 per cent annually, so that the economy is now contracting.
The result? An equally rapidly expanding epidemic of poverty. The amount of land being tilled has dropped, the level of agricultural productivity has dropped, people have sold their assets to survive. A third of all children are orphaned, and more than half of the poorest households are taking care of orphans. This year, 40 per cent of the population survived on food aid from the United Nations.
"We're in a chronic disaster situation; there is no ability for society to cope," said Derek von Wissell, who heads the national AIDS agency. "There is no spare, no fat, no cushion in communities, in families."
Mangaliso Shongwe, a farmer in Nkambeni village 100 kilometres from the capital who lost his wife, two children and a brother to AIDS and is himself living with the virus, explained how it works. "A person gets sick and the family pays [for medical care] a person dies and they pay for the funeral," he said. "Very soon you have no savings, you cannot pay to send children to school, you cannot pay to hire an ox to plow your field." He was moderately prosperous a decade ago, he said. These days he eats only one meal a day.
And yet Swaziland is ranked by the United Nations as a "middle-income country." It has a few high-value industries (Coca-Cola Ltd. has a significant presence in this sugar-growing nation, for example) and large agricultural plantations in the hands of a few wealthy people; they distort the figures and mask the reality that 70 per cent of people live in severe poverty that is rapidly deepening because of AIDS.
In a grim irony, the country's shrinking population means that, on paper — specifically on the UN and World Bank's sort of paper — Swaziland looks better off than it did even a couple of years ago: the GNP is divided over far fewer people in the per capita calculation. And thus it appears that conditions in Swaziland are improving, and so the country attracts less assistance, and qualifies for less aid.
"We desperately need to reassess what development is beyond simple economic indicators," said Alan Whiteside, a leading expert on AIDS and economies based at the University of KwaZulu-Natal in Durban. "You can't have this ridiculous situation where Swaziland can't get the help it dramatically needs."
While Swaziland has received substantial assistance from AIDS organizations in recent years, including more than $100-million from the Global Fund to Fight AIDS, its GNP per capita shuts it out of major development schemes and World Bank grants. Without the GNP figure, its infant mortality, maternal mortality and crude mortality (total number of deaths per 1,000 people), all heavily distorted by AIDS, would rank it alongside the poorest (and most-assisted) African nations.
As a result, experts such as Dr. von Wissell and Dr. Whiteside are calling for a redefinition of "emergency" in the humanitarian context, arguing that although what has happened here has happened slowly and silently, it has had an impact as severe as a tsunami or an earthquake — or worse — on the economy and the lives of the poor. Assistance for a country hit this hard has to be rethought, they say, to include not only the medical and orphan-care interventions, but also broad-spectrum anti-poverty measures to counteract the inevitable impact of AIDS.
"When a country is flat because of HIV, you need to get money into the household economy to get things back up," Dr. von Wissell said. He is proposing huge public works programs, of the kind introduced by the Roosevelt government in the United States during the Great Depression of the 1930s, to get wages into the hands of the poor. He is also urging the Swazi government (which has spending priorities that lean more toward the military, new monuments and fleets of cars for the King) to buy and give away free to the poor hundreds of thousands of goats, chickens, fruit trees and micro-irrigation projects. The government has already begun subsidizing education for orphans, and will make primary education free in 2009, as a way to stop the erosion of human capital.
Dr. von Wissell is far from confident it will be enough. "The problem is we're walking a road no one has walked before, so we will waste money and we will make mistakes, but someone come and tell me how to do it."
Meanwhile, the international community, which has been generous with AIDS funding but done little on poverty here, must get heavily involved in stopping the downward spiral of Swaziland. "You can do something about it and that's the point and that's what the world must respond to."