The first thing you notice as you approach Swaziland is the hilly terrain. Shrouded in fog, the hills tower over the road. Along the roadway, cows graze and groups of people sit, waiting for public transit vans. Billboards advertise cell phone plans, restaurants, hotels … and HIV testing.
One such billboard shows two young people at a desk together poring over a book. “Are you really just study pals?” it reads. “Why not test together?”
The billboard touches on the realities Swaziland faces as the country with the highest prevalence of HIV/AIDS in adults in the world. Although the rate has dropped slightly in recent years, more than one in four adults in Swaziland is living with HIV or AIDS, according to UNICEF estimates. Within a population of about 1.3 million people, more than 200,000 individuals are estimated to be HIV-positive.
Years ago, when the country’s health crisis was coming to light, two women decided to take action. Evelyn Shongwe and Mary Magagula (photo right), both members of Sharpe Memorial Church of the Nazarene in Swaziland, began discussing plans for an HIV/AIDS ministry soon after Swaziland’s King Mswati III declared, in 1999, that HIV/AIDS was a national disaster.
“We thought, ‘As a church, we can’t stay quiet,’” Mary, a retired nurse, says. “‘We have to do something.’”
On monthly visits to a hospital near their church, Mary and Evelyn witnessed sick people who were turned away due to a shortage of beds and told they would need to be cared for at home. Unfortunately, many of the caregivers at home didn’t know how to provide the type of care that people living with HIV or AIDS needed.
In 2002, two years after the idea emerged, Evelyn and Mary launched the HIV/AIDS Taskforce. Trained volunteers from various communities, known as “supporters,” began to visit homes and identify people suffering from HIV/AIDS, as well as other terminal diseases, to provide practical, emotional, and spiritual care.
According to Mary (photo left, on right), these visits are significant in light of the cultural stigma surrounding HIV/AIDS, such as the belief that most people contract the virus through unfaithfulness or prostitution. Some people do not get tested because they believe the illness is caused by witchcraft or poisoning. Once tested, women are sometimes reluctant to divulge their status for fear of being turned away or abandoned.
“At the beginning, they were hiding their diseases,” Mary says. “If they keep hiding their status, they get so stressed.”
Through their regular visits, the taskforce supporters build relationships. They provide encouragement, support clients’ health by encouraging them to take their anti-retroviral medication (ARVs) on schedule, provide spiritual advice and counseling, and bring essentials for nutrition, such as canned fish, beans, cooking oil, corn flour, and nutritional supplements.
Taskforce supporters also help others in the household who are indirectly affected by the disease.
“When we visit homesteads and find children who are not schooled because their parents are dead or because they are sick, we try to get them sponsorship,” Mary says.
Thabo* is one of the sponsored children. A soft-spoken teen, Thabo is in 8th grade at a local Nazarene high school. His favorite subject is agriculture, and he hopes to become a doctor some day. He is one of an estimated 73,000 children in Swaziland orphaned by AIDS, according to UNICEF estimates from 2013.
Though Thabo’s parents were HIV-positive, both died without telling him about their status—or his. Only after moving in with his grandparents was Thabo tested and found to be HIV-positive himself. Since then, the HIV/AIDS Taskforce has provided training to Thabo’s grandmother, helping her better care for Thabo and encourage him to take his medication on schedule.
ARVs can help patients live longer and better lives if taken properly. The Swazi government has provided ARVs to the public since 2004, making a formerly cost-prohibitive treatment more accessible. Not all patients follow the treatment closely enough for it to be effective, though. Some stop taking the medication due to the claims of faith healers. Others, like Thabo, don’t understand at first why they are the only person in a household taking the medication. Thabo didn’t take ARVs regularly until his grandmother received training and he could better understand the medication’s importance.
“We have patients discovered in 1999 who take ARVs and are still alive today,” Mary says.
With regular medication, support from his biological family at home and church family around the world, and hard work at school, there is now hope for Thabo to fulfill his dream of becoming a doctor some day.
Four support groups have now formed among some of the HIV/AID Taskforce’s clients. Beyond encouraging and spiritually supporting one another, the members of these support groups run gardens, from which the vegetables grown can help ensure a healthy diet, which is vital for those with HIV/AIDS, and can also be sold to help support members’ families.
Some of the groups also engage in other income-generating activities, like sewing and making jewelry, candles or soap. The groups schedule their own meetings—usually weekly—and support each other to build savings and provide credit, extending small loans to group members.
Members of the support group do not have to be HIV-positive themselves, though all have been impacted by the virus in some way.
Thoko* is HIV-positive and one of the Taskforce’s supporters. She is also a member of the Banqobi HIV/AIDS support group, which formed in 2007. Today, the group runs a large garden that grows a wide variety of crops, including maize, onion, lettuce, cabbage, beets, eggplant, carrots, pumpkin, watermelon, green peppers, and green beans.
“We are starting to be known in the community,” Thoko says with a smile. “Our dream is to become millionaires! Vegetables are becoming more expensive.”
The garden is thriving. Vegetables entered in 19 categories at a recent trade fair won the garden accolades and a gift card for 700 rand (about $55) from a local grocery store.
“We won because our vegetables were the best at the trade fair,” says Sindy* another HIV-positive supporter and support group member.
Alongside the vegetables in the garden, hope is growing, too.
“Yes, Jesus Loves Me”
On a cool September afternoon, Sindy, one of the Taskforce’s early supporters, visits a small, two-room house with Mary and Evelyn. Mary sits near the client, Thembi,* while Evelyn (right in photo left) presents a plastic bag filled with nutritious food. Thembi, a client since Sindy began visiting her in 2010, suffers from HIV, tuberculosis, and, more recently, a skin problem. Her caregiver shares Thembi’s health records with Mary, who is pleased to see that Thembi has been taking her medication faithfully.
“When you have tested [positive for HIV], they encourage you to take treatment and not wait until you are so weak,” Thembi says through a translator.
She speaks highly of the Taskforce, saying “[They] lifted my life, which was almost dead.” Her goals are to talk about God and preach the gospel of Jesus, talk to others about the virus, and visit people who are sick at their homes—the way the Taskforce has done for her.
After a song and prayer, the visitors pile into their pickup truck and follow a winding, dusty trail to a compound shared by three families.
At the next client’s home, the same procedure takes place: Evelyn delivers food, Mary examines the client’s health record, and Sindy talks to the client, Gugu*, who is an energetic and talkative storyteller, and whose facial expressions range from sadness to amusement as she responds to their questions with long stories. As she talks, the reasons for her dismay become clearer.
Gugu used to be a seamstress. The money she earned helped pay for school fees and food for her family. But as her illness worsened, she could no longer work. Because of this, only two of her three school-age children are attending school. The ARV treatment is helping, and she has regained her appetite, but her family still faces problems. They lack food. Because of the stigma around HIV/AIDS, some of the other people on the compound are afraid of Gugu and shame her. She wants her family to move elsewhere, but they can’t.
Like the first visit, this one ends with a prayer and a song. In the midst of her difficult circumstances, Gugu joins in singing these encouraging, simple words: “Yes, Jesus loves me. Yes, Jesus loves me. Yes, Jesus loves me. The Bible tells me so.”
A Fuller Future
The HIV/AIDS Taskforce now serves more than 600 clients. The number fluctuates based on how well clients are doing.
“Some clients, when they are better, go and get a job and you don’t see them again,” Mary says. “But that is the goal for them. They move on with their life.”
The Taskforce faces some big challenges. The HIV/AIDS prevalence rate remains high. Supporters are encouraged to have six clients, but they often take on more because multiple people are ill in the same household. Polygamy remains common in Swaziland, which continues the spread of HIV. All of this makes the supporters’ work emotionally challenging.
“To go every day, you get almost traumatized,” Evelyn says. “When you see someone’s life decline, you feel you didn’t do good.”
Evelyn says that having faith in God helps her keep perspective during difficult times.
There are many reasons for hope, though. Fewer children are now born HIV-positive, Evelyn reports. The stigma surrounding HIV/AIDS has lessened over the years, and more people are talking openly about their status. Mary says this is because now more people understand now that “you can be born with it.”
Evelyn and Mary are actively mentoring about 40 trained supporters working in two of Swaziland’s four regions. Resources permitting, they would also like to mentor the approximately 40 trained supporters who live in the other two regions.
Although their work with the HIV/AIDS Taskforce is difficult at times, it is also spiritually and emotionally rewarding.
“It uplifts your faith when you assist someone, see them get better and better, go back to work, and help their family,” Evelyn says. “After you work, you feel peace in your heart.”
-- Brad Crofford is a volunteer for NCM Africa. He holds a master’s degree in international studies from the University of Oklahoma and bachelor degrees from Southern Nazarene University. He grew up in West Africa and Haiti as the son of Nazarene missionaries Greg and Amy Crofford.