Organizations fighting HIV/AIDS in Swaziland were at first incredulous at reports that hundreds of impoverished HIV-positive rural residents were eating cow dung to give their stomachs something to digest before taking their antiretrovirals (ARVs).
"It seemed too sensational to me when I first heard it, but then an MP stood up in parliament and said it was in his area that people on ARVs were doing this," said Wandile Khoza, an AIDS activist in Swaziland's central commercial hub Manzini. "It has come to this; the food insecurity most Swazis are experiencing has come up against the world’s highest HIV prevalence rate.”
The Swaziland National Network of People Living with HIV/AIDS (SWANNEPHA) confirmed that some of its members were consuming cow dung after MP Josephs Souza of rural Lugongolweni reported first-hand knowledge of the practice following visits to his HIV-positive constituents.
"A rural health motivator took me to one of the patients on ARVs who is among those that now mix cow dung with water and then eat it before taking the tablets," the MP told parliament.
"We have resorted to eating rubbish for purposes of taking our ARVs because they must be consumed after a meal," said SWANNEPHA in a statement.
Research shows that taking ARVs on an empty stomach can exacerbate the side-effects of the drugs, including headaches, dizziness and tremors.
Uncertainty over ARVs
The revelations come as uncertainty over the availability of ARVs prompted Khoza and hundreds of other HIV-positive people to mount an unprecedented protest in Mbabane on 27 July.
Police refused members of SWANNEPHA permission to march in the streets, so 500 members took buses to the Health Ministry to deliver a petition. The umbrella organization also petitioned the National Emergency Response Council on HIV/AIDS (NERCHA), the government unit that finances SWANNEPHA and other AIDS organizations, which is itself facing a funding crisis.
"With the release of the ART budget in 'dribs and drabs', any patient on ART would be worried when they are not sure if they will get their monthly stock of treatment," the petition states. "They are human beings who deserve to have peace of mind."
Swaziland is in the midst of a financial crisis that has seen the government cut support to local humanitarian NGOs by 14 percent.
The estimated 65,000 Swazis on ARVs fear that continued budgetary uncertainty could hit their treatment and compromise their survival. 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.
Health Minister Benedict Xaba said on government radio recently that while the government's financial crisis must concern people living with HIV, there were adequate supplies of ARVs in stock.
AIDS activists are not convinced, however. "The statement that the minister made does not allay fears," the SWANNEPHA petition stated, before accusing the government of misusing state funds and an insincere commitment to the health sector.
|We have resorted to eating rubbish for purposes of taking our ARVs because they must be consumed after a meal|
The anxiety is partly linked to a recent report in the local media attributed to NERCHA, which claimed that all Swaziland's AIDS prevention programmes had been suspended due to lack of funding. Recent media reports have also caused alarm, with the Swazi Observer carrying a report headlined, "Only Two Months Supply of ARVs Left".
A spokesman for SWANNEPHA also noted a contradiction between the Health Ministry’s assurances and "the actual facts faced by people on the ground".
"We have to take on the government-run health system in this country," said SWANNEPHA chairman Patrick Mngometulu. "What good are ARVs if we can't access them because the nurses are on strike and the clinics are closed?"
Political analysts say public sector strikes are inevitable as the government continues to make budget cuts; all ministries have been told to reduce expenditure by 25 percent.
HIV has also hit Swaziland's school system hard. School heads have decided that beginning in August, all public schools will shut down for a month because the government has not fulfilled its commitment to pay fees for all orphans and vulnerable children.
One-fifth of Swaziland's population - an estimated 200,000 children under 15 - comprises children orphaned through HIV/AIDS, and head teachers, whose schools rely on student fees and government subsidies, say they can no longer afford to function.