AIDS defies funding and good intentions

Swaziland has millions of dollars to fight AIDS, but its spending choices have drawn criticism.

September 12, 2004|By John Murphy | John Murphy,SUN FOREIGN STAFF

MBABANE, Swaziland - One recent morning, Themba Ginindza opened the door to this African kingdom's AIDS council headquarters and sighed in disgust.

He had come to show off a new, high-tech computer system, the latest government effort to quell the wrath of HIV. With nearly 40 percent of its adults infected, the kingdom holds the grim distinction of having the highest HIV infection rate in the world.

The computer system, paid for largely by international donations, could make the distribution of lifesaving AIDS drugs swift and efficient, allowing doctors and nurses even in rural areas to access medical records, order blood tests and request drug refills for thousands of patients.

But as he stepped inside his office to show off the computer, Ginindza was met by a disturbing reminder of the gap between his country's aspirations and reality.

The lights were out again.

"How am I supposed to turn on the computers?" he asked.

In a country of 1.2 million people where blackouts are common and thousands of families still brighten their nights with candles, it's a good question, one that AIDS advocates here say the Swaziland government should have asked before deciding to commit millions of dollars in international aid to the computer system.

Even before they are brought online, the computers are being dismissed by some critics as a waste, the latest example of the Swaziland government's misguided, if well-meaning, efforts to fight AIDS.

After years of clamoring for money for treatment and care of its AIDS victims, Swaziland, like many African nations, is suddenly awash in millions of dollars from the United Nations, the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Last year, the Global Fund, a financing partnership of governments, private donors and civil society, awarded Swaziland $30 million - equal to more than half the country's overall health budget - for the country's AIDS projects, including providing AIDS treatment for free.

More funds available

Worldwide, the amount of money available to fight AIDS has increased to an estimated $6 billion this year from $1.2 billion in 2000, according to the United Nations. Meanwhile, prices for the lifesaving AIDS drugs have fallen sharply.

For the first time, being HIV-positive and poor in the developing world no longer means certain death because the drugs are too costly.

But now that the opportunity to make headway against the pandemic has arrived, critics fear that poor countries such as Swaziland lack the wisdom to seize it.

"The capacity is not there to spend what we have been given," says Hani Dlamini, director of the Swaziland AIDS Support Organization and a member of the National Emergency Response Council on HIV/AIDS.

Health experts have long warned that some of the world's poorest nations in Africa, Asia and the Caribbean hit hardest by AIDS might not be prepared to handle the huge infusions of money or to meet the demands of creating complex treatment programs.

In the case of Swaziland's computer system, electrical problems are just one of the barriers. The telephone lines - there are only 40,000 phones for 1.2 million people - are also unreliable, especially in rural areas.

`A white elephant'

More disturbing is the question of who will operate the computers when the nation faces a severe shortage of doctors, nurses and other health professionals.

"How will it operate? It won't work at all. It will become a white elephant," says Siphiwe Hlophe, director of Swaziland Positive Living for Life, an AIDS support group.

Many AIDS advocates here were also taken aback by the government's decision to pour $2 million of Global Fund money into building community centers for children orphaned by AIDS. The centers duplicate well-established services already provided by other aid agencies. Without a clear purpose, many of the new centers sit empty and unused.

A well-meant project to encourage communities to raise crops for orphans has also failed to meet expectations. In 12 percent of the country's chiefdoms, the fields yielded enough food. Forty percent failed altogether. The rest showed mixed results. In several communities, residents ate the seeds instead of planting them, a member of the government AIDS council said.

Likewise, a government project to place 55 shipping containers stocked with medical supplies across the country to assist AIDS patients receiving home-based care proved a disappointment. Many of the containers, aid workers say, sit empty because they have never been stocked.

Doctors and drugs

Most alarming to AIDS advocates here is the chaotic distribution of the AIDS drugs. While millions of dollars have been spent on questionable projects, the country has failed to hire desperately needed doctors and nurses. In the main government hospital here in the capital, a single doctor treats as many as 250 AIDS patients a day.

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