HIV/AIDS+WORK Swaziland

HIV/AIDS+WORKSwaziland:HIV/AIDS, workand developmentSabine BeckmannPallavi RaiILOAIDSwww.ilo.org/aids«The HIV/AIDSsituation continues tobe not only of publichealth importance,but a significantsocio-economic anddevelopment problem inSwaziland. The overallnational adult prevalenceis now estimated tobe about 38.8%, whichmeans that some 200,000individuals in the agegroup of 15-49 years andform the most productivepart of the labour forceare now living with thevirus (end 2003, Source2004 Report on the GlobalAIDS Epidemic UNAIDS)».

Copyright © International Labour Organization 2005First published 2005Publications by the International Labour Office enjoy copyright under Protocol 2 of the Universal CopyrightConvention. Nevertheless, short excerpts from them may be reproduced without authorization oncondition that the source is indicated. For rights of reproduction or translation, application should bemade to the Publications Bureau (Rights and Permissions), International Labour Office, CH-1211 Geneva22, Switzerland. The International Labour Office welcomes such applications.ISBN 92-2-115845-4The designations employed in ILO publications, which are in conformity with United Nations practice, andthe presentation of material therein do not imply the expression of any opinion whatsoever on the partof the International Labour Office concerning the legal status of any country, area or territory or of itsauthorities, or concerning the delimitation of its frontiers.Reference to names of firms and commercial products and processes does not imply their endorsementby the International Labour Office, and any failure to mention a particular firm, commercial product orprocess is not a sign of disapproval.ILO publications can be obtained through major booksellers or ILO local offices in many countries, or directfrom ILO Publications, International Labour Office, CH-1211 Geneva 22, Switzerland. Catalogues or lists ofnew publications are available free of charge from the above address.Printed by the International Labour Office, Geneva, Switzerland

AcknowledgementsThis report was developed with the technicalcooperation of ILO/AIDS and GTZ (DeutscheGesellschaft für Technische Zusammenarbeit),and funded through Italian Cooperation. Theresearch work was coordinated by Dr BenjaminAlli, Coordinator of Technical Cooperation andAdvisory Services, ILO Programme on HIV/AIDS and the World of Work, and Dr SabineBeckmann, Senior Technical Specialist. It wasprepared by Pallavi Rai, Technical Officer.The report benefited from valuable commentsfrom E.L.B. Dlamini, Deputy Commissioner ofthe Swaziland Ministry of Labour. We are alsograteful to Claudia Kessler of the Swiss TropicalInstitute, Basel, Switzerland, for reviewing thetext.ILO Programme on HIV/AIDSand the World of WorkGeneva, Mars 2005

AcronymsAGOAAIDSANCCIDACMTCCRCDFIDEUFLASFSEGDPGTZHIVICFTUIECMOACMOEPLWHARSSCSAMATSASOSFLSFTUSHAPESNAPSTISWANASOTASOTBTHOUNAIDSUNDPUNGASSUNICEFUSAIDWHOAfrica Growth and Opportunity Act (of the United States of America)Acquired immunodeficiency syndromeAntenatal clinicCanadian International Development AgencyCrisis Management and Technical CommitteesConstitution Review CommissionThe UK Department for International DevelopmentThe European UnionFamily Life Association of SwazilandFederation of Swaziland EmployersGross domestic productGerman Technical Cooperation (Deutsche Gesellschaft für TechnischeZusammenarbeit)Human immunodeficiency virusInternational Confederation of Free Trade UnionsInformation, education and communicationMinistry of Agriculture and CooperativesMinistry of EducationPeople living with HIV/AIDSRoyal Swazi Sugar CorporationSouthern Africa Multidisciplinary Advisory Team(of International Labour Organization)Swaziland AIDS Support OrganizationSwaziland Federation of LabourSwaziland Federation of Trade UnionsSwaziland HIV/AIDS Public EducationSwaziland National AIDS ProgrammeSexually transmitted infectionSwaziland Network of AIDS Service OrganizationsThe AIDS Support OrganisationTuberculosisThe Traditional Healers’ AssociationThe Joint United Nations Programme on HIV/AIDSThe United Nations Development ProgrammeUnited Nations General Assembly Special SessionThe United Nations Children’s FundUS Agency for International DevelopmentWorld Health Organization

ContentsExecutive summary 1A. Situation analysis 21. Recent economic trends and labour market situation 22. Trends in HIV/AIDS prevalence 3i. Characteristics of the epidemic 3ii. Factors contributing to the spread of the infection 43. Demography 5i. The impact on the labour force 5ii. Projected active labour force, by gender 6iii. Projected age-specific effects on the active labour force 6B. Economic impact of HIV/AIDS 71. Macroeconomic impact 7i. Gross domestic product 7ii. Unemployment 7iii. Poverty 82. Impact on specific economic sectors 8i. Public sector 8ii. Core industries 93. Microeconomic impact 10i. Enterprises 10ii. A business response to the epidemic 12iii. Households 13C. Policy options 14i. National response 14ii. International response 14iii. ILO projects in the workplace 15D. Recommendations 16Bibliography 17

Executive summarySwaziland has a population of 1 million. Its HIVprevalence rate stood only at 5% in 1992 beforerising to more than 38.8 % in 2003 (UNAIDS). It isexpected to stabilize at 36% by 2010, shrinkingthe country’s population by 25%.The impact of the epidemic is felt at manylevels: it has had a negative impact on productionas about 45% of Swazis in their twenties are HIVpositive—thehighest rate so far (UNAIDS 2002) 1 .In fact, HIV/AIDS, more than drought conditions,could potentially worsen Swaziland’s continuingfood crisis 2 . Rural areas, and especially theagricultural sector, are particularly hard hitas Swaziland’s economy is largely based onagriculture. The labour pool is limited and AIDSrelatedmortalities are therefore leading to adecrease in productivity. Moreover, Swaziland’shigh unemployment rate does not translateinto an available pool of labour to harvest thecrops of small-scale farmers when adults areincapacitated by HIV/AIDS.New policies are needed to go beyond theworkplace and benefit not only employees butalso encompass communities and vulnerablegroups, such as orphans and women: orphansrequire assistance and training so that they cancontinue their education; and women wouldbenefit from education programmes to makethem more in demand in the labour market.Given the threat posed by AIDS, it is essentialthat a national response be mainstreamedacross all major sectors, rather than beingseen purely as a health issue. The workplaceserves as a platform for programmes to promoteawareness of HIV/AIDS-related issues and ofthe urgent need for prevention measures. Suchprogrammes should include trade unions andlocal employers’ expertise, and policies shouldbe formulated under tripartite agreements.The health sector is understaffed and lackingin resources and medicines. Recently, theMinistry of Health and health-care clinics havebeen collaborating with traditional-medicinepractitioners in order to better assist patientswith AIDS-related illnesses.Despite the recorded increases in mortality,there is little empirical or field evidence that HIV/AIDS has affected the profitability and productivityof Swazi businesses, except for illustrativeevidence from small-scale studies. The responseby Swazi businesses to the epidemic has focusedmainly on avoidance of costs associated with theepidemic. However, such strategies have merelyresulted in the burden of HIV/AIDS being passedon to households.At the household level, there is a growingtrend towards older people looking after theirorphaned grandchildren or taking over theharvest. Loss of the breadwinner, poverty andincreased orphaning has led to children droppingout of school and worsening food insecurity. Theburden on families increases as their diminishingfinancial resources are used up on health carefor those ill or dying as a result of HIV/AIDS.There are few HIV/AIDS workplace programmesas many employers are reluctant totake responsibility for the problem. However,some companies do realise the importance ofretaining staff, experience, and skills and havepioneered investing in workplace programmes.1 These estimates look at the 15–49-year-old age group.2 Recent FAO analysis. See http://www.fao.org/Swaziland: HIV/AIDS work and development1

A. Situation analysisPiggsPeakMhlumeMBABANELobambaManziniSitekiMankayaneBigBendHlatikuluNhlanganoLavumisa1. Recent economic trends and labourmarket situationThe Kingdom of Swaziland gainedindependence from Britain in 1968 underKing Sobhuza II, who wielded almost absolutepower, and the current king, Mswati III, hasmaintained that legacy. The first phase afterindependence (1968–73) was characterizedby multi-party democratic processes withina monarchical system. In the second phase(1973 onwards), the inherited constitutionwas repealed in 1973 by the Royal Decree,which banned political activities and enabledthe king to assume legislative, judicial andexecutive powers. Some changes have takenplace over the years with the emergence of anew parliament and regional councils based ontraditional Swazi law, resulting in a dual systemof government.2Swaziland: HIV/AIDS work and developmentSwaziland is the smallest country inSouthern Africa, with an estimated populationof 1 million. The country has a good roadand communications infrastructure and itis possible to reach the two main cities fromany part of the country within two hours.Traditionally there has been a large migrantworking population working in South Africanmines but, in the past 20 years, the immigrant

labour force has increasingly been based onsugar, citrus and timber estates. Swazilandhas a youthful population, with 46% of itsinhabitants under 15 years of age.The HIV/AIDS situation continues to benot only of public health importance, but asignificant socio-economic and developmentproblem in Swaziland 3 . The overall nationaladult prevalence is now estimated to be about38.8%, which means that some 200,000individuals in the age group of 15-49 years andform the most productive part of the labour forceare now living with the virus (end 2003, Source2004 Report on the Global AIDS EpidemicUNAIDS). Population growth is projected to benegative by 2004. These high prevalence ratesherald a future burden of HIV-related illnesses,with serious consequences for the health-caresystem, which is unlikely to be able to copewith the increasing demand. The government’sability to deliver services will also be severelyreduced by the dwindling workforce and thedeteriorating socio-economic fabric of thecountry. This state of affairs necessitates animproved understanding of the driving forcesof the epidemic so that appropriate policyinterventions can be made.2. Trends in HIV/AIDS prevalenceHIV/AIDS was first detected in Swaziland in1986 and a National AIDS Control Programmewas established in 1987. The 8th sentinelsurvey of 2002 puts the national HIV prevalenceamong antenatal clinic (ANC) attendees at39% (see Figure 1), whereas UNAIDS reports aprevalence rate of 33.4% at the end of 2001.The number of estimated AIDS-related deathsin 2001 alone was 12,000 and probably thefirst cause of mortality in the country.The data show Swaziland to be on a parwith other countries and provinces in the region(with the exception of Southern Mozambique).Geographically, all regions show reasonablyhigh HIV prevalence rates: Manzini had thehighest rate of 41% and Hhohho had thelowest of 36.6%. However, the HIV prevalencetrend over the years appears to show somedegree of stabilization in the Manzini regionand a marked increase in HIV prevalence wasrecorded for the Shiselweni region in 2000–2002 (see Table 1).i. Characteristics of the epidemicThe overall HIV prevalence amongadolescents (aged 15–19) was 32.5% in 2002but further segregation by residence and ageshows that there has been a sharp increase in theFigure 1. Infection among ANC population454035302015105019921994 1996 1998 2000 2002Source: The 8th Swaziland sentinel survey of 2002Table 1: HIV prevalence (%) in Swaziland, by region1994 1996 1998 2000 2002Hhohho 15.5 26.3 30.3 32.3 36.6Lubombo 16.8 26.5 31.5 34.5 38.5Manzini 15.6 27.7 34.8 41 41.2Shiselweni 16.8 23.9 29.6 27 37.9Source: Sentinel surveillance survey report, 2002number of infections among 15–19-year-oldsin urban areas, while it appears stable in ruralparts. The reverse pattern is seen in the 20–24-year-old age group. The 25–29-year-old agegroup had the highest prevalence, followedby 20–24-year-olds. Overall prevalence in15–24-year-olds was 41.6% and this group isused as an impact-assessment indicator forestablishing infection rates among the youngpopulation and monitoring achievementstowards UNGASS targets 4 relating to HIV/AIDS.What makes Swaziland unique is that the highprevalence rates are uniformly distributedbetween urban and rural areas at 35.6% and32.7% respectively (SNAP 2000 5 ). This is dueto the country’s good road and communicationsinfrastructure, that even out differencesbetween rural and urban populations.Despite the many efforts made in theresponse to the epidemic, HIV prevalenceamong pregnant women attending antenatalclinics continues to show increasing HIVinfectiontrends 6 . What is worth noting is that67% of the HIV-infected pregnant women were3 Findings of the 2002 HIV sentinel survey.4 These targets were established at the United Nations General Assembly Special Session on HIV/AIDS in New York in June 2001.5 SNAP: Swaziland National AIDS Programme6 All HIV prevalence data are from the 8th Sentinel Surveillance Survey report in Swaziland in2002.Swaziland: HIV/AIDS work and development3

4Swaziland: HIV/AIDS work and developmentless than 25 years old and about 87% of thoseinfected were under 30 years of age. As withthe adolescents mentioned above, this highlevel of infection among young females reflectsa high rate of new infections (incidence). Ifthese trends persist, they will have a severeimpact on the socio-economic fabric of thecountry, since this age group represents theeconomically-productive and -reproductivepopulation.Equally high HIV prevalence rates havebeen recorded among married and unmarriedpersons—36.8% and 40% (2002) respectively.This shows that people get infected very young,even before the mean age of getting married.ii. Factors contributing to the spread of HIVinfectionSome cultural expectations and genderrelations have been found to contribute to HIVtransmission—in particular those that increasewomen’s vulnerability.In Swazi society women lack bargainingpower to negotiate safe sex, and polygamy iscommon which greatly increases women’s riskof contracting HIV. The 2002 survey found that,of those who tested positive for syphilis, 53%were HIV-positive; and among those who testednegative for syphilis, 38% were HIV-positive.This trend has also been observed inBotswana, resulting in the infection beingpassed from one generation to the other. TheGovernment of Botswana noted that, in moreadvanced epidemics, stopping the spreadof HIV from one generation to another is oneof the key interventions required. Given thatprevalence rates have been found to be 4–12times higher in young females than youngmales, this means stopping the spread fromolder men to girls.Belief in witchcraft: This tends to delayproper treatment of the villagers who areinfected with fully blown HIV/AIDS. It has beenseen that when they reach the hospital it isusually too late and some of the local healersadvice them to sleep with an innocent baby toget rid of HIV/AIDS (quoted from the Ministryof Labour).Wife’s inheritance: If a person dies of HIV/AIDS, it is customary that the younger brother‘marries’ the widow of the dead brother in orderto bring up the children. He in turn, almost7 See the World Vision website: www.wv.org.za/countries/swaziland.htm8 Alan Whiteside & Nkosinathi Ngcobo, Jane Tomlinson, & Alison Hickey (March 2003), “Whatis driving the HIV/AIDS epidemic in Swaziland? And what more can we do about it?” NationalEmergency Response Committee on HIV/AIDS and UNAIDS.never ensures whether the widow is infectedwith HIV, in which case his wife gets infected.Church attitudes: Some churches are stillreluctant to teach the people about HIV/AIDS.They insist that the answer to HIV/AIDS isacceptance of Christ who will empower thebeliever to abstain and live a holy life.Low level of condom use: Condoms aregenerally available in the country but theirlevel of use is low, due to widespread mythsabout them. Furthermore, in Swazi society, theyouth become sexually active early in life. In a‘knowledge, attitudes and practice’ baselinestudy conducted by Family Life Association ofSwaziland and the United Nations Children’sFund (UNICEF) in 2001, 45% of young peoplereported being sexually active and felt that 70%of their friends were also sexually active. Mostparents thought that young people engagedin early sexual activity (as evidenced by earlypregnancies).Poverty: Poverty assessment surveyscarried out by the World Bank and the UnitedNations Development Programme (UNDP) showthat 66%of Swazis live in absolute poverty. Forrural areas, the percentage of people living inabsolute poverty is even higher at 80%. Thedata show high inequalities in the distributionof income, with 10% of the population obtaining60% of the country’s income, and 90% of thepopulation receiving only 40% of the income.This ever increasing gap is indicative of highlevels of poverty in the country which arefurther exercerbated by the high rates of HIV 7 .Also, poor nutrition and bad general healthamong the people make their body’s immunesystem less able to fight infection. Therefore,the virus is more likely to gain a hold. Thereis also evidence of gender discrimination inaccess to health care, with women not alwaysgetting the medical attention or treatment thatthey need.Lack of information: A behavioural surveycarried out in 2003 8 concluded that the Swazipeople are highly knowledgeable about HIV/AIDS/STIs, even though this knowledge has nottranslated into desirable behavioural change.As a result, there is a need for clarificationabout protection from HIV, update on provisionstargeting young people, efforts at demystifyingpopular myths to avoid stigmatization amongpeople who are inaccurately informed.Vulnerable groups: Income inequalityincreases the likelihood that poor women willbe forced into transactional sex as a survivalstrategy. Orphans and vulnerable children aremore likely to be exploited and this may includesexual exploitation and abuse. In Swaziland,youth that do not find formal employment

are forced into poverty and lack access toopportunities and resources, contributing totheir vulnerability to HIV.Migration: Migration has been a causalfactor in the spread of HIV infection in manycountries in Africa. According to a census inSwaziland (carried out by ILO/SAMAT—theSouthern Africa Multidisciplinary Advisory Teamof the International Labour Organization), therewere 51,000 absentees—mainly men workingin South Africa in the late 1990s.Census data(1997) show that the Shiselweni region hasthe highest levels of emigration, with over 90%of people migrating to the Manzini region. Astudy on subsistence agriculture farms showedclose correlation between migration andHIV prevalence and AIDS deaths. It showedthat the Shiselweni region had the highestnumber of AIDS-related deaths, followed bythe Manzini region, but the Shiselweni regionhas the lowest prevalence of HIV (27%), andthe Manzini region the highest (41%). Thisis because of the migration pattern withinShiselweni and the lower socio-economicstatus of the region. Those who migrated fromthe Manzini region could have acquired theinfection elsewhere and only returned home todie. This study revealed that many householdsreported family members returning home inthe terminal stages of the disease.3. Demographic impactThis section presents an analysis ofprojections made by ILO on the dimension ofhuman losses faced by Swaziland, and theirconsequent impact on the labour market 9 .However, these projections are rough estimates.They may provide a benchmark around which toframe national policies but should be used withcaution. It must also be noted that these datamake no distinction between the participationof those in the labour force who are affected/infected by HIV and those who are not. Thisis problematic since HIV/AIDS may havesignificant consequences—for example, lowerparticipation of infected workers, and increasedparticipation of non-HIV-infected workers andrelatives of those infected. The lack of data onthe informal sector is also important, as thisis where most people in urban areas work,and informal activities provide a livelihood formillions of inhabitants.three years of depressed food production andrural incomes. The estimated life expectancyat birth according to recent estimates (2004)is 37,5 years 10 . The population growth rateis 0.55 (2004 est.) Furthermore, the currentimpact of the HIV/AIDS pandemic is exactinga very heavy burden on the population and theeconomy. The peak ages for HIV/AIDS (andresulting mortality) are 25–35 for women, and30–40 for men. (ILO projections, see figure 5).Economically and biologically, these are themost productive years in a person’s lifetime.But the potential to produce and reproduce isreduced as the epidemic sweeps away youngadults who would otherwise be key contributorsto household and national production.This has resulted in lower life expectancy,higher infant mortality and death rates, lowerpopulation and growth rates, and changes inthe distribution of population by age and sexthan would otherwise be expected (July 2004est.). The following projections by the ILO showa breakdown of how and where exactly are thelosses in population located.Figure 2. Impact of HIV/AIDS on population growth160014001200100080060040020001985 1990 1995 2000 2005 2010 2015 2020i. Impact on the labour forceThe projections in Figure 2 show thatpopulation growth over the past two decadeshas been seriously undermined by AIDS. Somepopulation growth continues, but at greatlyreduced levels Figure 3 shows AIDS has amajor impact on the work force; it is projectedthat, by 2005, the HIV/AIDS-related lossesin the labour force can be calculated to beabout 10%, rising to 30% by 2020 . The figureis a projection for the total labour force (aged15–49) from 1985 to 2020. Even though thePOP(With AIDS)POP(No AIDS)The 2004 Human development reportclamps down Swaziland with a HDI of 0.51,an index which combines measures of lifeexpectancy, school enrolment, literacy andincome. The levels of human developmentindicators have considerably worsened given9 UN Population Division, World Population Prospects, the 2000 Revision, New York, 2001. Theestimates used for these projections are from the ILO Labour and Population Programme. Thoughlabour force data are available for workers from the ages of 10 to 65+, this paper only addressesthe active labour force of 15–49-year-olds. Labour force participation rates, from UNAIDS, areused to make labour force projections. These projections have been now updated (2004) and areavailable at ILO/AIDS HQ Geneva.10 http://worldfacts.us/Swaziland.htmSwaziland: HIV/AIDS work and development5

Figure 3. Age-wise loss in the active labour force302520151050-51990 2000 2005 2010 2015 2020labour force is still expected to grow, increasedmortality due to HIV/AIDS will result in fewerpersons of working age than would be the casein a no-AIDS scenario.15-24 25-34 35-44 45-54Figure 4. Gender-wise population distribution due to HIV/AIDSii. Projected active labour force, by gender8007006005004003002001000Males1985Males1990Males1995Males2000Males2005Males2010Males2015Males2020Populationwith AIDSPopulationwithoutAIDSThe projections in Figure 4 show theactive labour force from 1985 to 2020, butdisaggregated by gender. For the year 2005,the projections show a loss of 488,000 womenand 480,000 men. Even though Swaziland willlose a higher proportion of women than menfrom the total population, it can be seen that,within the labour force, more men will be lost.Furthermore, in the absence of AIDS, the malelabour force is projected to grow much morethan the female one.Figure 5. Age-specific impact of HIV/AIDS on the active labour force180160140120100806015-2425-3435-4445-54402001985 1990 1995 2000 2005 2010 2015 2020iii. Projected age-specific effects on the activelabour forceFigure 5 shows the percentage loss due toAIDS, by different age groups. It can be seenthat the age group 25–34 is projected to havethe highest loss due to HIV/AIDS. The result is agreater number of young workers in the labourforce than older ones. The loss due to HIV/AIDS is also seen in the younger age groups(15–24-year-olds), but, in the later years of theprojection, the 25–34-year-old age group willlose a greater percentage of its work force, andwill grow at a slower rate than the other groups.In effect, the labour force will get younger dueto HIV/AIDS. This effect would be even morepronounced if one added to these estimatesthe entry into the overall labour force theincreasing number of young orphaned childrenunder the age of 15.6Swaziland: HIV/AIDS work and development

The above-mentioned estimates lead to thefollowing conclusions:• The Swaziland labour force will grow muchmore slowly over the coming decades dueto HIV/AIDS, with both fewer women andmen in the active labour force.• The age distribution of both the populationand the labour force will continue to bedrastically changed by HIV/AIDS, consistingof the very young and the old who will haveto work more because an entire generationwill be lost in the middle-age groups.• Given that the estimated number of 35,000orphans (UNAIDS 2001) is expectedto increase to 85,900 by 2006 11 , thelabour force situation will be even moreserious, with large numbers of childrenentering the labour force very ill-preparedin terms of their health and educationalcharacteristics. These orphans will requireadditional assistance and resources inorder to be integrated into society, otherwisethe increasing orphan problem will have anegative impact on social and economicdevelopment.11..Whiteside A, Wood G (1994) The Socio-Economic Impact of AIDS in Swaziland, Government ofSwaziland, Mbabane.Swaziland: HIV/AIDS work and development7

B. Economic impact of HIV/AIDS12 South African Customs Union—namely, Botswana, Lesotho, Namibia, South Africa and Swaziland13 UN Office for humanitarian affairs ‘Integrated regional information network’ website.8Swaziland: HIV/AIDS work and developmentMore than 80% of the population inSwaziland is engaged in subsistenceagriculture. Recently, however, the textileindustry has been expanding rapidly, largely asa result of Taiwanese investment associatedwith the implementation of the USA’s AfricaGrowth and Opportunity Act (AGOA). Themanufacturing sector has diversified since themid-1980s. Mining has declined in importancein recent years, with only coal and quarrystone mines remaining active. The economyis heavily dependent on South Africa, fromwhich it receives nine-tenths of its imports andto which it sends more than two-thirds of itsexports. Customs duties from the SouthernAfrican Customs Union and worker remittancesfrom South Africa substantially supplementdomestically-earned income.The government is trying to improve theatmosphere for foreign investment. The Swazieconomy relies heavily on the export sector,which is largely based on agriculture (whichaccounts for 10% of GDP), agriculturally-basedindustries along with manufacturing (48%of GDP). Since the economy of Swaziland isdependent on scarce skilled manpower, it ispredicted that the impact of HIV/AIDS will besevere.1. Macroeconomic impactSwaziland has a GDP per capita ofUS$1,390 and is significantly poorer than itsSACU 12 neighbours, such as Botswana andNamibia. There are two forms of land holdingsin the country. Fifty per cent of rural land isFigure 6. Total GDP at constant (1985) factor cost160014001200100080060040020001995/96 1996/97 1997/98 1998/99 1999/2000 2000/01Source: Central Bank SwazilandTotal (Em)at constant(1985)factor costheld in trust for the Swazi Nation by the kingand is farmed on a subsistence basis by smallfarmers. The balance is farmed using modernmethods by companies and individuals oftenin partnership with the government and theSwazi Nation. Some 40% of the land is titledeed land, used in sugar estates and forestryplantations. The land holdings are held in trustfor the king and controlled by chiefs accordingto traditional arrangements. More than 50% ofthe income is obtained from its share of SACUcustoms revenue.i. Trends in Gross domestic productThe GDP growth in the country is shown inFigure 6. Despite AIDS, the macro-indicatorsapparently have not changed much but thesefigures do not depict the changes withinvarious folds of the economy. These changescan be understood by looking at case studiesin specific sectors. GDP growth was fairlyconsistent until date (see figure 6). Currently,the outlook is poor as Swaziland is not anattractive prospect for foreign investment. Theeconomic growth rate increased from 2.7% in1998 to over 3% in 1999, after which it fell to2.5% in 2000, before further falling to 2% in2001.ii. UnemploymentFormal employment is quite stagnantin Swaziland, while informal employment isincreasing (and the tax base changing). HIV/AIDS is definitely having a negative impacton the employment situation. Formal-sectoremployment recorded only 749 additional jobsto the country’s 93,962 jobs already existingin 2001, which is low even for a small economysuch as Swaziland’s. Unemployment standsat 40%, according to the Ministry of EconomicPlanning and Development 13 .A shortage of workers leads to higherwages, which leads to increasing labour costs.The poor growth of the labour force causescapital output ratio to rise faster. The informalsectorworkers are most likely to suffer fromthe consequences of HIV/AIDS, since they donot have health facilities or social-protectionarrangements in their workplaces. This will,in turn, disrupt productivity as the frequentreplacement of workers becomes increasinglydifficult. Moreover, the replacements will

not immediately reach the same levels ofproductivity, due to less experience. Theeffect will be more pronounced where on-thejoblearning is important. There is a lack ofinformation on prevalence rates in differentsegments of the labour force, and the impactof HIV infection on the productivity of infectedworkers.iii. PovertyHIV/AIDS deepens poverty and increasesinequalities at every level—household,community, regional and sectoral. Povertycontributes to epidemic disease, whichcontributes to poverty, thereby creating avicious circle. For example, loss of labour in afarming system may result in failure to maintaininfrastructures such as terracing, leadingto soil erosion, and decreasing agriculturalproductivity. This will impoverish householdsand communities, reduce their ability to sustainthemselves and result in poorer socialization,less formal education and, ultimately, cultural aswell as material impoverishment. In 1997, thefood poverty line 14 included 48% of the nationalpopulation (29.7% of the urban and 55% of therural), and the total poverty line included 65.5%(45.4 % urban and 70.6% rural).2. Impact on specific economic sectorsThere is ample evidence to substantiate thatAIDS-related mortality is incrementally erodingthe capacity of various economic sectors and,inevitably, has dramatic repercussions. Theimpact of the epidemic has been studied inthe private sector as well. Businesses have feltthe socio-economic impact of the epidemic.The excess morbidity and mortality due toAIDS have significantly reduced productivity,increased production costs (due to highabsenteeism and funeral attendance) andcaused disruptions in business operations. Themain causes of increase in cost for companiescan be attributed to increased death benefits,medical costs, training costs and funeral costs.There has also been an increase in recruitmentcosts; costs due to reasonable accommodation,catering for employees’ families and orphans;and extended succession plans.i. Public sectorThe public sector in Swaziland has felt theimpact of HIV/AIDS, as evidenced by firm-levelstudies. These studies have empirical dataon the actual impact of AIDS on depletionof resources. In 2001, an assessmentwas commissioned by the Government ofSwaziland to determine the impact of HIV/AIDSTable 1: HIV prevalence (%) in Swaziland, by regionYear 1998 1999 2000 2001Private sector 59 983 61 003 61 613 60 381Public sector 31 891 32 210 32 693 33 216Total formal employment 91 874 93 213 94 306 93 597% change 1.46 1.17 -0.75Informal sector 11 8244 12 6175 13 5509 14 5925Source: Central Bank Swazilandon the three Central Agencies of the country.These are the Ministries of Finance, EconomicPlanning and Development, and Public Serviceand Information. This study concluded that, asa result of HIV/AIDS alone, the three ministrieswill lose 32% of their staff to the epidemic over20 years. Moreover, it will result in increasedpension fund contributions, sick leave,compassionate leave, training and other costs.The current value base cost of the epidemic tothe three central agencies is (conservatively)estimated to be (in local Lilangeni) E 10,535,994 over the period 2002–2010. Thisequates to 1.5% of the annual salary budgetfor the three ministries 15 .These ministries employ an essential partof the labour force in the country. Over 70%of Swaziland’s labour force works on land andthe Ministry of Agriculture and Cooperatives(MOAC) is mandated with ensuring that the landremains productive and continues to serve thepopulation. The MOAC is faced with increasedmorbidity and mortality among its employees.While not all of these deaths or illnesses canbe attributed to HIV/AIDS, there is a definiteincrease in retirements, pension payouts andexpenditure on health care by government (SeeFigure 7).Figure 7. Trend in pension payout by the public service fund to its members(1995-2001)1001010.11995 1996 1997 1998 1999 2000 200114 UN Common Country Assessment: http://www.ecs.co.sz/cca(Logarithmic scale)pension annuitydeath annuityretirementgratuitySource: Government of Swaziland, Assessment of the Impact of HIV/AIDS on the Central Agencies of the Government of the Kingdom ofSwaziland.15 Government of Swaziland, Assessment of the Impact of HIV/AIDS on the Central Agencies ofthe Government of the Kingdom of Swaziland: Executive Summary. 2002.Swaziland: HIV/AIDS work and development9

16 Pension annuity refers to on-going payout due to members and/or dependants after the initiallump sum payout in the form of death or retirement gratuity.17 http://www.ilo.org/public/english/region/afpro/mdtharare/country/swaziland.htm18 Gilbertson I, Whiteside A (1993) AIDS and commercial agriculture, International Conference onAIDS. 1993; 9(2):918 (abstract no. PO-D28-4202).19 Ian Gilbertson, Senior Medical Officer, Mhulume Sugar Estate, Swaziland, quoted in ToupouzisD (1998) The Implications of HIV/AIDS for Rural Development Policy and Programming: Focus onSub-Saharan Africa. HIV and Development Programme, UNDP, June 1998.20 Whiteside A, Wood G (1994) The Socio-Economic Impact of AIDS in Swaziland,” Government ofSwaziland, Mbabane.21 Ibid.22 Loewensen A, Whiteside A (1997) Social and Economic Issues of HIV/AIDS in Southern Africa,SAfAIDS Occasional Paper No. 2, SAfAIDS, Harare, Zimbabwe.23 Whiteside A, Wood G op cit.10Swaziland: HIV/AIDS work and developmentThe open-handed sick leave policy of thegovernment has wide-ranging implications forthe ministry, too. An employee can only bereplaced if he has officially retired (PensionFund 1995). This can only happen after oneyear, in the case of chronic conditions. In themeantime, reduced productivity and increasedproduction costs result from other employeesbeing paid overtime to do their sick colleague’swork. Furthermore, the sick employeecontinues to draw his salary during this time.These factors also lead to loss of agriculturalknowledge, skills and experience.The ministry has, in the past, developed amultisectoral approach to eradicate HIV, asfollows:a. Establishment of an HIV/AIDS focal pointwithin the ministry, run by a full-time focalpoint officerb. Information, education and counselling (IEC)activities for their staffc. Control of sexually transmitted infectionsthrough condom distributionHowever, these activities need to besustained and the coverage does not extend tofield workers and extension officers.Although the trend in death annuity indicatesa general increase (see Figure 7), there was asharp increase between 1998 and 1999 andagain after the year 2000. On applying trendanalysis using the linear regression model, itwas found that there was an increase of E1.7million in death annuities for each subsequentyear.The government does not provide any specialmedical benefits to its employees for healthcare within Swaziland. The employees and theirdependants pay out of their own pockets fortheir health care. They seek care from publichealth services and private providers. The PublicService Pension Fund was established in 1993to administer benefits accrued to members.Members are civil servants who contribute 5–10% of their monthly pensionable salary whilethe government contributes the balance oftheir pension package. Figure 7 shows pensionpayouts for all civil servants 16 . All availablefigures show a sharp increase beginning in1996 in total payouts to members.ii. Core industriesAgricultureAgriculture is the largest sector in Swaziland(as in most African economies), accounting fora large portion of production and the majority ofemployment. The loss of a few workers duringthe crucial periods of planting and harvestingcan significantly reduce the size of the harvest.In countries where food security has beena continuous issue because of drought, anydeclines in household production can haveserious consequences. Additionally, a loss ofagricultural labour is likely to cause farmers toswitch to less labour-intensive crops. In manycases, this may mean switching from exportcrops to food crops. Thus, the epidemic couldaffect the production of cash crops as well asfood crops.Due to unfavourable weather conditionsthat affected the agricultural output of mostcountries in Southern Africa, Swazilandrecorded a 30% deficit in maize production 17 .A case study of the Mhlume Sugar Companyexamined the effect of HIV/AIDS on all aspectsof the operation of the estate. The sugar estateprovides both housing and health care for allof its employees and their families. The studyconcluded that AIDS will have a major impact onthe estate, including effects on the productionprocess, employee benefits, the medical costsand facilities, and the overall well-being of theestate 18 . The senior medical officer attributed30% of all employee deaths over a three-yearperiod to AIDS 19 . (A worker in the private sectorgenerally has about 21 days’ sick leave 20 .)Health careThe cost per patient per year is estimatedto be E4,000 in Swaziland. Therefore, it isestimated that, by 2000, the AIDS epidemicwill result in an annual health-care cost ofE62.9 million and, by 2006 that cost will riseto E73.4 million 21 . The effect of HIV-relatedillnesses accounted for 13% of the Ministry ofHealth’s budget in 1994 and almost double thenumber of outpatient visits by 1999 22 . Anotherearlier study 23 estimates that, in 1994, about250 hospital beds would be required for adults

due to AIDS and another 149 beds would berequired for the paediatric AIDS cases, requiringa significant percentage of the 1,540 hospitalbeds in the country. The study projected that,by 1998, over half of the hospital beds in thecountry would be occupied by AIDS patients.Transport and miningIn Swaziland, the country is small enoughthat few truck drivers are required to spend thenight away from home while working. There aretwo groups at risk, however: those who makecross-border deliveries, and those who are intransit from other countries 24 . Miners workingin South Africa send a considerable amountof money home to Swaziland to support theirfamilies there; in 1983, 15% of rural incomeswere derived from this source. As HIV-infectedmigrants become ill and are unable to workin the mines, they will return home and thatincome will be lost. High HIV prevalence willalso reduce the number of new miners recruitedfrom Swaziland to work in South Africa. Sinceminers have a relatively high prevalence rate,this will have a significant impact on householdincome 25 .In the transport sector, it was seen that,given the poverty in the country and the restof the sub-region, these workers do not have tolook around for sexual partners. In most cases,they are available along their truck routes.Studies have, however, revealed that condomuse was high among transport workers 26 .The Transport Sector Project AdvisoryCommittee was put in place in March 2002and it was decided that representatives ofmajor organizations and institutions runningthe transport industry would form a committeethat would pave the way towards a sectoralresponse to HIV/AIDS. In collaboration withthe European Union, ILO and GTZ, a strategicaction plan was developed for implementationover a period of three years.EducationIn the early 1990s, the HIV prevalence rateamong university students was 18.4%, andit was predicted that most of these studentswould die within 10 years of their graduation.Thus, the investment society has made intheir human capital will not be fully realized 28 .It was not until the late 1990s that the realeffects of the epidemic were felt within thissector. More and more teachers left classesunattended. The Ministry of Education (MoE)is not in a position to accurately state the HIVprevalence rate within the education sectoramong teachers, pupils and parents andcan only give estimates based on projectionstudies, which are derived from data obtainedfrom surveys conducted every two years bythe Swaziland National AIDS Programme. TheMoE commissioned an Impact Assessment ofHIV/AIDS on the Education Sector. The studyprojected that 50,000 Swazis were dying ofAIDS, while 300,000 were estimated to dieof AIDS in 15 years. The number of orphanswas estimated at 35,000, and was projectedto increase to 120,000 in 15 years. The studyfurther revealed that there was confusionacross the population regarding basic factsabout HIV and AIDS, that the Ministry could notfulfil its mandate effectively and that the cost ofmaintaining the current standard of educationwould be exorbitant.3. Microeconomic impacti. EnterprisesThere have been a few recent empiricalstudies of the cost of AIDS on companiesand they show that the private sector hasbeen equally hard hit. They also show thatthe workplace can be an important HIVsentinel surveillance site, providing valuableepidemiological data on low-risk populations.Surveillance in the workplace also providesessential data for monitoring and measuringthe epidemic and for planning and managing itin an organization.A recent study by the Royal Swazi SugarCorporation (RSSC) of 4,183 mainly maleworkers found HIV prevalence to be 37.5% 29—37% among permanent employees, 43%among seasonal employees and 35% amongcontract employees. The highest prevalenceof 43% was among agricultural employees,followed by 31% in manufacturing and 26.7%among service and administrative staff. In thejob categories, the lowest-income age grouphad the highest prevalence—42.6%. Accordingto skills, 30% prevalence was seen in thehigher-skilled age group and 13.4% in thehighest skilled and professional age group.24 Ibid25 Ibid.26 Mndzebele A (July 2002) Report of the HIV/AIDS Strategic Action Process, for the SwazilandTransport sector. Draft final version.27 Ibid.28 Southern African Economist, 1997. AIDS toll on regional economies, (Issue :15 April–15 May 1997)29 This study reports the results of HIV testing of 4183 (predominantly male) employees in theLubombo region of Swaziland and a comparison with the national antenatal HIV data for thecountry and the region. The survey was done by Dr Clive Evian, AIDS Management and Support, anHIV consulting organization based in Johannesburg.Swaziland: HIV/AIDS work and development11

30 Muwanga FT (2001) Private sector response to HIV/AIDS in Swaziland – impact, response,vulnerability and barriers to implementation of workplace HIV/AIDS prevention programmes31 Muwanga, Fred Tusuubira (August 2001). Private Sector Response to HIV/AIDS in Swaziland-Impact, Response, Vulnerability and Barriers to Implementation of workplace HIV/AIDS preventionprogrammes.32 According to the Federation of Swaziland Employers (FSE) 2001 register, there are 440businesses affiliated with the organization. Twenty-four companies were randomly selected forthis survey. The number of workers that each business employs ranges from 2 to over 3,000. Thesurvey included firms from diverse industrial sectors such as manufacturing, food processing,wholesale/retail, hotels, production and agro-industries.12Swaziland: HIV/AIDS work and developmentAmong others, a probability survey analysedthe impact of HIV/AIDS on the private sector,focusing on costs imposed as a result ofincreased illness and deaths from HIV/AIDS 30 .It was carried out on 45 businesses in thecountry affiliated to the Federation of SwazilandEmployers, and stratified according to numberof employees. The report also discussesthe knowledge, attitudes and practices ofbusinesses in the area of HIV/AIDS at the firmlevel.A prevalence of HIV was found in mostbusinesses in Swaziland and excess morbidityand mortality due to AIDS have significantlyreduced productivity, increased productioncosts and caused disruptions in businessoperations (see Figure 10). A total of 73% ofbusinesses reported having had an employeeliving with HIV/AIDS. The group most affectedis the medium to large enterprises (250-599employees) with over 87% of companies in thisgroup having had a case of a worker living withHIV/AIDS. The study found that 33% of surveyedcompanies had experienced increased loss ofskills, with the impact being felt more by thelarger companies. The study also revealedthat 31% of the companies surveyed hadexperienced an increase in recruitment andtraining costs. Again, this was felt more acutelyin the larger enterprises.The above-mentioned impacts resultin an overall reduction in experience, skill,institutional memory and performance of theworkforce. Unit productivity is disrupted due toFigure 8. Percentage of Companies experiencing reduced productivity100%90%80%70%60%50%40%30%20%10%0%21-49 50-99 100-249250-599 >600Company size (no. of employees)Disrupted operationsIncreased production costsReduced productivityincreased staff turnover and companies incurincreased costs in recruitment and training.The main causes of reduced productivity areincreased absenteeism due to HIV/AIDS-relatedillnesses, workers taking time off to look aftertheir sick relatives, funeral attendance andhigh labour turnover due to HIV/AIDS-relateddeaths of employees (see Figures 8 and 9).The same study also found that in a privatesector company, the number of employeestaking extended sick leave was on the increase(see Figure 10). The company had a policy ofproviding 60 days’ leave for employees sufferingfrom tuberculosis. Such employees largelyaccounted for the increase in the number ofthose taking extended sick leave. The companyclinic diagnosed an average of 7 new cases oftuberculosis every year—an incidence rate of11 per 1,000 cases. Over 90% of these withTB are co-infected with HIV. The direct cost ofabsenteeism for a company was calculated atE 354,000 for the year 2001.The AIDS-specific mortality rates arestill below what has been projected. Earlierprojection estimated that the private sectorin Southern Africa would lose up to 3% ofits workforce per year to AIDS (WhitesideA and Wood G, 1993; Smart, 1999). Thistranslates into a mortality rate of 30 per 1,000employees. The highest from this study was17.21 per 1,000—far lower than the estimatedfigures. Tuberculosis and HIV co-infection areprevalent among employees (see Figure 11).In fact, a very high degree of correlation wasfound between the two diseases.ii. A business response to the epidemicMany Swazi businesses provide a widerange of employee benefits (see Table 3). But,due to the large outlay in employee benefits,businesses are vulnerable to the economicimpact of excess morbidity and mortality dueto HIV/AIDS. A study by Muwanga found thatonly few businesses had well-defined policiesto guide their HIV-prevention-and-controlprogrammes 31 . Some big businesses alsoresorted to ‘outsourcing and limited benefits’to their employees.However, many firms do provide in-housemedical benefits to employees. Apart fromthose shown in the table above, benefitsalso include retirement schemes, death-inservicebenefits, burial fees, medical care,group health insurance, disability paymentsand on-going family support. Health educationprogrammes are the only elements that arewidely implemented but these are limited toemployees and management. Another study 32

showed that the impact of AIDS on businessdepended on the benefit package offered byindividual firms.Both these studies prove that moreemphasis on workplace education is requiredso that the employers and workers are awarethat that, to maintain commercial viability, itis economically astute to reduce operationalcosts incurred by HIV/AIDS. This is a potentialarea where ILO/AIDS can work on with theMinistry of Labour and employers and workersassociation. It is also vital to enable smalland medium-sized companies that lack thenecessary financial and human resourcesto run these programmes, partnerships withlarger enterprises active in the fight againstHIV/AIDS are recommended. Most businessesare willing to implement HIV-preventionprogrammes in the workplace and to commitavailable resources to this cause, but somelack the expertise to do so.Figure 9. Percentage of Companies experiencing costs of funerals anddeath benefits due to HIV/AIDS10080Increased loss of skillsIncreased costs for recruitment6040Increased training costsIncreased funeral costsIncrease in health care costs20Increase in death benefits021-49 50-99 100-249 250-599 >600Company size (No. of employees)Figure 10. Number of employees taking sick leave for a period longer than30 days in a private sector companyNumber of patiens1210864201992 1993 1994 1995 1996 1997 1998 1999 2000 2001YearFigure 11. The association between turbeculosis and AIDS deaths in aPrivate sector companyMortality rate per 1000 employees201510501997 1998 1999 2000 2001non-HIV related HIV-related TB-relatedTable 3: Medical benefits provided by Companies to employeesMedical benefits 21-49 50-99 100-249 250-599 >600 TotalFree treatment onsite 1 3 3 3 2 12Treatment at private clinic 2 3 3 3 1 12Health insurance 3 1 3 2 3 128 2 3 2 1 16No responsibility other thansick leaveSource: Central Bank SwazilandSwaziland: HIV/AIDS work and development13

Table 4: Companies that have workplace HIV/AIDS policies21-49 50-99 100-249 250-599 >600 TotalPolicy on chronic diseases 1 2 4 2 2 11Policy on chronic diseases1 2 3 2 2 10including HIV/AIDSHave policy on eligibility or 5 2 2 2 2 8maintenance of medicalbenefitsHave a specific policy on4 1 2 1 0 13HIV/AIDSHave policy on HIV testing 0 1 2 0 1 4Do HIV testing of employees 0 1 0 0 0 1Do test applicants for HIV 0 1 0 0 0 1Source: Central Bank Swazilandiii HouseholdsAIDS-related morbidity and mortality havewide-ranging ramifications for households.These include increases in health-care costsand the diversion of labour from the farm tocare for the sick person. In the event of death,there is loss of labour, loss of institutionalmemory, loss of income if the deceased wasa breadwinner, and additional costs for thefuneral. These events, in turn, have a negativeimpact on the amount of land cultivated, thecrop yield and cropping patterns. Besides that,HIV/AIDS affects the growth of many marketsfor goods and services as affected householdsdivert expenditure to meet HIV/AIDS-relatedcosts. Non-essential goods with high elasticityof demand are likely to be more susceptibleto shifts in household expenditure than stapleproducts. Many middle-income householdsbecome poor, and market growth for goodsand services targeted at upwardly-mobilehouseholds may be negatively affected.Table 5 shows the result of a study on anagricultural household in Swaziland 33 . A clearcausality between the incidence of HIV and thedesired output can be seen. HIV/AIDS has ledto:• a reduction in crop yield and land undercultivation,• shifts in cropping patterns• an increase in the number of householdscaring for orphans• more children dropping out school due tolack of feesThe fact that the region receives little anderratic rainfall and has poor soils increasesthese households’ vulnerability to the impact.Furthermore, according to the results of thestudy, AIDS mortality is expected to reachits peak in the year 2008, which meansthat the worst is yet to be seen. The numberof orphans is expected to rise by 10,000every year for the next six years, and morehomes will be left destitute by the epidemic.Mitigation and coping strategies are at apreliminary stage and are yet to be refined. Anumber of commercial establishments haveinitiated health programmes for those withchronic illnesses and these programmes arebeing expanded and modified to deal with theincreasing demands caused by AIDS.Within the household, women are themost affected. A study by UNDP indicated thatwomen’s lack of access to land makes themmore vulnerable to HIV/AIDS as they are forcedto depend on men for it 34 . The majority of singleparentwomen reside on peri-urban areas inrented accommodation. They have nowhereto leave their children when they die. With thedeaths of such mothers, these children arelikely to be left homeless children.The UNDP study also found a growingnumber of child-headed households as aresult of both parents having died from AIDS.Such homes experience extreme difficulties intrying to survive and their poverty levels are aserious cause for concern. Some get sporadicassistance from the community, but this is notenough in the medium/long term.33 Muwanga. Impact of HIV/AIDS on agriculture and private sector in Swaziland.34 UNDP, Mbabane (2002) Gender-focussed responses to HIV/AIDS.14Swaziland: HIV/AIDS work and development

Figure 12 . Need for a Workplace prevention programmeEducational materials42%Determineseroprevalenceamongst employees2%Conduct impactstudies 21%Details ofgovernmentstrategies 6%Evaluation ofworkplaceprogrammes 8%Cost-benefit analysisof preventionprogramme 21%ProduceTable 5: Effect of AIDS on agricultural productionAverage household productionper yearNon-AIDSrelateddeathsAIDSrelateddeaths% reductionin productiondue to AIDSMaize 35.06 bags 16.05 bags 54.2%Cattle 13.61 herds 9.58 herds 29.6%% of land cultivated 84.2% 50% 34.2%Source: Results of the study ‘Impact of HIV/AIDS on agriculture andprivate sector in Swaziland’Swaziland: HIV/AIDS work and development15

C. Policy optionsDeveloping a policy response to theepidemic requires a sound knowledge of theongoing activities by the donor, and publicand private sector in the area. A number offoreign donors have been mobilized againstHIV/AIDS, and the government, with the helpfrom civil society, NGOs and donors, has putin place a range of responses, interventionsand strategies to combat the spread of theepidemic and to deal with its consequences.However, little change in HIV prevalence hasbeen observed so far. Furthermore, the needto deal with the consequences of illness, deathand orphaning means that additional resourcesare needed at a time when existing capacity isbeing eroded.i National responseSwazi authorities have publicly acknowledgedthat HIV/AIDS has become a nationalcalamity. In February 1999, King Mswati IIIcalled for all sectors—public, private, andNGOs—to take action. In May 1999, the PrimeMinister launched the Cabinet Committee onHIV/AIDS, chaired by the Deputy Prime Minister,and the multi-sectoral Crisis Management andTechnical Committees (CMTC) on HIV/AIDS.The government recognized that the crisis couldnot be addressed by the Ministry of Healthalone and required a multi-sectoral strategy.The new committees will set policy directionsand manage the mobilization of resourcesfor all sectors, ensuring a more unified andcoherent national response.In addition, the SNAP (Swaziland NationalAIDS Programme) Secretariat was establishedin the Ministry of Health in 1989, with supportfrom the World Health Organization (WHO).A National AIDS Task Force has also beenestablished. The first sentinel surveillancesurvey was conducted in 1991 and subsequentsurveys have been conducted annually, exceptin 1997, because of resource constraints.The bulk of AIDS-related activities havebeen carried out by NGOs and AIDS serviceorganizations, such as:• The Family Life Association of Swaziland(FLAS), which conducts lectures on familyplanning, STIs, and AIDS in army barracks ineight sites, as well as education programmesin industry, and youth counselling;• The Swaziland AIDS Support Organization(SASO), which supports programmesbenefiting PLWHA;• The AIDS Support Organization (TASO),which provides counselling and testingservices;• The Traditional Healers’ Organization (THO),which provides HIV-prevention education;and• The NGO coalition Swaziland Network ofAIDS Service Organizations (SWANASO),which coordinates the activities of NGOsworking in HIV/AIDS.ii International responseA number of activities funded by multilateraland bilateral donors have been implemented,including the following:• UNAIDS, through the Ministry of Education,has supported the NGO -Swaziland HIV/AIDS Public Education (SHAPE) in workingwith secondary schools. Through their IECactivities, NGOs have been largely effectivein bringing information about HIV/AIDSinformation to the country. However, sexualbehavioural change and condom use havenot accompanied that information.• The Baphalali Swaziland Red Cross, incollaboration with the Ministry of Health,is working to improve the screening of theblood supply in the country.• Together with the government and theItalian Cooperation, UNAIDS is also fundingtwo pilot sites for home-based care inrural areas, involving traditional healersand community volunteers. The SalvationArmy, Hospice at Home, the CatholicChurch through Caritas, and the Swedishmissionary Mkhuzweni Health Centre arealso involved in home-based care.• GTZ has supported many HIV/AIDS-relatedcare activities and provided condoms andthe Italian Cooperation is supporting homebased care pilot projects.• The European Union (EU) supports theSHAPE HIV-prevention project in secondaryschools.• USAID, DFID and CIDA have also beenworking closely with NGOs to fight AIDS.Besides, a coordinating theme group,composed of UNAIDS with representativesfrom UNICEF, UNDP, UNFPA, WHO, andUNESCO, and chaired by WHO, supports16Swaziland: HIV/AIDS work and development

the following activities:• improving community home-based careand counselling;• strengthening a multisectoral response;• supporting the HIV and TB Preventionand Counselling Pilot Project;• building the capacity and coordinatingthe work of AIDS service organizations;• mobilizing young people against HIV/AIDS;• providing support for people living withHIV/AIDS; and• supporting the work of SHAPE insecondary schools.• WHO has provided technical assistancein HIV/AIDS evaluation and programming;surveillance; a TB and HIV/AIDS programme;and development of a national HIV/AIDSpolicy. It has also supported the publicationof health-education materials.• UNDP has been active in policy-leveladvocacy, and is providing technicalassistance to the Ministry of Healthand NGOs, and supporting sentinelsurveillance• UNICEF has supported a situation analysisof orphans; provided training for primaryschoolteachers in HIV/AIDS education;and assisted NGOs in capacity-building.• UNFPA has financed study tours for NGOsand sponsored workshops on HIV, genderissues, and poverty alleviation. UNFPA is amajor donor of condoms along with otherdonors.iii ILO projects in the workplacethe world of work. Ten African countries areincluded in the project.It should be noted that the Federationof Swaziland Employers (FSE), establishedin 1964, has had a strong influence not onlyin economic matters, but also in politicalaffairs. On 12th April 1973, the independentconstitution was repealed by the Royal Decreeand all political parties such as ImbokodvoNational Movement, and Ngwane NationalLiberatory Congress (NNLC) were banned. TheDecree also prohibited meetings held withouta written consent of the Commissioner ofPolice. This affected the unions as they couldnot meet with the rank and file membershipto deliberate on issues. Many unions dieda natural death as a result of this. The year1975-77 saw a visible vacuum in collectivebargaining because the only active union wasthe Bank Workers union. It was decided thatto bring pressure to the government to allowfreedom of association and right to organize, itwas important to urge them join the ILO: Afterthe government joined the ILO a tripartite groupwas represented at the GB. This resulted inSwaziland ratifying more than 30 internationalConventions including convention 89 and 98that influenced the country’s legislation inSwaziland. The Swazi Federation of Labourand SFTU work together on many labour andsocio-economic issues. After Swaziland revisedits legal framework in 2000, it has benefitedfrom major technical cooperation programmesgeared to build capacity for CMAC (conciliators,mediators and arbitrators). Many programmes(such as those mentioned above) are in thepipeline for implementation.• HIV prevention in the transport sector ineight Southern African countries. Thisproject includes Swaziland and involvesthe mobilization of ILO’s social partners inthe fight against HIV/AIDS in the transportsector, developing national policies forthe prevention and the mitigation of theimpact of HIV/AIDS in that sector, assistingcountries in national strategic planning anddeveloping a regional strategy based on thenational strategies of the eight participatingcountries.• ILO/USDOL HIV/AIDS Workplace EducationProject• ILLSA: Geared to strengthen lawenforcement• ILO/IPEC Programme on Child Labour• HIV/AIDS and the world of work: tacklingthe consequences for labour and socioeconomicdevelopment: to raise awarenessamong ILO’s constituents and otherstakeholders about the labour and socialimplications of HIV/AIDS and to promotethe ILO Code of Practice on HIV/AIDS andSwaziland: HIV/AIDS work and development17

D. RecommendationsThe commitments outlined in this paperare signs that the country is ready to tackle theHIV/AIDS epidemic. However, the governmentmust also commit its resources to proactiveHIV/STI prevention and control. In addition togovernment efforts, community participationat all levels is essential for effective HIV/AIDScare, prevention, and support activities. In thepresence of a coherent HIV/AIDS policy, andmultisectoral involvement, Swaziland will beable to fight the HIV/AIDS epidemic.i GeneralGiven the threat posed by AIDS, a nationalresponse should be mainstreamed across allmajor sectors, rather than being consideredpurely as a health issue to be dealt with by theMinistry of Health.• A multisectoral reaction should be fullyincorporated into the planning process,targeting ways and means of reducingtransmission and morbidity and mitigatingthe negative impact of AIDS. Althoughorganizations such as UNDP and theWorld Bank have commissioned situationanalyses in certain geographical regions,few comprehensive sectoral impactassessments have been done.• Human resource development efforts needto aim at replacing skills and ensuring anadequate pool of skills at any given point intime.• On a macroeconomic level, the generationof employment through enterprisedevelopment and investment promotionmust be made a priority in order to maintaina level of investment proportional to theannual GDP growth.and public awareness programmes leadingto changes in sexual behaviour. Suchindicators will be useful in formulatingpreventive messages and public-awarenessstrategies in the future. It would also beused for identifying population groups andassessing over time the effectiveness ofthese programmes.• ILO could play an important role incollaborating with the trade unions insensitizing staff on issues related toHIV/AIDS. This would include trainingand enhancing the capacities of suchstaff in terms of tackling HIV/AIDS in theworkplace, including such issues in tradeunion activities, and designing awarenessraisingprogrammes.• As mentioned in Section B, some progressivepublic and private sector employers haveadopted comprehensive prevention andcare programmes for their staff. The role ofthe ILO vis-à-vis employers is to help ensurethat such policies permeate all firms andnot only a select group of large corporations,so that the benefits reach the grass-rootslevel. This should also extend to the publicsector and the informal economy.• In creating a social safety net, it is importantto develop a comprehensive ‘HIV/AIDS inthe Workplace’ programme, for which theILO Code of Practice on HIV/AIDS and theworld of work may be used as a guide. Thefindings of research carried out on labourlegislation provisions relating to HIV/AIDSrelateddiscrimination can be a usefulstarting point.18Swaziland: HIV/AIDS work and development• There is a need for research that generatesestimates of losses, the gender and agedistributions of human capital losses, themain skill levels affected, and identificationof these losses by region and sector. Studieswould also need to take into account anyprevious efforts by the public services inthese regions and their capacity to alleviatethe AIDS-related labour resource problems.• There has been very little research done onthe behavioural aspect of HIV/AIDS as it is asensitive issue and the impact of education

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ISBN-92-2-117159-0ILOAIDSInternational Labour Office4, route des MorillonsCH-1211 Geneva 22Switzerland.E-mail: iloaids@ilo.orgWebsite: www.ilo.org/aids