SwazilandIn Swaziland, a staggering 42.6 per cent of people are suffering from HIV/Aids. Bill Corcoran reports from the capital Mbabane
"Jesus takes away sin, and the diseases in our bodies," reads the sign stuck to the wall beside the swinging doors that open into the male HIV/Aids ward in the Mbabane Government Hospital.
The poster is one of dozens that have been put up around the dilapidated hospital in Swaziland's capital in an attempt to foster a sense of hope amongst the thousands of HIV/Aids infected patients who attend for treatment.
But beyond the doors to the male ward, one sees little hope in the eyes of the frail men who occupy the rusting iron beds that run in rows up and down the ward.
As the doctors and nurses go about their duties, the emaciated patients stare vacantly at undetermined points around the room; it is as if the effort of trying to hold on to their fragile lives is too much for them to endure.
The hope that such posters are trying to foster is in short supply amongst the 1.1 million population of the tiny mountainous country wedged between South Africa and Mozambique.
The recently released HIV/Aids figures for Swaziland puts the infection rate at 42.6 per cent, which is the highest infection rate in the world, and an increase of four per cent on the 2003 figures.
According to Unicef Swaziland communications officer, Nonhlanhla Hleta-Nkambule, there are many factors such as the stigmatisation of the disease and the custom of polygamy amongst Swazis - that have led to such high infection rates.
But she says the most crucial issue in the fight against the disease revolves around the cultural dynamic that exists between male and female Swazis. Within the Swazi culture women are expected to be subservient to men, and this cultural phenomenon is engrained to such an extent that women are viewed as minors under the constitution.
"Women come to us and say: 'because I'm married, my husband has paid 'Lobo' - or bride price - so I can't ask him to wear a condom'," explains Nonhlanhla in an effort to describe how their cultural norms are perpetuating the spread of the disease.
These norms have also led to many of the initiatives aimed at tackling the epidemic engulfing the kingdom proving less successful than they might be, as many men either refuse to participate, or disregard the wishes of their sexual partners. One such initiative experiencing this lack of male participation and support is run by the non-governmental organisation, the Swazi Infant Nutrition Action Network (Sinan).
The organisation runs an outreach programme into rural areas, which tries to educate and ensure that HIV infected mothers, as well as fathers, optimise the nutrition and hygiene methods available to them in order to combat the effects of the disease.
The hope is to reduce the mother to unborn child infection rate by 50 per cent.
Without intervention, 40 per cent of children born to HIV infected mothers will contract the disease.
Nusipho Gwebu, a social worker with the programme, maintains this lack of support from most Swazi men is a constant stumbling block that she and her colleagues must overcome if they are to ensure that best practices are implemented.
"Women are denied the chance to implement the good health care practices because men dominate at the household level in terms of finances and prioritising what should be done. We need men to educate men, because they won't respond to a woman like me," she says.
This view is borne out by the participation rate of men in the programme. Of the 200 slots available for each mother, father and child - the programme carries on after the child's birth - only 50 fathers have become involved.
A typical scenario in rural areas is a mother and child occupying a homestead made from sticks and mud, with no running water or electricity, and no male partner in sight, says Nusipho. "In Swazi culture, looking after the child is totally down to the mother as is looking after the home, so they [ the fathers] just come and go as they please," she says.
Rather than handing out the anti-retroviral drugs - one can only receive them at the organisation's clinic - Nusipho says she and her colleagues try to give practical advice in terms of healthcare practices and how to recognise the symptoms of the disease.
"A lot of the time people think they are okay and just have an illness, so they go to the local traditional healer," she reveals.
"So we tell them about how to ensure their baby remains healthy, what the symptoms are and we talk to them about the situation they have with their partner".