Condom Nation

Life in Swaziland in the era of HIV


The Kingdom of Swaziland is unique in many ways. It is the last remaining absolute monarchy in Africa and has the highest prevalence of HIV in the world: more than one adult in every four is infected with the virus.


Family structures are complex, and that makes life in the homestead complicated. A single compound can be home to large numbers of children that are related to one another through one parent but not both; absent parents are a norm. Men have far more power than women, and the culture provides no space to people who are anything but heterosexual. Formal polygamy, once the norm, is now on the decline. But 45 year-old King Mswati III has fourteen wives and is soon to marry a 15th. It is widely accepted that men will have several girlfriends at the same time as an officially sanctioned wife.


Though HIV continues to spread, over 80% of the people who need medication to control their infection are getting it. That’s an extraordinary achievement in a country of 1.2 million people where 40% of adults are unemployed, where foreign investment is very limited and where personal freedoms are limited by a government appointed by the King.


Swaziland is so much more than the HIV epidemic it has been facing for the last three decades. Its landscapes are stunning, and its families and communities extraordinarily resilient. Condom Nation is the story of a nation managing and learning against the odds. The stories of family life portray the people behind the challenging but changing HIV epidemic. Antiretroviral drugs have given Swaziland a pause, a chance to move beyond AIDS and death, an opportunity to conquer the virus and work out how the nation - the kingdom - can thrive.


Here is a small selection of images from the book.

Matata Road Show T-shirts, as worn by the team from Family Life Association of Swaziland (FLAS) at the Road Show in Matata - a day of music, live entertainment and education.

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A traditional Swazi wedding. Just outside Manzini Happy Manana (the bride) and Sibusiso (the groom) are getting married. Neither have previously been married. Although still widespread, polygamy is in decline, in part due to improved levels of education leading to women questioning their role in Swazi society. In September 2013 King Mswati III announced his engagement to his 15th future wife.

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George and Phumpaphi's homestead. 

They live together on their homestead (umuti) with some of George’s nine grandchildren from his two daughters. Both George and Phumpahi were previously married, but both spouses are now dead. George had an HIV test at Family Life Association of Swaziland (FLAS) when he was ill and thought he had TB, but he tested negative to TB and HIV. Phumpahi has also tested HIV negative.

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George and Phumpahi's homestead.

Nozipho (16) has not had a boyfriend and not yet accessed any HIV services. She's currently in Grade 6 and plans to be in school until the age of 22 to study agriculture and science.

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Lobamba, 'the spiritual village of the nation'.
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Gunile's homestead.

Gunile’s Mum, Anna (46) is the mother of 10 children and is bedridden. Her bedroom is a hive of activity with Nokawazi (12) studying, Mazului (6) playing, and Londiwe (3) and Nosikelelo (2) finishing their lunch. Gunile’s father has four wives, the first died and two live on their homestead. Gunile has a different father, born before Anna met him.

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Gunile's homestead. 

Anna is weaving a mat outside her hut at the top of the valley. She sells the mats which help provide an income for the family.

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Gunile's homestead.

One of Gunile's many daily chores is collecting firewood in the local forest.

She became pregnant with her boyfriend, but the baby died a few months ago at the age of 6 months. She is very clear that she doesn’t want to catch HIV. “...then my child just got unwell then after six months she died, she just sick and died, but I never give up.” We talked about how HIV affects her family and that no one living on the homestead was open about being HIV positive, if indeed any were.

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Gunile's homestead. 

Zweli, Mladvo and Siyabonga hearding the goats into the pen for the night.

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Gunile's homestead. 

Nokwazi (12) is helping prepare the evening meal.

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Gunile's homestead. 

The dresser in Mpendulo’s (24) hut. All the adult men of the homestead are away most of the time. The headman works as a truck driver for the local forestry company and Mpendulo went away to South Africa in June 2013 in search of work.

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Gunile's homestead. 

Time spent chatting around the fire. The younger family members have gone to bed whilst Gunile prepares food for tomorrow.

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Nkonathi (28) is waiting for his first visit to the Family Life Association of Swaziland (FLAS) mobile clinic. FLAS provide mobile clinic services to remote rural communities that otherwise would be unable to access HIV and family planning services. Today the mobile clinic visits the Makhekhe community near Mhlambanyatsi. The journey to get there is along very rugged and sometimes steep dirt tracks.

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Nkonathi Dlamini's (28) first visit to the FLAS mobile clinic. He's concerned as he's got chest pain and flu, but isn't ready to take an HIV test despite a long conversation with Dunsami, the nurse. Nkonathi currently isn't working, but he does help with farming on the homestead with his mother, father, brother and sister. He hopes to come back with his girlfriend for an HIV test soon.

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Nomsa's homestead. 

Nomsa's children are very resourceful in making toys, playing and having fun. Nomsa (26) found out she was HIV positive in 2010 and went on antiretroviral therapy in 2011. Her husband, Sikhumbuzo (29) is away at work. She has 5 children : Sandile (11), Nomzamo (9), Colisile (7), Tanele (5) and Mithwisa (2). The 2nd wife, Plilisiwe, is in another homestead, she has 3 children (aged 2, 5 and 10). The third wife Jabu, who has now left and married another man, has 2 children (5 and 9).

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Nomsa's homestead. 

Nomsa (26) is preparing and supervising lunch for all the children.

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Nomsa's homestead.

The children help with water for the dogs and goats. Some homesteads in the area are given just 20 minutes between 8-10am and 2-5pm each day at the local well to gather a maximum of 3 containers of 25 litres of water.

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One of the padlocked taps at St Phillips Mission, where water can be scarce.

Water is an issue on the homesteads and has been a problem for over a decade. Many homesteads are given 20 minutes between 8-10am and 2-5pm each day at the local well to gather a maximum of 3 containers of 25 litres of water. Many homesteads are now unable to grow their own food due to lack of water and rely on buying food from travelling corn sellers.

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The commercial fields beyond St Philips in the southern Lubombo region are very well irrigated through a system of canals, unlike the small homesteads, unable to grow very little, if anything, due to lack of water.

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The church at St Philips Mission where Cabrini Ministries are based. 

They offer medical and HIV services but, due to it being a Catholic ministry, no family planning services. There is a good relationship between Cabrini Ministries.and Family Life of Swaziland (FLAS), who provide family planning services as well as HIV services to the community every fortnight.

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Nana (30), Ntombikayise (10) and Majahenele (1).

The family used to walk to the clinic at Cabrini Ministries (an hours drive away), but now they rely on the fortnightly outreach. Nana found out she was HIV positive in 2009 after testing when her husband, Dumsani (43) became sick. Notomikayise (10) is on antiretroviral therapy (ART) and TB treatment. They are uncertain if he was born HIV positive or not. The younger children are HIV negative as Nana was on antiretroviral therapy when they were born. There is a good relationship between Cabrini Ministries.and Family Life of Swaziland (FLAS) who, as well as HIV services, provide the family planning services to the area. The family started using FLAS services last year. After having injections for birth control, Nana recently stopped as it was causing pain. They now rely on condoms to prevent further pregnancies.

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A typical evening at home with Lungile

An exhausted Lungile (33) climbs into bed with her sister and the girls, Sinenhlanhla and Vuyolwethu. The rest of her extended family have joined them for the evening - her room is the fun place to be.

Lungile became pregnant after her first date and gave birth to a baby in 2003 who became ill and died. That same week she found out she was HIV positive and became very week. “I told myself I have to be strong as I am the first born of my family and I am needed by my brothers and sisters."

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Lungile in the Family Life Association of Swaziland (FLAS) clinic with Mandla, Busisiwe and Winzile.

Busisiwe is about to start antiretroviral therapy and her husband Mandla has come in for a CD4 test. Their daughter Winzile (3) is HIV negative. Busisiwe has been HIV positive since 2008 and took antiretroviral medication to ensure she didn't pass HIV on to her unborn child. 

Lungile (33) is the only member of staff at FLAS who is open about her HIV positive status which has been very useful in her work. “I believe I have helped many women living with HIV, some of whom had lost hope, and have helped them to gain it back through encouraging them and sharing my story with them.”

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Bonsile and Elijah's homestead. 

Bonsile (39), Nonhale (2) and Tsapelo (3). Bonsile lives in the lowvelde with her husband Elijah (57) and their seven children. Bonsile spoke to the nurse of her fears and worries of her and her husband’s health. Her husband catches sexually transmitted infections but refuses to use a condom. “He won’t listen to me, a woman, but he would listen to you a man. If you could come back and start talking with him.” It seems that all of the responsibility for family planning and sexual health fall to her, but she has very little power to influence her husband’s choices and actions.

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Bonsile and Elijah's homestead. 

Nonhale (2) helping look after the chicks. Her mum, Bonsile, breeds chickens for an income.

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Bonsile and Elijah's homestead.

Bonsile (39) prepares food in the kitchen. The family are African Zionists, where the women provide each other with support around issues such as HIV but the men are generally not open about their HIV status. Some of the leadership are said to believe that being a member of the church provides the necessary protection from HIV.

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The bustling market in Manzini, next to the main bus station.

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The Male Circumcision Clinic at Family Life Association of Swaziland (FLAS). 

Research indicates that male circumcision reduces the risk that a man will be infected by an HIV positive woman by about 60%, although condom use is still encouraged. Each week FLAS visit different schools, often in very rural areas to encourage boys to attend the male circumcision clinic.

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Thokozani Hlanze attending the Male Circumcision Clinic at FLAS. 

Thokozani (18) has tested for HIV 5 times, but now believes in abstinence, encourage by his mother, to protect against HIV until he gets married. He is HIV negative in his pre-op test today. He hopes to become a businessman in the future and make his family farm more commercial.

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Alice, a sangoma (traditional healer) in Sitjeni, Lobamba, in consultation with Mantfombi. 

When Mantfombi (37) was ill Alice encouraged her to go to the clinic where, in 2009, she discovered she was HIV positive. She started antiretroviral therapy (ART) in 2011 and continues to drink an imbita called Zifozonke from Alice. She takes them at different times. Sangomas are encouraged to work with modern clinics. There are different imbita depending if the client is on ART or not. They don't consider any traditional imbita to be able to help in the same way that ART can. Mantfombi attends her local Zionist church who know about her condition and help practically and financially when she gets ill.

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Alice, a sangoma (traditional healer) in Sitjeni, Lobamba has prepared many medicines. 

After the Tinhlola Kuphengula (bone throwing) Alice would usually prescribe imbita or umutsi (traditional medicine made from roots, bark and leaves).

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The New Life in Christ, African Zionist church in Lobamba. Pastor and founder, Cyprian and churchman Mduduzi (Comfort, 18).

The church was founded in 2007 and currently has about 30 members. The Siquco (rotational dance) summons the spirits and angels. Converting Swazis to Christianity led to the establishment of local native churches often called Zionist churches and based in a modest house in a village or homestead. The congregation gather on Sundays and, led by weekend preachers dressed in white, green or blue carrying staffs, they will spend most of the day singing, drumming and preaching. The emphasis is on healing and in this there are many aspects that are similar to the practices of the traditional sangoma healers. People often join the church because of sickness.

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The New Life in Christ, African Zionist church in Lobamba. Pastor and founder, Cyprian's son. 

The church was founded in 2007 and currently has about 30 members. The Siquco (rotational dance) summons the spirits and angels. Converting Swazis to Christianity led to the establishment of local native churches often called Zionist churches and based in a modest house in a village or homestead. The congregation gather on Sundays and, led by weekend preachers dressed in white, green or blue carrying staffs, they will spend most of the day singing, drumming and preaching. The emphasis is on healing and in this there are many aspects that are similar to the practices of the traditional sangoma healers. People often join the church because of sickness.

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