Sixteen years on from the first World AIDS Day in 1998, this year the global diplomatic response to HIV/AIDS is in danger of falling down the list of priorities confronting world leaders.
It is in 2011 that the UN last hosted a high-level summit on the issue, but it’s not since 2005 that world leaders – hosted by the then Labour government at the G8 in Gleneagles – agreed to remobilise the campaign to help more of those people living with AIDS around the world.
And since then, the rights of women and of gay and lesbian people in some acutely affected countries – long recognised as key to tackling the epidemic – risk moving backward, not forward.
Kofi Annan famously said that “AIDS has a female face”; and yet the slow progress on improving women’s rights has made tackling the epidemic harder. And the growing intolerance to those who are gay in some parts of the world, and the anti-gay legislation recently passed in countries like Gambia and Uganda, is only reinforcing the stigma that those living with HIV/AIDS still have to face and therefore making the task of tackling the epidemic harder still.
Next month, attention will rightly focus on the regions and people who face the toughest fight against HIV, and where the need for coordinated international involvement is most pressing.
For many years, that place has been sub-Saharan Africa. The international donor community has aggressively focussed its resources on tackling the disease there, and in 2012, the region received nearly 50 per cent of global HIV spending.
But despite that political and financial commitment, the region remains the most affected by HIV and AIDS in the world.
The epidemic has taken an appalling human toll, and has damaged the social and economic fabric of many affected countries.
In truth, some governments in sub-Saharan Africa have been slow to react to the consequences of the epidemic. None more so than the Kingdom of Swaziland.
Swaziland today has the highest HIV prevalence in the world. One in four Swazi adults – over a quarter of the population – now live with HIV.
In a country of 1.2m, that’s over 200,000 people living with HIV.
And the consequences are tragic: in 2013, more than 4,500 Swazi’s died from AIDS, and according to the latest estimates from the UNAIDS agency, 17,000 Swazi children are now living with HIV.
Swaziland’s government is today trying to cope with this epic health crisis. Yet its efforts to respond to the HIV epidemic are being held back by a dire political and economic situation.
In the face of the crisis, Swaziland’s King Mswati III – Africa’s last remaining absolute monarch – has been widely criticised by the international community, and rightly so.
The country’s politics is stifled by the state of emergency which the King’s father introduced in 1973, banning political parties, many aspects of which still exist.
Swaziland’s economy is slowly recovering from a chronic slowdown, during which the International Monetary Fund (IMF) publicly scolded King Mswati for his running of the country’s finances. In 2011, the IMF stated that government budgets had reached such a “critical stage” that income had become “insufficient to cover essential government expenditures”.
At that time, the government’s funding for education and healthcare – including grants to elderly people living with HIV, and orphans of the epidemic – went unpaid.
Swazi civil society groups have argued that the King is now out of touch with the standard of living of his citizens, and that his approach has exacerbated the Swazi government’s economic difficulties.
Indeed, the King reportedly declined to accept a $340m bailout which was offered by the South African Government at the height of Swaziland’s financial crisis because of the accompanying political reforms which the deal demanded.
In the same year, his government threatened to cut civil servant salaries by 10 per cent while simultaneously boosting the King’s annual allowance from $24m to $30m. And despite the challenging economic situation, his personal fortune continues to grow to a reported $100m.
With this poor governance and financial backdrop, it’s no surprise that the Swazi government has struggled to cope with the HIV epidemic now crippling its people.
Given the scale of the challenge facing Swaziland, more action is clearly needed to cut HIV transmission rates and reverse one of the world’s worst outbreaks of the epidemic.
The international donor community should continue to engage with civil society, healthcare providers, and the Swazi government to tackle the epidemic. But campaigners should also be willing to use the opportunity of this year’s World AIDS Day to focus public attention on the plight of Swaziland’s 200,000 people living with HIV.
In addition, democratic reforms must be a focus for international engagement with Swaziland. The catalogue of complaints against King Mswati’s government highlighted by campaign groups such as Amnesty International and Human Rights Watch cannot be simply swept under the carpet whilst donor’s focus on the tackling the HIV epidemic.
If anything the human rights situation in Swaziland is worsening. The government recently passed a resolution which appears to restrict the activities of trade unions representing workers and employers.
And in June this year, President Obama officially removed Swaziland from the list of African countries that benefit from the US government’s African Growth and Opportunity Act because of a lack of reform, specifically on workers right.
The UK should now join other countries in calling on King Mswati to implement governance changes and should work to encourage greater democratic freedoms for Swazi’s citizens, including press and legal reforms.
Finally, the Commonwealth has a unique opportunity to influence Swaziland’s government to engage with a process of reform. Its monitoring mission for the 2013 national elections helped to focus attention on the areas that still require improvement, especially engagement with civil society and political organisations.
The continued HIV/AIDS crisis in Swaziland underlines the need to boost international support to tackle the epidemic, including redoubling our diplomatic focus and preventing HIV/AIDS from slipping down the agenda of the world’s leaders.
The world is rightly focussed on tackling the ebola outbreak which has swiftly become a global health priority, but as World AIDS Day has arrived, we must also not forget the horrific human cost of HIV/AIDS, which claims the lives of over a million people each year.
Gareth Thomas is Labour MP for Harrow West and shadow minister for Africa and the Middle East