THE HOLLOWED GENERATION

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A Hollowed Generation

Plunge in Life Expectancy: Hut by Hut, AIDS Steals Life in a Southern Africa Town

"Baba pointed out that the disease was due to the previous evil karma, and was

not at first disposed to interfere" –Sri Sai Satcharitra, Ch. XIII.

November 28, 2004

By MICHAEL WINES and SHARON LaFRANIERE

LAVUMISA, Swaziland - Victim by victim, AIDS is steadily boring through the

heart of this small town.

It killed the mayor's daughter. It has killed a fifth of the 60 employees of the

town's biggest businessman. It has claimed an estimated one in eight teachers,

several health workers and 2 of 10 counselors who teach prostitutes about

protected sex. One of the 13 municipal workers has died of AIDS. Another is

about to. A third is H.I.V.-positive.

By one hut-to-hut survey in 2003, one in four households on the town's poorer

side lost someone to AIDS in the preceding year. One in three had a visibly ill

member.

That is just the dead and the dying. There is also the world they leave behind.

AIDS has turned one in 10 Lavumisans into an orphan. It has spawned street

children, prostitutes and dropouts. It has thrust grandparents and sisters and

aunts into the unwanted roles of substitutes for dead fathers and mothers. It

has bred destitution, hunger and desperation among the living.

It has the appearance of a biblical cataclysm, a thousand-year flood of misery

and death. In fact, it is all too ordinary. Tiny Lavumisa, population 2,000, is

the template for a demographic plunge taking place in every corner of southern

Africa.

Across the region, AIDS has reduced life expectancy to levels not seen since the

1800's. In six sub-Saharan nations, the United Nations estimates, the average

child born today will not live to 40. Here in Swaziland, a kingdom about the

size of New Jersey with one million people tucked into South Africa's northeast

corner, two in five adults are infected with H.I.V., the virus that causes AIDS.

Life expectancy now averages 34.4 years, the fourth lowest on earth. Fifteen

years ago, it stood at 55. By 2010, experts predict, it will be 30.

Epidemics typically single out the aged and young – the weak, not those at

society's core. So what happens to a society when its fulcrum - its mothers and

fathers, teachers, nurses, farm workers, bookkeepers, cooks, clerks - die in

their prime?

Part of the answer lies in Lavumisa, where two visitors spent five weeks

recently talking to more than 60 residents, following the terrible ripples that

an unrestrained epidemic is sending through the community.

Sickness leads to death, death leads to destitution, destitution worsens a host

of social ills, from illiteracy to prostitution to abandoned babies. Multiply a

single illness or death scores of times, and a town like Lavumisa begins to

unravel.

The average life expectancy here is 34 years, but there are fewer and fewer

34-year-olds - just the very young and the old, struggling to do a

34-year-old's job.

Today, Lavumisa's schools are collapsing. Crime is climbing. Medical clinics are

jammed. Family assets are sold to fend off hunger. The sick are dying, sometimes

alone, because they are too many, and the caretakers are too few.

Much of this is occurring because adults whose labors once fed children and paid

school fees and sustained families are dead. Lavumisa's lost generation of

adults has reached beyond the grave, robbing survivors of their aspirations,

reducing promising lives to struggles for existence.

Sixteen-year-old Nkuthula Madlopha wanted to be a police officer. Instead, next

year she will till her grandparents' fields, filling in for her dead parents.

Her brother will herd livestock. Their grandmother, Vayillina Madlopha, wanted

a quiet old age. Instead, at 80, she is a new mother. "I thought my

daughters-in-law would be serving me food, washing for me and cleaning the

yard," she said. "Now I must start afresh."

Eleven-year-old Ntokozo wanted to be a third grader. Instead, he lies on the

floor of his one-oom hut, his knees swollen like baseballs and his mouth pitted

with sores. His mother, who died in May, infected him with H.I.V., either during

her pregnancy or later as he helped tend her oozing sores. His sister, Nkululeko

Masimula, 26, wanted a job. " I wanted to have my own business; to be a

hairdresser or a wholesaler," she said. Instead, she tends her brother and

their 61-year-old grandmother. She sells the family's chickens to raise money

for food. Finding the $20 a month required to take her brother to the nearest

antiretroviral drug site, 60 miles away, is a pipe dream.

Dido Khosa, 9, wants his mother back. "She used to cook food, wash my clothes,

do things for me," he said, sobbing. Instead, he describes a life of regular

beatings by his father and his father's girlfriend and periodic escapes to the

homes of neighbors.

Delisile Nyandeli, slim and pretty, wanted her own home and family. Instead, she

cares not only for her orphaned sisters and brothers, but also for the orphaned

children of two sisters who died of AIDS and whose husbands fled. At age 20,

she is a mother to nine other children besides herown boy.

"Today, when I was cleaning this house," she said, "I thought about it - if my

mother were alive, she would be the one doing this. Because when my sisters

don't have any pencils or other things they need for school, they come to me.

"And I can't help them."

A Hard Life Made Harder

Baked by drought, blessed with a single paved street, a gas station, two liquor

stores, two bars and a wretched crafts stand for tourists speeding from the

adjacent South Africa border post, Lavumisa clings to Swaziland's lower rungs.

Life would be hard here, even without AIDS.

A mostly rainless decade has discouraged most farmers from planting maize, the

staple crop, much less the cotton that once underpinned the local economy. Many

survive on homegrown chickens and pigs, donations from the World Food Program

and the kindness of relatives who work across the border or in Swaziland's

better-off cities.

The town does not keep death statistics. Most people quietly bury relatives in

their yards or nearby fields rather than buy a cemetery plot. But Mzweleni

Dlamini, the acting chief for Lavumisa and the surrounding region, does not

need a tally to tell him the toll is very high.

Two years ago, he shifted his regular meeting with subordinates from weekends to

Tuesdays because Saturdays and Sundays were consumed by funerals. Now he has

given permission for weekday funerals because there are too many dead for the

traditional weekend services alone.

With the dead gone, it is the impoverished survivors' turn to suffer.

At Lavumisa Primary School, a beige L-shaped building of concrete classrooms

clumped around a red dirt yard, enrollment has fallen nearly 9 percent in five

years, to 494 students, as children drop out to support families. One in three

students has lost at least one parent.

Nomfundo, a 15-year-old seventh grader, made the four-mile trek home from school

one recent day with her brother, Ndabendele, 10. He carried his books in a torn

plastic bag. She sported the shaved head customary for girls in mourning.

Their 34-year-old mother, a domestic worker, died Aug. 29; their father died in

2003. Care of the children has fallen to their grandmother, Esther Simelane,

53, who has been jobless for 14 years. Since the illnesses began, she has sold

four of the family's eight goats to raise money for food.

"Wheesh! Now I can feel the hardship," Nomfundo said. "Who is going to pay my

school fees? Even the clothes. Where am I going to get them?" She tugged at her

school uniform skirt, riddled with holes and hemmed several times to hide tears.

 

"I feel small," she said. "We used to have track suits. Now we no longer have

track suits. Other kids say, 'Oh, now you don't have a track suit. Not even

shoes! Now you are on the same level as us.' "

Actually, the two children are headed lower. Unbeknownst to them, their

grandmother has tested positive for H.I.V., apparently contracting the virus

while dressing her daughter's bleeding sores. Mrs. Simelane has kept the news

from Nomfundo and her brother to spare them further trauma.Should Nomfundo

manage to stay in school another year, she will move up to Ndabazezwe High

School. Elphas Z. Shiba, the headmaster, keeps careful track of his 366

students in stacks of ledgers. Mr. Shiba can state that at the beginning of

this year, Ndabazezwe High had 40 students who had lost at least one parent.

Nine months later, there were 73, 20 of whom had lost both father and mother,

nearly all of whom are desperately poor. A decade ago, Mr. Shiba said, the

schoolhad perhaps five orphans, none of them needy.

Both the primary and the high school are staggering under the burden of feeding

and educating a growing army of orphans who, by and large, cannot pay the

school fees. The state has pledged to pay to educate orphans, but so far it has

picked up but half the Lavumisa primary-school fees.Mr. Shiba said the high

school was getting a mere $15 of the $100 a year it costs to educate each

orphan. Ndabazezwe High School is now deeply in debt by Swazi standards. It

owes $275 for electricity; $200 for water; $260 for books and hundreds more for

office equipment. The security guards have not been paid in two months. Borrowed

money bought the woodworking and home-economics materials needed for final

exams. Even school lunches are hit-or-miss.

Mr. Shiba and Stephen Nxumalo, the headmaster at Lavumisa Primary, reluctantly

intend to carry out a resolution adopted in May by the nation's main teachers'

organization. Starting in January, students who do not pay their fees -

currently about 100 in the primary school, 258 in the high school - will be

barred from classes.

"The number of those who don't pay keeps increasing," Mr. Nxumalo said. "It's

because of the orphans. We are going to send them home, because we have no

option."

Tibuthye, Sandile and Nkuthula Madlopha stand to be among the first to go.

Their parents are buried on a hillside outside Lavumisa. Their father died in

1999 at 46; their mother three years later at 32. The father's parents,

80-year-old Vayillina Madlopha and her 82-year-old husband, Ellias, now raise

three children, ages 10, 12 and 16, on Ellias's $75-a-monthpension. For the old

couple, the son's death was a double blow. Gone is the $30 a month that he gave

them to supplement their meager income. Gone is the extra labor and money for

diesel fuel that he provided during the planting season on their farm. Their

fields of maize, pumpkin and beans now lie fallow.

After school one day, Mrs. Madlopha bent over an open fire, teaching 10-year-old

Tibuthye how to bake buns to sell at school for a few cents. "I am old, I will

die," she said. "They must learn how to work, so they will be able to do these

things on their own."

Nkuthula, 16, has plans for after her graduation. "I want to be a police," she

said in halting English. But the Madlophas cannot afford to fix their broken

tractor, much less to educate three children. "They need too many exercise

books and school uniforms," Mrs. Madlopha said. "We can't afford all that. We

are failing them."

Grim Choices for Children

What has befallen the Madlophas is happening across Lavumisa. When a family

loses a parent to AIDS, public health experts here say, the household

production of maize quickly falls by half; the number of livestock owned by

nearly a third. It is the equivalent of draining the bankaccount. Unable to

both feed and educate their children, impoverished single parents frequently

farm them out to relatives, following an axiom of Swazi culture that one takes

care of one's own blood, no matter the cost. One in six families has already

has taken in a child left parentless by AIDS, according to the World Food

Program.

"We Swazis don't believe there are orphans," said Lavumisa's mayor, Victor

Simelane, who is not related to Esther. "But now the extended families cannot

support the magnitude of the orphans." Increasingly, such children face a grim

choice: either seek shelter with whomever will take them in, or live on the

streets.

As he walked down Lavumisa's main drag, yards from the South African border gate

one afternoon last month, the mayor spotted Thabiso Mavimbela, 12, darting

across themacadam. "You see," he said, "here is one of these street kids. They

don't have extended families. They're loitering around the town." Five years

ago, he said, such kids did not exist.

Thabiso's world is a fearful place. He spends much of his after-school time on

Lavumisa's streets. After his mother died five years ago, his father abandoned

him. He ended up in his great-grandmother's mud-and-stone hut, , its walls a

checkerboard of holes and openings stuffed with rags, down a rutted dirt road

from the primary school.

The two sleep on grass mats on the dirt floor. Thabiso's uncle occupies the only

foam mattress. Thabiso has no toothbrush, no washcloth, nothing except his

tattered clothes. At night, he said, mice bite his feet.

Those are the least of his problems. "My uncle tells me: 'When your

great-grandmother dies, I will kill you too,' " he said. Panicky, he grinds his

wet eyes into the cuff of his green-and-yellow school uniform. "I know that when

she dies, I have to be killed. I don't have any other place togo." Thabiso's

uncle says the boy is treated well. But in an interview in early September, his

aunt, Thembi Simelane, said Thabiso sometimes sought refuge in her home,

declaring that he would rather sleep on his mother's grave than in a hut with

his uncle.

Ms. Simelane once was Thabiso's lifeline. Despite losing her husband to AIDS

three years ago and rearing her own five children, she supported the child with

profits from clothes bought in South Africa and resold in Lavumisa. But she had

to abandon that work last year when she, too, fell ill.

Last January, she tested positive for H.I.V. "My days are numbered," she told a

visitor in September. She showed a speechless Thobile Jele, a social worker at

the mayor's office, a will scrawled in black crayon on school notebook paper.

It bequeathed to Ms. Jele her five children. It did not mention Thabiso. At the

end of October, Ms. Simelane died.

Roaming Lavumisa's streets with Thabiso is Dido Khosa, 9, whose mother died in

2002 at age 28. His father and his new girlfriend now care for him, after a

fashion.

When a neighbor questioned him some weeks ago, Dido told her he had spent two

days alone at home without food.

Filching family money to buy bread, he said, brings a stiff penalty. Pulling

down his dirty sweat pants, Dido displayed a two-inch scar on his thigh where,

he said, his father had beaten him with a pipe. He worried an abscessed tooth

with a stick.

"I eat when there is food at school," he said.

Asked who takes care of him, he replied, "No one."

In August, Lavumisans noted a new sign of the growing stress on families: two

abandoned babies, left on doorsteps days apart.

A Weakened Work Force

In a way, one might not expect the hollowing out of Lavumisa's adult population

to have much affected its minuscule economy. Unemployment in Swaziland averages

34 percent. There is no shortage of cheap labor to replace a fallen clerk or

farm worker.

But the death rate is transforming businesses and the work force, in ways not easily visible.

Peter McIntyre, 66, is one of Lavumisa's real estate baron's and probably its

biggest private employer, owner of a grocery store, a liquor store, the gas

station and the Lavumisa Hotel. He has lost about a fifth of his 60 workers to

AIDS; the latest, a yard worker named Julius, died Oct.4. Another worker is

dying, he said; she begs him daily to look after her five children when she is

gone.

Employees like the yard worker are easily replaced. Not so his accountant, who

died of AIDS in 2001. Mr. McIntyre's relatives said it took three months to

find and train a qualified replacement. His three sons, in their 30's and heirs

to the empire, see a lesson in that. The South African government intends to buy

the land beneath the grocery and hotel and build a new border crossing. The sons

are not sure that they want to rebuild after the sale.

"My sons are very wary to open a new shop," Mr. McIntyre said. "They say you

have so many hassles - people dying; you can't build a permanent staff. I don't

know where it is going to end, what's going to happen to Swaziland."

Medical clinics are caught in a double squeeze, with mushrooming caseloads and a

steadily sicker staff. Visits to Lavumisa's one-room medical clinic have jumped

by nearly a fifth since 2000. At the regional health center in nearby

Matsanjeni, home to the only doctor within at least 30 miles, outpatient visits

have tripled since 1998.

The Matsanjeni clinic is chronically short-staffed. On an average day, officials

say, at least one of its 18 nurses is either sick or on leave for a funeral. The

administrator suspects that the recent deaths of at least two clinic workers

were caused by AIDS. Mothers-to-be suffer most; theprenatal clinic is closed

much of the time.

Only one segment of the economy is prospering. In the Lavumisa region, with

21,000 residents, reported crimes over a three-month period - largely

burglaries, assaults and thefts of goats or cows - have increased 25 percent in

two years.

Prostitution is booming. On the broad dirt road that parallels the South Africa

border sit the Lavumisa Hotel, the town's two bars and, each evening, a string

of 18-wheelers parked for the night. More than 1,100 rigs cross this border

every month, fueling a growing sex trade with local women. In 2000, a report

for the United States Agency for International Development concluded that

Lavumisa had five resident sex workers. On a recent Thursday night, perhaps a

dozen worked the bars.

Some are recent AIDS orphans. They are driven by their poverty: performing sex

with a condom nets a woman about $4.50; without a condom, perhaps $9. An

enterprising sex worker can make $50 a night.

"I used to stay with my mother and father, before they died of H.I.V. illness,"

said Thebisa, 18, during a break at the Lavumisa Hotel bar. "And then I

couldn't afford to go to school. My father died in '98. The following year, it

was my mother. I began working this way in 2000."

Her 19-year-old friend, Dabsile, another AIDS orphan, said: "A lot of my friends

are in this business. Some of us, it's because there's nobody to look after us.

For some of us, it's because there's peer pressure."

Dabsile said she was terrified of getting AIDS, and in fact, AIDS warnings are

plastered on storefronts and billboards in Lavumisa. Jars of free condoms sit

on the border-crossing counters and on other counters across town. Counselors

advise prostitutes and truckers alike aboutprotected sex.

Yet Dabsile has never worried enough to take an H.I.V. test or to insist on

condoms with her boyfriend, who knew nothing of her truck-stop trade. They

initially had protected sex, she said, "but as time goes on, you don't as

much."

A Gathering Storm

Lavumisa and other towns like it are windows into the crisis that has beset

Swaziland. AIDS kills an estimated 50 people here and H.I.V. infects 55 more

each day, erasing hard-won economic gains of the last 20 years, according to

the United Nations and the World Health Organization.

"It is the most efficient impoverishing agent you can find; it just sucks out

the resources," said Dr. Derek von Wissell, who directs Swaziland's National

Emergency Response Council on H.I.V./AIDS, the agency charged with stemming the

epidemic.

Until the late 1990's, when AIDS began to hit with force, Swaziland seemed a

society on its way up, making strides in health care, education and income. No

more.

Economic growth and agricultural production have slowed. School enrollment is

down. Poverty, malnutrition and infant mortality are up. By 2010, the United

Nations forecasts, children who have lost one parent or both will account for

up to 15 percent of Swaziland's one million people.

The adult H.I.V. infection rate, 38.8 percent, now tops Botswana's as the

world's highest. The death rate has doubled in just seven years.

"Swaziland is frankly beyond the threshold of what we thought could happen,"

said Duncan Earle of the Global Fund to Fight AIDS, Tuberculosis and Malaria,

who oversees $48million in AIDS-related grants to the kingdom. "Ten years ago,

we thought the peak infection rate would be 20 to 25 percent. This stretches

the imagination."

A long-promised flood of antiretroviral drugs financed by the Global Fund and

other donors could help stem the carnage. But like the rest of sub-Saharan

Africa, Swaziland is starting slowly. Only about 4,000 of the 26,000 who need

drugs get them. Perhaps 8,000 will have them by the end of 2005.

In 16 months, the Global Fund has disbursed $5.1 million in AIDS grants to

Swaziland. Yet not until this month did the overwhelmed Health Ministry hire

its first two doctors to work on H.I.V. programs. Some $2.8 million earmarked

for orphans' education is locked in the Treasury, even as the government this

year spent $600,000 on the king's 36th birthday party.

To the United Nations envoy for AIDS in Africa, Stephen Lewis, it is hard to

fathom the consequences awaiting a nation with a vanishing middle generation.

"I resist an apocalyptic scenario," Mr. Lewis said. "But I have to admit, in the

middle of the night I ask myself: 'How are these societies going to survive?' "

Lavumisa's story is not entirely bleak. Two decades into the epidemic, Mayor

Simelane said, people here are "beginning to accept that they are being

attacked by this monster" instead of linking AIDS to witchcraft or a white plot

against blacks.

The city allots 2 percent of its limited budget to anti-AIDS social work, and

has a $2,000 emergency fund for burying the dead. Chief Dlamini, King Mswati

III's representative to the area, has dedicated three acres to a garden for

orphans. A free feeding center for orphans isunder construction near the town

butchery. The high school has started a garden to feed hungry students.

A new mobile H.I.V. testing center is drawing customers on its weekly visits.

One recent afternoon, two dozen people, mostly women, waited for it to open. At

the Matsanjeni regional health center, seven miles away, a counselor said 350 to

400 people had visited since testing began last December.

But for every resident who faces AIDS or steels himself for a test, another

shies away, fearful of the outcome.

Busisiwe Matse, a 44-year-old mother of six, went to the center in early

October. Her husband, Boy, a former miner, is bedridden with symptoms of AIDS.

She had been almost constantly ill for nearly a year. She was almost relieved,

she said, when the counselor informed her that she was infected because now she

can seek treatment.

Boy Matse's other wife, Khanyisile, 27, refuses to check her own status. "I'll

do it later," she said.

Dr. von Wissell, the Swazi AIDS czar, has an ambitious agenda to reach families

like the Matses. He plans to use Global Fund money to speed drugs, food and

social support to towns hits by AIDS and to increase care for orphans.

Despite a sluggish start, he said, the government is moving as quickly as the

frail health infrastructure permits. Antiretroviral treatment could be

available near Lavumisa in six months, he said, but that will not be enough to

halt the epidemic.

He does not know, he acknowledged, how much worse that epidemic will become.

Virtually all the Swazis dying today were infected in the 1990's, when the

infection rate was far lower than it is today. Those who are just now infected

will not fall gravely ill until about 2012 - a tidal wave of illness and death

that is still eight years away.

How Lavumisa and other similar towns will cope with that is anyone's guess.

"Nobody has ever walked that road," Dr. von Wissell said. "Nobody."

http://www.nytimes.com/2004/11/28/international/africa/28swazi.html?ex=1102701445&ei=1&en=deccfb69c0407aa3

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