A hut-to-hut survey in 2003 found that a quarter of all households had lost someone to AIDS in the preceding year, and one third 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.
Tiny Lavumisa, a town of 2,000 people with a single paved street, a gas station, and two liquor stores, is an example of the demographic plunge taking place in every corner of southern Africa. Across the region, AIDS has reduced life expectancy to levels not seen since the 1800s. In six sub-Saharan nations, the United Nations estimates, the average child born today will not live to 40.
An Epidemic's Ripples
Here in Swaziland, a kingdom in southern Africa about the size of New Jersey, two in five adults are infected with HIV, the virus that causes AIDS. Life expectancy for Swaziland's 1 million people now averages just over 34 years, the fourth-lowest in the world. Fifteen years ago, it stood at 55. By 2010, experts predict, it will be 30.
Epidemics typically single out the aged, the young, and the weak. So what happens to a society when its coreits mothers and fathers, teachers, nurses, farm workers, bookkeepersdie in their prime?
One answer lies in Lavumisa, where the ripples that an unrestrained epidemic is sending can be easily seen: Sickness leads to death, death leads to destitution, destitution worsens a host of social ills, from abandoned babies to illiteracy to prostitution. Multiply a single illness or death dozens of times, and a town like Lavumisa begins to unravel.
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.
Feeling the Hardship
Nomfundo, a 15-year-old seventh-grader at Lavumisa Primary School, made the four-mile trek home from school one day recently with her brother, Ndabendele, 10. She had shaved her head as is customary for girls in mourning. Their 34-year-old mother died in August; their father died in 2003. Care of the children has fallen to their grandmother. 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 says. "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, which was riddled with holes and hemmed several times to hide tears.
"I feel small," she says. "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 children are headed lower. Unbeknownst to them, their grandmother has tested positive for HIV.
Delisile Nyandeli 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. At age 20, she is a mother to nine other children besides her own son.
At 80 years old, Vayillina Madlopha was hoping to have a quiet old age. Instead, she is caring for two grandchildren whose parents have died of AIDS. "I thought my daughters-in-law would be serving me food, washing for me, and cleaning the yard," she says. "Now I must start afresh."
When Parents Die
Thabiso Mavimbela, 12, spends much of his after-school time on Lavumisa's streets. When his mother died five years ago, his father abandoned him. Now he lives with his great-grandmother in a mud-and-stone hut on a rutted dirt road. He sleeps on grass mats on the dirt floor. He has no toothbrush, no washcloth, nothing except his tattered clothes. At night, he says, mice bite his feet.
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. At last count, Ndabazezwe High had 73 students who had lost at least one parent, 20 of whom had lost both their father and mother, and nearly all of whom are desperately poor. A decade ago, the headmaster says, the school had perhaps five orphans, none of them needy.
Public-health experts here say that when a parent dies of AIDS, the household production of maize quickly falls by half, and the number of livestock owned by nearly a third. It is the equivalent of draining the bank account.
Clinics are caught in a double squeeze, with mushrooming caseloads and a steadily sicker staff. At the health center in nearby Matsanjeni, home to the only doctor within at least 30 miles, outpatient visits have tripled since 1998.
Today, only one segment of Lavumisa's economy is prospering: crime. Reported crimes over a three-month period (largely assaults, burglaries, and thefts of goats or cows) have increased 25 percent in two years.
Prostitution is booming. More than 1,100 trucks cross the border with South Africa every month, fueling a growing sex trade with local women, some of whom are young girls, often recent AIDS orphans.
"I used to stay with my mother and father, before they died of HIV illness," says 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."
Worse To Come?
Each day in Swaziland, AIDS kills an estimated 50 people and HIV infects 55 more, erasing hard-won economic gains of the last 20 years, according to the UN and the World Health Organization.
"It is the most efficient impoverishing agent you can find; it just sucks out the resources," says Dr. Derek von Wissell, the director of Swaziland's National Emergency Response Council on HIV/AIDS. An infusion of antiretroviral drugs could help, but like the rest of sub-Saharan Africa, Swaziland is just starting to distribute the drugs.
Until the late 1990s, 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. At almost 39 percent, Swaziland's adult HIV infection rate now tops Botswana's as the world's highest. The death rate has doubled in just seven years.
Von Wissell does not know how much worse the epidemic will become. Most Swazis dying today were infected in the 1990s, when the infection rate was far lower than it is today. Those who are just now infected will not fall gravely ill until about 2012a tidal wave of illness that is still seven years away.
How Lavumisa and other similar towns will cope with that is anyone's guess.