By Craig Timberg
Washington Post Foreign Service
Sunday, October 29, 2006
MBABANE, Swaziland -- This tiny kingdom's new anti-AIDS campaign arrived without warning one day in July, featuring a slogan both unusually explicit and dripping with implied accusations: Makhwapheni Uyabulala.
Your secret lover can kill you.
Despite living in a country that has the world's highest rate of HIV, Swazis had grown accustomed to bland billboards suggesting that more condoms or a positive attitude toward the disease would curb its spread. These new ads were different.
By the time they disappeared two weeks later in a frenzy of controversy, they had sparked a passionate national debate about how best to combat a disease that, Swazis say, has pushed their country to the brink of collapse. And the ads forced many here to confront how freewheeling sex was fueling an epidemic of early death.
In Swaziland's bustling capital, callers were jamming the lines of radio shows. Men at pubs began looking askance as their friends maneuvered their way into casual hookups. And Musa Ndlangamandla, the stocky 35-year-old editor of the Swazi Observer newspaper, began rethinking his attitude toward casual relationships.
"Sometimes you need shock therapy," said Ndlangamandla, a short man with a neatly trimmed goatee, broad shoulders and a bit of a beer belly. He was so impressed by the campaign that he began printing "Say No to Multiple Sex Partners!" in capital red letters on the front page, just below the newspaper's nameplate.
Swaziland, a southern African country about half the size of Maryland, at first glance appears deeply traditional, with cattle roaming freely among clusters of mud-and-thatch huts nestled in the green folds of steep mountainsides. But Swazis say it is modernizing at warp speed, with new highways, shopping malls and easy access to American soap operas and gossip about the exploits of Hollywood celebrities.
Although polygamy is common -- the king has 13 wives -- even more common, Swazis say, are relationships in which men have only one wife but girlfriends also. Women often maintain several partners as well. A study by a Christian aid group, World Vision, reported in May that in several southern villages, roughly three out of five residents, both men and women, reported having two or more sexual partners in the past three months.
The word makhwapheni (pronounced "ma-kwa-penny"), which means "your secret lover," became the centerpiece of radio and newspaper ads on the order of Derek von Wissell, 62, a courtly, gray-haired former cabinet minister who founded the national AIDS commission in 2002. He grew frustrated with his agency's inability to curb a virus that had infected an estimated 200,000 of Swaziland's 1 million residents. Among adults 15 to 49, the rate was even higher, with one out of three infected.
Von Wissell concluded that the vague, unfocused public education campaigns common here and throughout Africa had failed. In this, he was persuaded in part by the research of Daniel T. Halperin, an AIDS expert for the U.S. Agency for International Development based in Swaziland, who in speeches and private presentations pointed to dozens of studies showing that condom promotion campaigns were having little impact and that it would be more effective to target the multiple, concurrent sexual relationships that fuel high rates of HIV.
"We have been pussyfooting around sex," von Wissell said in an interview in his office in a small concrete building dominated by a convenience store and gas station. "The first thing you must recognize is that sex spreads HIV."
The issue of multiple sexual partners has rarely been the focus of anti-AIDS campaigns in Africa, both because of taboos against publicly discussing sex and because of a long-standing consensus among anti-AIDS groups that educational messages should inspire hope rather than fear, researchers say. Campaigns have been especially careful to avoid suggesting that people with the disease -- including millions of women who had sex only with their unfaithful husbands -- bear any blame for contracting it.
The makhwapheni campaign cast that conventional wisdom aside in what von Wissell said was a desperate bid to force Swazis to take responsibility for protecting themselves, and their loved ones, from AIDS.
The ads were designed to look like cellphone text messages. Perhaps the most brazen was written as a sexual invitation from a married woman to her secret lover. Beside the image of the cellphone screen, the words "why kill your family" were written in English. In smaller letters, in siSwati, the dominant language in Swaziland, was the slogan "makhwapheni uyabulala" -- your secret lover can kill you.
Another ad, also in siSwati, bore a similar cellphone message, but next to it were the words "watifaka elubishini," which mean "and more orphans were left behind."
But some Swazis, such as activist Gcebile Ndlovu, 44, who had spent years battling the stigma surrounding AIDS, said they felt insulted and undermined by the campaign.
Ndlovu, a mother of three who has a round face and graying hair that she wears in braids, had watched her husband shrivel up and die from AIDS eight years ago. The makhwapheni ads outraged her, she said. They blamed the victims. And, she said, they would increase the stigma that she and other activists carrying the virus had struggled to ease.
"Who wants to be called a makhwapheni?" Ndlovu said as she wiped tears from her eyes. "Is this campaign going to encourage people to test, so that they know their status? Or is it going to drive people underground?"
For activists, the campaign painfully recalled an earlier era of the epidemic, before the arrival of antiretroviral drugs here made AIDS a chronic but survivable disease for many. AIDS activists also objected to the moralizing tone of the makhwapheni ads. They preferred messages urging wider use of condoms.
"Don't tell me how many people to have sex with," Ndlovu said. "You can't dictate that to me. I go to bed with someone. That's my choice. Rather, tell me how to be safer."
In just a few days, Ndlovu and another AIDS activist organized one of the largest demonstrations in Swaziland's limited history of democratic protests. Hundreds of men and women, many wearing T-shirts with the words "I am HIV positive," delivered a petition to the office of the prime minister. Then they marched on von Wissell's office, singing "Away with makhwapheni!"
Von Wissell refused to meet the throng, but a few days later, he gave in to the complaints and suspended the campaign.
The word makhwapheni, however, was not so easily erased from the minds of Swazis. All over the country, it continued to dominate conversations. When cellphones buzzed with the arrival of text messages, some would joke, "Is that your makhwapheni?"
Radio host Bongani Dlamini, 50, who used one of Swaziland's most popular shows to defend polygamy and other Swazi traditions, attempted to eliminate the word on his show, out of deference to von Wissell's decision. But his callers would not follow such edicts. They kept calling, and they kept demanding that Swazis abandon their makhwaphenis.
"Those are the people who are doing the damage!" callers raged, Dlamini recalled.
It was about this same time, AIDS activists say, that children of women with HIV began asking their mothers, "Do you have a makhwapheni?" In other families, the frenzy stirred up by the campaign, activists said, prompted at least a few families to banish relatives who were open about having HIV.
"It was saying, women are prostitutes, women are the ones bringing HIV into the home as if it was us who were bringing HIV here," said Siphiwe Hlophe, 47, a friend of Ndlovu's who helped organize the protests.
But von Wissell was convinced that the message, even if it upset some, was working. And in the face of attack, he had decided not on surrender but on a tactical retreat. In meetings with Ndlovu and other activists, he vowed to resume the campaign, with an important concession. The word at the center of the controversy, makhwapheni, would be used no more.
The new campaign, which includes television ads, began in late September, two months after the makhwapheni messages were suspended.
The changes are not nearly enough for Ndlovu, though she says that she has lost the will to continue the fight. "Even now," she said, her soft voice cracking with hurt, "the messages are the same. And because I'm quiet, Siphiwe is quiet, no one is saying anything about it."
Von Wissell was not entirely pleased with the outcome, either, fearing that the loss of his shocking slogan watered down the impact of the ads. Preliminary research on the makhwapheni campaign, conducted for the AIDS commission, showed tremendous reach throughout Swaziland.
Among Swazis surveyed, 86 percent had heard of the campaign, and despite the controversy, 91 percent agreed with its message warning against the dangers of multiple sexual partners, and 78 percent said it made them consider changing their own sexual behavior. The study was funded by the U.S. Agency for International Development.
It is far too soon to tell whether the makhwapheni campaign, or its toned-down successor, caused changes that will lower Swaziland's HIV rate.
The AIDS activists who opposed it remain doubtful.
"I wonder how many Swazis are now faithful to their partners?" Hlophe said with a skeptical smile. "It did not make any difference."
But one man it did affect was Ndlangamandla, the newspaper editor.
Years of watching Swazis die, including several friends, did not force him to accept that his fondness for girlfriends endangered him and his wife, and ran the risk of making their two children orphans. The makhwapheni campaign -- and especially the conversations it provoked -- did.
"I will be at the bar," Ndlangamandla said, "but you'll never find me with another woman. I'm scared."