"I've been in Darfur, in Burma, and I couldn't believe this. It's the biggest disaster I've seen," says Elias Pavlopoulos, the head of mission for Médecins sans Frontières (MSF).
Startling words, but perhaps not surprising of a sub-Saharan African nation whose very existence, the United Nations Development Program once said, could be threatened by the incidence of HIV within its borders.
Such is the state of affairs in the Kingdom of Swaziland, which now has the dubious distinction of having the world's highest rate of both HIV and tuberculosis (TB). About 26% of adults aged 15–49, or about 202 000 of all the citizens of Africa's last absolute monarchy, are HIV positive, according to the Swaziland government. That number is expected to rise to 219 393 within three years. HIV, of course, also leaves people open to opportunistic infections, particularly TB, so it's not altogether unexpected that the TB prevalence rate is 1275 per 100 000 population. Some 83% of those are HIV-positive. To add to the misery, 7.3% of new TB cases, and 15% of retreatment cases, in 2010–11 were drug resistant ones.
Why are the 1.2 million people of this landlocked kingdom — just 200 km by 130 km, or roughly the size of Wales — in such dire straits?