Eddie Simelane is a patient. Every two months, this 46-year-old, HIV-positive father of four wakes up early to line up at a government clinic near eSwatini’s capital for his supply of free anti-retroviral medication. The emaSwati are no strangers to pandemics. This small nation, formerly known as Swaziland, has one of the world’s highest HIV prevalence rates, estimated at over 27%. But it’s not that pandemic that scares him, Simelane says. It’s coronavirus. He says he’s lucky to have not fallen ill, but says it’s thrown his life into disarray. “Here in eSwatini, COVID-19 has taken many lives that I’ve heard of,” he said outside a clinic on a foggy morning last week. “And the difficult part of it is the economy. The economy has been down and there’s been no jobs for everybody for something like a year now.” He’s not exaggerating the effect of this pandemic — in a nation that is smaller than all but three U.S. states, everything feels like it hits closer to home. While eSwatini has only reported some 17,000 cases, and just under 670 deaths, its small size makes each loss seem much bigger. eSwatini, according to the Africa Centers for Disease Control, has seen 1,400 confirmed COVID-19 cases per 100,000 people — and 55 deaths per 100,000 people. But the population is just over a million people. According to the Johns Hopkins Coronavirus Resource Center, eSwatini’s COVID-19 mortality rate stands at 3.9%. That’s more than twice the U.S. death rate, of 1.8%, and also higher than the death rate in the continent’s epicenter — and eSwatini’s biggest neighbor — South Africa, which is 3.4%. And it has affected lives at all levels of society. Acting Prime Minister Themba Masuku fell into this job because Prime Minister Ambrose Dlamini died of COVID-19 in December. He said the past year has been tough. “It’s something that we had never seen before, we had never experienced before,” he said. “So, when it started, we tried to manage it. The first wave, I think we fairly managed that, but the second wave, which was brutal, this is when we felt overwhelmed. But it taught us certain things that we have now put in place so that if the next, the anticipated — which I really don’t want — the third wave, we think we will be more prepared than the first and second waves because we didn’t have the experience.” But health minister Lizzy Nkosi says their records found that HIV-positive COVID-19 patients did not fare as badly as they had feared. “What we’ve learned — not just us, but across the world — is that HIV turned out not to be such a major factor,” she said. “It is a factor, but in terms of the people that get severely ill and the people that we’ve lost — I mean, from our death audit that we did recently, we found that 82% of the people that have died have had comorbidities, and about 80% of those had either diabetes mellitus, high blood pressure and the combination of those.” She said the nation is starting to vaccinate health workers and will soon expand the vaccination plan. That is cold comfort for Simelane. He is a careful man, he says — he faithfully takes his medication and takes meticulous care of his possessions, mending a small rip in his red backpack with a row of neat stitches. But, like people across the globe, he says he struggles with COVID-19 anxiety. “I’m worried, because I actually don’t know how you contract the virus,” he said. “That is what worries me the most. Because you can say that you have protected yourself with masks and everything, only to find out at the end of the day that you caught COVID, not knowing how.”
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