Mbabane, Swaziland - Nokwanda Dlamini* was 14 when she tested positive for HIV.

Too sick to go to school and on the verge of developing AIDS, Nokwanda had been living with her grandmother for a year in Siphocosini, a village about 20km from Swaziland's capital Mbabane.

Following a neighbour's advice, Nokwanda's grandmother took her to get an HIV/AIDS test, and was left shattered by the result.  

"How did this happen? What have you been doing? You're too young to have it!" she said.

Nokwanda was shocked by the news as well, but hid the truth about how she caught HIV from her grandmother - she had been raped by her uncle.

"I felt like I was lost," she told Al Jazeera. "I asked myself 'why me?'"

All too familiar story

HIV, or the human immunodeficiency virus, attacks the immune system weakening the body's ability to fight infections and disease.

Although there is no cure for the virus, specific treatments have been developed which allow people who have been infected to live a long and healthy life.

However, if left untreated, patients will likely develop AIDS (acquired immunodeficiency syndrome) when the body is left vulnerable to opportunistic infections. 

She didn't believe that I had been raped. Today, I'm still not sure if she believes me.

Nokwanda Dlamini, HIV victim

Nokwanda's story is all too familiar in Swaziland, which has the world's highest HIV prevalence rate affecting 26 percent of the population.

While new HIV cases are declining overall, young women aged 24 and under are at least three times more likely to contract the disease than their male counterparts. This is attributed to high levels of sexual violence, widespread poverty and patriarchal norms that limit women's decision-making on their sexual health.    

Now 21,  Nokwanda volunteers once a month at an organisation that works with HIV-positive children and adolescents.

She said that working with this group gives her support that she doesn't get at home, where she doesn't speak about her condition with her family.

"She [grandmother] didn't believe that I had been raped," she said. "Today, I'm still not sure if she believes me."

Sexual violence

According to a UNICEF report, one in three Swazi girls experience sexual violence before age 18.

Nokwanda said that she sometimes sees the uncle who raped her in town. She said that her mother - with whom she was living at the time of the attack - "beat" her uncle when she found out, but did not go to the police.

Hleli Luhlanga of Swaziland Young Women's Network - an Mbabane-based organisation that advocates for young Swazi women's rights - said that sexual violence stems from Swaziland's deeply patriarchal culture, where women are viewed as being subordinate to men.

"It goes back to the patriarchal notion of women being looked at as owned objects and property," she said.

Critics say that while rape in Swaziland is illegal and technically punishable by up to 15 years in prison, in reality, acquittal rates are high and sentences light.

Current legislation is nearly 100 years old and activists have been calling for the "Sex Offences and Domestic Violence" bill - which defines rape and sexual harassment - to be enacted since 2006, without success.

Living with HIV

Nokwanda takes her antiretroviral medicine - which she receives for free from the clinic where she volunteers with the youth group - twice a day, in private, so that nobody sees her.

Swaziland's King Mswati III delivers a speech during the launch of a campaign calling for his male subjects to get circumcised to curb the spread of HIV infection. Although government initiatives have helped lower infection rates, there are few programmes that specifically target young women [Getty Images]

HIV in Swaziland is still very stigmatised and Nokwanda prefers as few people to know about her condition as possible. She said that having HIV complicates friendships and relationships.

"If a boy comes to you asking for a relationship, you have to say: 'How can you love me? I have HIV,'" she said.

New HIV infection rates have gradually fallen since 2010 thanks to increased access to testing and medicine from outreach work, as well as successful prevention of mother to child transmissions.

But critics say that Swaziland's HIV response is failing to address the epidemic's gender imbalance.

Young women are the most vulnerable to HIV, yet there are hardly any programmes aimed at girls and young women. The government is not doing enough to address structural and cultural causes like poverty and gender based violence.

Access to information is also a major obstacle as sex education for girls at school is restricted until they are in their teens, by which time they are often experimenting.

According to the 2011 Swaziland HIV Incidence Measurement Survey (SHIMS), the prevalence of HIV among Swazi women aged 18-19 is 14 percent and 31 percent for those aged 20-24, compared to just one percent and seven percent for men in the the same age bracket. 

Poverty

According to World Bank figures, 63 percent of Swaziland's population lives below the poverty line, with unemployment at an estimated 40 percent.

Poverty drives the country's HIV gender disparity because without economic empowerment, young women are more likely to engage in transactional sex where condom use is compromised.

According to the latest UNAIDS report, young women frequently, and increasingly so, engage in sexual partnerships with older men who support them financially in exchange for sex. Whereas, the older men are more likely to have multiple sexual partners and therefore are more likely to have HIV.

 Public health services grinding to a halt

Lindiwe Simelane, regional coordinator of Swaziland National Network of People Living with HIV and AIDS, said that a lot of girls and young women are heads of their households, often having already lost their parents to HIV. She said that many have transactional sex to provide for their siblings.

"They try to go out and have an affair with any man who is working to get money," she said.

Cultural norms

According to Simelane, men who are having sex with young girls are usually already married. Having multiple partners and polygamous marriages for men is common practice in Swaziland and women aren't usually empowered enough to say no, or insist on condom use with their husbands or partners.

Despite increased condom proliferation in recent years, 94 percent of new infections occur from unprotected heterosexual sex.

Analysts say that men lack education on condom use and myths about condoms, that they "contain worms", for instance, are prevalent, and there is the popular phrase "you can't eat a sweet in the wrapper".  

Nokwanda is currently awaiting her high school exam results and she wants to become a nurse. She has a boyfriend who knows about her condition, who is not HIV-positive.

"It's difficult living with HIV - you never know how people are going to react. It's very difficult, but we live."

*Nokwanda asked that her name be changed to protect her identity.

Source: Al Jazeera