HIV/AIDS in Swaziland

HIV/AIDS in Swaziland was first reported in 1986 but has since reached epidemic proportions due in large part to cultural beliefs which discourage safe-sex practices. Coupled with a high rate of co-infection with tuberculosis, life expectancy has halved in the first decade of the millennium. Swaziland has the highest prevalence of HIV as percentage of population (adults 15-49 years) in the world as of 2016 (27.2%).[1][2]

Prevalence

HIV/AIDS remains one of the major challenges to Swaziland's socioeconomic development. The epidemic has spread relentlessly in all the parts of the country since the first reported case in 1986.[3]

Periodic surveillance of prenatal clinics in the country has shown a consistent rise in HIV prevalence among pregnant women attending the clinics. The most recent surveillance in antenatal women reported an overall prevalence of 42.6% in 2004. Prevalence of 28% was found among young women aged 15–19. In women ages 25–29, prevalence was 56%.[4]

The Human Development Index from the UN Development Programme reports that as a consequence of HIV/AIDS, life expectancy in Swaziland has fallen from 61 years in 2000, to 32 years in 2009.[5]

From another perspective, the last available World Health Organization data (2002) shows that 64% of all deaths in the country were caused by HIV/AIDS.[6] In 2009, an estimated 7,000 people died from AIDS-related causes.[7] On a total population of approximately 1,185,000[8] this implies that HIV/AIDS kills an estimated 0.6% of the Swazi population every year. Chronic illnesses that are the most prolific causes of death in the developed world only account for a minute fraction of deaths in Swaziland; for example, heart disease, strokes, and cancer cause a total of less than 5% of deaths in Swaziland, compared to 55% of all deaths yearly in the US.[9]

The United Nations Development Program has written that if the spread of the epidemic in the country continues unabated, the "longer term existence of Swaziland as a country will be seriously threatened".[10]

History

The first reported case of HIV in Swaziland was in 1987. The spread of HIV throughout Swaziland in the 1990s coincided with the increase of migrant workers from Swaziland to the mines of South Africa.[11]

Cultural background

Traditional Swazi culture discourages safe sexual practices, like condom use and monogamous relationships. There is a cultural belief in procreation to increase the population size, and Swazis believe a woman should have a minimum of five children and that a man's role is to impregnate as many partners as he can. Men may never get married but still have many children from multiple partners.[5] The few men who do get married often practice polygamy. Sexual aggression is common, with 18% of sexually active high school students saying they were coerced into their first sexual encounter.[3]

Many thousands of children have been orphaned by AIDS, and only 22% grow up in two-parent families.[12]

National response

In 2003, the National Emergency Response Committee on HIV/AIDS (NERCHA) was established to coordinate and facilitate the national multisectoral response to HIV/AIDS, while the Ministry of Health and Social Welfare (MOHSW) was to implement activities. The previous national HIV/AIDS strategic plan covered the period 2000–2005; a new national HIV/AIDS strategic plan and a national HIV/AIDS action plan for the 2006–2008 period are currently being developed by a broad group of national stakeholders. To date, the six key areas of the plan are prevention, care and support, impact mitigation, communications, monitoring and evaluation, and management/coordination.[4]

Despite the widespread nature of the epidemic in Swaziland, HIV/AIDS is still heavily stigmatized. Few people living with HIV/AIDS, particularly prominent people such as religious and traditional leaders and media/sports personalities, have come out publicly and revealed their status. Stigma hinders the flow of information to communities, hampers prevention efforts, and reduces utilization of services.[4]

On June 4, 2009, the USA and Swaziland signed the Swaziland Partnership Framework on HIV and AIDS for 2009-2014. The President's Emergency Plan for AIDS Relief will contribute to the implementation of Swaziland's multi-sectoral National Strategic Framework on HIV/AIDS.[13] The plan was reconducted with a new eNSF (National Strategic Framework) for 2014-2018.[14]

Various community responses have been implemented as a result of this plan, consisting in the implementation of a decentralised coordination. For example, the formation of 3 regional and community structures, including Nhlangano AIDS Training Information and Counseling Center in the Shiselweni Region.[14]

HIV-TB co-infection

Tuberculosis is also a significant problem, with an 18 percent mortality rate. Many patients have a multi-drug resistant strain, and 83 percent are co-infected with HIV.[15] There are roughly 14,000 new TB cases diagnosed each year.[16]

References

  1. ↑ "Swaziland 2016 Country factsheet". UNAIDS. Retrieved 14 January 2018.
  2. ↑ "Prevalence of HIV, total (% of population ages 15-49)". The World Bank. Retrieved 6 May 2014.
  3. 1 2 "Swaziland HIV/AIDS health profile" (PDF). USAID. September 2008. Archived from the original (PDF) on 2009-09-10. Retrieved 2009-10-21.
  4. 1 2 3 "Health Profile: Swaziland" Archived 2008-08-17 at the Wayback Machine.. United States Agency for International Development (June 2005). This article incorporates text from this source, which is in the public domain.
  5. 1 2 "Swaziland: A culture that encourages HIV/AIDS". Integrated Regional Information Networks (IRIN). 15 April 2009. Retrieved 2009-10-21.
  6. ↑ Swaziland, Mortality Country Fact Sheet 2006. WHO. "Archived copy" (PDF). Archived from the original (PDF) on 2009-08-05. Retrieved 2009-11-23. . Accessed November 22, 2009
  7. ↑ UNAIDS Report on the global AIDS epidemic 2010 Annex 1 - HIV and AIDs estimates and data, 2009 and 2001. UNAIDS. "Archived copy" (PDF). Archived from the original (PDF) on 2012-07-03. Retrieved 2012-09-07. . Accessed October 6, 2011
  8. ↑ World Population Prospects: 2008 Revision. United Nations. http://www.un.org/esa/population/publications/wpp2008/wpp2008_text_tables.pdf. Accessed October 6, 2011
  9. ↑ Causes of death in US, 2006. CDC. https://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf. Accessed November 22, 2009.
  10. ↑ Country programme outline for Swaziland, 2006-2010. United Nations Development Program. http://www.undp.org.sz/index.php?option=com_docman&task=doc_download&gid=19&Itemid=67. Accessed November 22, 2009
  11. ↑ Crush, Jonathan (2010). Migration-Induced HIV and AIDS in Rural Mozambique and Swaziland. Idasa. ISBN 978-1-920409-49-4.
  12. ↑ "GOVERNMENT'S PROGRAMME OF ACTION 2008-2013". The Government of the Kingdom of Swaziland. 27 March 2009. pp. 4–5. Archived from the original on 17 January 2010. Retrieved 2009-10-21.
  13. ↑ "Partnership to Fight HIV/AIDS in Swaziland". Office of U.S. Global AIDS Coordinator and the Bureau of Public Affairs, U.S. State Department. Retrieved 2009-10-21.
  14. 1 2 "SWAZILAND GLOBAL AIDS RESPONSE PROGRESS REPORTING 2014" (PDF). Joint United Nations Programme on HIV and AIDS (UNAIDS). Retrieved 2017-03-23.
  15. ↑ "Swaziland: An MSF Doctors Explains HIV-TB Co-Infection". USA: Doctors Without Borders/Médecins Sans Frontières. October 28, 2009. Archived from the original on July 25, 2011. Retrieved 2009-10-31.
  16. ↑ "HIV-TB in Swaziland: A Deadly Co-Infection Epidemic". USA: Doctors Without Borders/Médecins Sans Frontières. October 28, 2009. Archived from the original on June 21, 2010. Retrieved 2009-10-31.
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