HIV/AIDS+WORK Swaziland

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A. Situation analysisPiggsPeakMhlumeMBABANELobambaManziniSitekiMankayaneBigBendHlatikuluNhlanganoLavumisa1. Recent economic trends and labourmarket situationThe Kingdom of Swaziland gainedindependence from Britain in 1968 underKing Sobhuza II, who wielded almost absolutepower, and the current king, Mswati III, hasmaintained that legacy. The first phase afterindependence (1968–73) was characterizedby multi-party democratic processes withina monarchical system. In the second phase(1973 onwards), the inherited constitutionwas repealed in 1973 by the Royal Decree,which banned political activities and enabledthe king to assume legislative, judicial andexecutive powers. Some changes have takenplace over the years with the emergence of anew parliament and regional councils based ontraditional Swazi law, resulting in a dual systemof government.2Swaziland: HIV/AIDS work and developmentSwaziland is the smallest country inSouthern Africa, with an estimated populationof 1 million. The country has a good roadand communications infrastructure and itis possible to reach the two main cities fromany part of the country within two hours.Traditionally there has been a large migrantworking population working in South Africanmines but, in the past 20 years, the immigrant
labour force has increasingly been based onsugar, citrus and timber estates. Swazilandhas a youthful population, with 46% of itsinhabitants under 15 years of age.The HIV/AIDS situation continues to benot only of public health importance, but asignificant socio-economic and developmentproblem in Swaziland 3 . The overall nationaladult prevalence is now estimated to be about38.8%, which means that some 200,000individuals in the age group of 15-49 years andform the most productive part of the labour forceare now living with the virus (end 2003, Source2004 Report on the Global AIDS EpidemicUNAIDS). Population growth is projected to benegative by 2004. These high prevalence ratesherald a future burden of HIV-related illnesses,with serious consequences for the health-caresystem, which is unlikely to be able to copewith the increasing demand. The government’sability to deliver services will also be severelyreduced by the dwindling workforce and thedeteriorating socio-economic fabric of thecountry. This state of affairs necessitates animproved understanding of the driving forcesof the epidemic so that appropriate policyinterventions can be made.2. Trends in HIV/AIDS prevalenceHIV/AIDS was first detected in Swaziland in1986 and a National AIDS Control Programmewas established in 1987. The 8th sentinelsurvey of 2002 puts the national HIV prevalenceamong antenatal clinic (ANC) attendees at39% (see Figure 1), whereas UNAIDS reports aprevalence rate of 33.4% at the end of 2001.The number of estimated AIDS-related deathsin 2001 alone was 12,000 and probably thefirst cause of mortality in the country.The data show Swaziland to be on a parwith other countries and provinces in the region(with the exception of Southern Mozambique).Geographically, all regions show reasonablyhigh HIV prevalence rates: Manzini had thehighest rate of 41% and Hhohho had thelowest of 36.6%. However, the HIV prevalencetrend over the years appears to show somedegree of stabilization in the Manzini regionand a marked increase in HIV prevalence wasrecorded for the Shiselweni region in 2000–2002 (see Table 1).i. Characteristics of the epidemicThe overall HIV prevalence amongadolescents (aged 15–19) was 32.5% in 2002but further segregation by residence and ageshows that there has been a sharp increase in theFigure 1. Infection among ANC population454035302015105019921994 1996 1998 2000 2002Source: The 8th Swaziland sentinel survey of 2002Table 1: HIV prevalence (%) in Swaziland, by region1994 1996 1998 2000 2002Hhohho 15.5 26.3 30.3 32.3 36.6Lubombo 16.8 26.5 31.5 34.5 38.5Manzini 15.6 27.7 34.8 41 41.2Shiselweni 16.8 23.9 29.6 27 37.9Source: Sentinel surveillance survey report, 2002number of infections among 15–19-year-oldsin urban areas, while it appears stable in ruralparts. The reverse pattern is seen in the 20–24-year-old age group. The 25–29-year-old agegroup had the highest prevalence, followedby 20–24-year-olds. Overall prevalence in15–24-year-olds was 41.6% and this group isused as an impact-assessment indicator forestablishing infection rates among the youngpopulation and monitoring achievementstowards UNGASS targets 4 relating to HIV/AIDS.What makes Swaziland unique is that the highprevalence rates are uniformly distributedbetween urban and rural areas at 35.6% and32.7% respectively (SNAP 2000 5 ). This is dueto the country’s good road and communicationsinfrastructure, that even out differencesbetween rural and urban populations.Despite the many efforts made in theresponse to the epidemic, HIV prevalenceamong pregnant women attending antenatalclinics continues to show increasing HIVinfectiontrends 6 . What is worth noting is that67% of the HIV-infected pregnant women were3 Findings of the 2002 HIV sentinel survey.4 These targets were established at the United Nations General Assembly Special Session on HIV/AIDS in New York in June 2001.5 SNAP: Swaziland National AIDS Programme6 All HIV prevalence data are from the 8th Sentinel Surveillance Survey report in Swaziland in2002.Swaziland: HIV/AIDS work and development3
Page 1 and 2: HIV/AIDS+WORKSwaziland:HIV/AIDS, wo
Page 3 and 4: AcknowledgementsThis report was dev
Page 5: ContentsExecutive summary 1A. Situa
Page 10 and 11: 4Swaziland: HIV/AIDS work and devel
Page 12 and 13: Figure 3. Age-wise loss in the acti
Page 14 and 15: B. Economic impact of HIV/AIDS12 So
Page 16 and 17: 16 Pension annuity refers to on-goi
Page 18 and 19: 30 Muwanga FT (2001) Private sector
Page 20 and 21: Table 4: Companies that have workpl
Page 22 and 23: C. Policy optionsDeveloping a polic
Page 24 and 25: D. RecommendationsThe commitments o
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HIV/AIDS+WORK Swaziland

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