HIV/AIDS+WORK Swaziland

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