The HIV/AIDS Epidemic in Swaziland October 2005 Swaziland has the highest HIV/AIDS prevalence rate (the percent of people living with the disease) in the world, a much higher rate 1 than the sub-Saharan African region overall (38.8% compared to 7.5%). Moreover, a recent survey suggests that HIV prevalence 2,3,4 rates in Swaziland continue to increase. As of the end of 2003, there were an estimated 220,000 people living with HIV/AIDS in Swaziland, or almost 4 in 10 adults.1 The epidemic has already had a profound effect in Swaziland, posing significant development challenges to this middle-income country.2,5,6,7 The Government of Swaziland created the Swaziland National AIDS Programme in 1987 8,9 to respond to the epidemic and declared HIV/AIDS a national disaster in 1999. In 2001, the National Emergency Response Council 2,8 on HIV and AIDS (NERCHA) was established, and the National AIDS Strategic Plan for HIV/AIDS 2006 - 2008 is currently under development.6 Figure 1: Percent of Adults Estimated to be Living Figure 2: Number of People Estimated to be Living with HIV/AIDS, 2003 with HIV/AIDS, 2003 Swaziland 38.8% South Africa 5,300,000 Botswana 37.3% Nigeria 3,600,000 Lesotho 28.9% Zimbabwe 1,800,000 Zimbabwe 24.6% Tanzania 1,600,000 South Africa 21.5% Mozambique 1,300,000 Namibia 21.3% Kenya 1,200,000 Zambia 16.5% Dem. Republic of Congo 1,100,000 Malawi 14.2% Zambia 920,000 Mozambique 12.2% Malawi 900,000 Tanzania 8.8% Uganda 530,000 Kenya 6.7% Botswana 350,000 Nigeria 5.4% Ghana 350,000 Dem. Republic of Congo 4.2% Lesotho 320,000 Uganda 4.1% Angola 240,000 Angola 3.9% Swaziland 220,000 Ghana 3.1% Namibia 210,000 Madagascar 1.7% Madagascar 140,000 Seychelles* 0.2% Mauritius* 700 Mauritius** 0.1% Seychelles** <200 Sources: UNAIDS, 2004 Report on the Global AIDS Epidemic, and 2002 Report on the Global AIDS Epidemic. *As of 2002. **As of 2001. Sources: UNAIDS, 2004 Report on the Global AIDS Epidemic, and 2002 Report on the Global AIDS Epidemic. *As of 2002. **As of 2001. Overview • The first case of HIV in Swaziland was reported in 1986.10 • Swaziland has more than two hundred thousand people estimated to be living with HIV/AIDS (220,000 as of the end of 2003). 1 • The HIV/AIDS prevalence rate11 in Swaziland is the highest of any country in the world (38.8%), and significantly higher than that of the sub-Saharan African region overall (7.5%) and globally (1.1%). 1 • In 2003, an estimated 17,000 Swazis died of HIV/AIDS, and life expectancy at birth in Swaziland has fallen below 40 years in large 1,12 part due to HIV/AIDS. Most deaths due to HIV/AIDS in Swaziland occur among young people.8 • HIV is spread primarily through heterosexual sex in Swaziland. 8 Populations and Regions Affected • Women account for over half (55%) of adults estimated to be living with HIV/AIDS in Swaziland.1 • Recent studies suggest that youth in Swaziland are at significant risk for HIV infection, with young women hardest hit.8,10 Among young people ages 15-24, the estimated number of young women living with HIV/AIDS was more than twice that of young 13 men. Although recent studies suggest that HIV prevalence may be declining among young people ages 15-19, prevalence rates continue to increase among those ages 20-29. 8 14 • In 2003, 16,000 children in Swaziland were estimated to be living with HIV/AIDS and there were an estimated 65,000 AIDS 1,15 orphans. • HIV prevalence remains high among pregnant women across the country, with the highest rates in Manzini and the lowest 10,16 in Hhohho. Other Key Data • Knowledge of HIV/AIDS: Studies have found that general awareness of HIV/AIDS in Swaziland is relatively high. For example, 1 among young women ages 15-24, 81% knew that a healthy looking person could be infected with HIV. • Access to Antiretroviral Therapy (ART): Access to ART is limited in Swaziland. As of March 2005, an estimated 8,373 people were receiving ART (23% of those estimated to be in need as of December 2004). 8 The Henry J. Kaiser Family Foundation: 2400 Sand Hill Road, Menlo Park, CA 94025 Phone: (650) 854-9400 Facsimile: (650) 854-4800 Website: www.kff.org Washington, DC Office: 1330 G Street, NW, Washington, DC 20005 Phone: (202) 347-5270 Facsimile: (202) 347-5274 International Support/Major Donors • Several donor governments provide funding and other support to address Swaziland’s HIV/AIDS epidemic, including the United States, the United Kingdom, Italy, and the European Union.5 The U.S. Government provides bilateral assistance to Swaziland for its HIV/AIDS activities, although Swaziland is not one of the 15 focus countries of the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR).17 The U.S. also provides support for HIV/AIDS efforts around the world through its contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund). • The Global Fund has approved two HIV/AIDS grants in Swaziland.18 • UNAIDS and the UN Family support a variety of HIV/AIDS activities in Swaziland.2,5,8 Table 1: HIV/AIDS in Swaziland1,8,13,19 Indicator Swaziland Sub-Saharan Africa Global Estimated number of people living with HIV/AIDS, 2003 220,000 25 million 37.8 million Percent of adult population estimated to be living with 38.8% 7.5% 1.1% HIV/AIDS, 2003 Estimated number of deaths due to HIV/AIDS, 2003 17,000 2.2 million 2.9 million Women as percent of adults estimated to be living with 55% 57% 48% HIV/AIDS, 2003 Percent of young women, ages 15-24, estimated to be 31.6 – 47.4% 8.9% 1.4% living with HIV/AIDS, 2001 Percent of young men, ages 15-24, estimated to be living 12.2 – 18.3% 4.4% 0.8% with HIV/AIDS, 2001 Estimated number of AIDS orphans, 2003 65,000 12.1 million 15 million Number of people estimated to be receiving antiretroviral 8,373 (March 500,000 970,000 (June therapy (ART), 2005 2005 est.) (June 2005 est.) 2005 est.) Number of people estimated to be in need of ART, 36,500 4.0 million 5.8 million December 2004 Key Sources/Websites • Government of Swaziland, Ministry of Health and Welfare: www.gov.sz/home.asp?pid=61 • Swaziland National Emergency Response Council on HIV and AIDS (NERCHA): www.nercha.org.sz/ • UNAIDS Swaziland Country Page: www.unaids.org/en/geographical+area/by+country/swaziland.asp • UNDP Swaziland: www.undp.org.sz/ • World Health Organization Swaziland Country Page: www.who.int/countries/swz/en/ • The AIDS Information and Support Centre (TASC): www.tasc.org.sz/ • Family Life Association of Swaziland (FLAS): www.flas.org.sz/ • Swaziland Network of AIDS Service Organisations (SwaNASO): www.sanaso.org.zw/country-networks.htm#swaziland References 1 UNAIDS, 2004 Report on the Global AIDS Epidemic, July 2004. 2 UNAIDS Swaziland Country Page: www.unaids.org/en/geographical+area/by+country/Swaziland.asp. 3 Reuters, “Swaziland: More than Half of Young Adult Swazis have HIV: Survey”, April 6, 2005. http://www.aegis.com/news/ads/2005/AD050656.html. 4 UN Integrated Regional Information Networks (IRIN), “Swaziland: HIV Prevalence Rate among Pregnant Women Rises”, April 5, 2005. http://www.aegis.com/news/irin/2005/IR050419.html. 5 UNAIDS, UNAIDS at Country Level: Progress Report, 2004. 6 USAID, “Health Profile: Swaziland HIV/AIDS”, April 2005. 7 World Bank, “Country Classification: Country Groups”: http://www.worldbank.org/data/countryclass/classgroups.htm. 8 WHO, “Summary Country Profile for HIV/AIDS Treatment Scale-Up: Swaziland”, June 2005. 9 National Emergency Response Council on HIV and AIDS (NERCHA), Annual Report for the Year Ended 31st March 2004”, http://www.nercha.org.sz/AR2004.pdf. 10 Kingdom of Swaziland, Ministry of Health & Social Welfare, 8thHIV Sentinel Serosurveillance Report, December 2002. 11 Among adults ages 15-49. 12 UNAIDS, “Africa Fact Sheet”, March 2005. 13 UNAIDS, Youth and HIV/AIDS: Opportunity in Crisis, 2002. 14 Under age 15. 15 Ages 0-17, living in 2003. 16 UNAIDS/WHO, “Swaziland: Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections – 2004 Update”: http://www.unaids.org/html/pub/publications/fact- sheets01/swaziland_en_pdf.pdf. 17 U.S. Department of State, Office of the Global AIDS Coordinator: www.state.gov/s/gac. 18 The Global Fund: www.theglobalfund.org. 19 WHO, “3 by 5” Progress Report, December 2004. Prepared by Jennifer Kates and Alyssa Wilson Leggoe of the Kaiser Family Foundation (KFF). Additional copies of this publication (#7366) are available on the Kaiser Family Foundation’s website at www.kff.org. The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.
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