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 19–49 in the world as of 2012 (26.5%).
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%.
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. In 2009, an estimated 7,000 people died from AIDS-related causes. On a total population of approximately 1,185,000 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.
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".
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.
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. 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.
Many thousands of children have been orphaned by AIDS, and only 22% grow up in two-parent families.
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.
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.
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. The plan was reconducted with a new eNSF (National Strategic Framework) for 2014-2018.
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.
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. There are roughly 14,000 new TB cases diagnosed each year.
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