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Analytical summary - HIV/AIDS

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HIV and AIDS continue to be an overwhelming crisis in the country, rapidly spreading and profoundly impacting on the socio-economic and cultural spheres of life. The rising HIV prevalence has had a positive and a negative effect on the healthcare system.

Positively, it drew political attention once again as a sector that needs to be prioritised and negatively, had been enormously been pressurised and over-stretched by the consequences of HIV and AIDS. Hospital wards are heavily congested with over half of hospital beds occupied by patients with HIV and AIDS-related illnesses. As previously alluded HIV and AIDS is among main contributors of the high mortality rates prevalent in the country. According to the Swaziland Demographic and Health Survey (DHS) 2006/07, the prevalence of HIV in the reproductive age population (15-49) is 26 per cent.

Due to the diverse, vigorous interventions pursued in the health sector the epidemic is stabilizing, albeit at an unacceptably high level. Besides the stabilization being observed in the fight against the epidemic the national response is yet to generate actual reversal in epidemiological trends. New infections in adults are projected to slightly decrease from 12,281 in 2009 to 11,381 in 2015.

On the other hand, AIDS deaths are projected to increase from 7,114 to 8,389 during the same period. The main drivers of the epidemic in Swaziland are multiple concurrent partnerships, early sexual debut, low levels of contraceptive use, inter-generational sex, mobility and migration, low levels of male circumcision, and alcohol and drug abuse mostly perpetuated behind gender inequalities and sexual violence.

HIV prevalence across the four regions of the country shows that the epidemic has spread fairly uniformly and has stabilized in all regions since the beginning of the decade. The level of HIV prevalence does not vary significantly by residence, with an estimated 41 per cent prevalence in urban and 37 per cent in rural areas in 2008. The vulnerable groups mainly women and children remain the hardest hit. More women (31 per cent) than men (21 per cent) are infected.

With regard to treatment, care and support of HIV and AIDS patients, the enhanced availability of anti-retroviral therapy (ART) has brought longer and improved quality of life for many infected and affected people. Access to free ART’s has been enhanced by further decentralization to the lowest level of service delivery (clinics). Such initiatives minimise hidden cost barriers to treatment by patients such as food and transport costs. In 2008 more than 30,000 people received ART, increasing to approximately 72, 000 in 2011 using the CD4> 350 threshold. Improvements in TB case detection and treatment success rates are enhancing the management of HIV patients enrolled on ART.

The number of children orphaned by HIV and AIDS in Swaziland was estimated at around 108,000 in 2007. Uptake of the services for prevention of mother- to- child transmission (PMTCT) has drastically increased. According to the Health Management Information System (HMIS) routine data, 91% of HIV-positive pregnant women receive a complete course of antiretroviral prophylaxis to reduce the risk of mother-to-child-transmission of HIV. Further, 87.7% of health facilities provide PMTCT services in the country.