HIV in Eswatini
Swaziland or Eswatini, as it was officially renamed in 2018 by King Mswati III, is a tiny landlocked country in Southern Africa. It has the highest prevalence of HIV in the world, with the disease infecting about 31% of its sexually-active population. In 2018, HIV infected about 8,000 new adults and caused approximately 3,000 new fatalities. However, recent data suggests that the country has found ways to slash the new rate of infections by almost 45%. Here are eight facts about the fight against HIV in Eswatini.

8 Facts About Eswatini’s Fight Against HIV

  1. Mode of transmission: Heterosexual sex is the primary way HIV is transmitted, with about 94% of all new cases coming from it. The disease affects sex workers, adolescent girls and young men and women significantly more than other demographics.
  2. Poverty and education: Almost 59% of people in Eswatini live below the poverty line. Some regions have still not been able to recover from the regional droughts of 2015 and 2016. Due to poor economic conditions, young girls are often unable to continue their education. As a result, they are less empowered to negotiate for safer sex and sometimes also have to resort to prostitution. Rampant poverty also means that many suffering from the disease cannot afford proper healthcare.
  3. Most affected age group: Adults between the ages of 15 and 49 are most affected by HIV. Over the long term, this has induced major cultural changes surrounding death and illness. It has also led to an expansion of services such as life insurance and mortuary.
  4. Impact on women: HIV has affected women disproportionately. 35.1% of women in Eswatini are living with HIV, compared to 19.3% of men. This stems from widespread gender inequality in the country. Gender-based violence and men indulging in more than one partnership at the same time increase the risk of women contracting HIV. King Mswati withheld royal assent on The 2015 Sexual Offences and Domestic Violence Bill, which could offer more protection to women. The bill finally passed in 2018, however. This is an essential first step for improving gender equality in Eswatini.
  5. Condition of children: About 11,000 children (0-14 years) were living with HIV in Eswatini as of 2018. Only 76% of these children were on ARV treatment. Approximately 45,000 children have also been orphaned due to AIDS-related illnesses. Fortunately, the number of new infections and AIDS-related deaths have reduced to fewer than 1,000 each year.
  6. Increase in circumcision: The proportion of men opting to be circumcised increased significantly in recent years. Circumcision is a scientifically-proven way of reducing the transmission of the virus. The rate of male circumcision in the productive age group (15-49 years) more than doubled from 7% in 2007 to 19% in 2010.
  7. The 90-90-90 model: UNAIDS has developed the 90–90–90 testing and treatment targets to help Eswatini and other countries across the world address HIV and AIDS. Local and national efforts are working towards the following three goals by 2020: 90% of people living with HIV will be aware of their HIV-positive status, 90% of those who have been diagnosed with HIV will continuously and consistently receive antiretroviral therapy (ART) and 90% of all people who are receiving ART will have viral suppression. The 90-90-90 model is a world-renowned global benchmark to curb the spread of HIV in geographies with high prevalence.
  8. Availability of condoms: Targeted mass media campaigns promote condom use and sexual health services distribute condoms across the county. These efforts have resulted in about 51 condoms per year per male available in Eswatini. However, in spite of increased availability, condom use has actually declined. This suggests that a change in mentality is more important than increasing the distribution of condoms.

It is clear that Eswatini has made great strides in the fight against HIV in recent years. However, the high HIV prevalence indicates the government needs to address significant problems such as poverty, gender inequality and risky cultural practices, which contribute to a high risk of HIV infection. Moving forward, a greater focus must be placed on combatting HIV in Eswatini.

Akshay Anand
Photo: Flickr

HIV in SwazilandBy scaling up testing and treatment efforts in the past years, Swaziland has achieved big successes in the fight against the HIV epidemic. As a new study shows, more than 73 percent of adults living with HIV now have viral load suppression (VLS) and the rate of new infections with HIV in Swaziland has dropped by 44 percent since 2011.

With more than 27 percent of the adult population infected in 2016, Swaziland is the country with the highest HIV prevalence in the world. UNICEF reports that the epidemic’s effects are felt across all aspects of society: the high prevalence of the virus draws financial resources from other priority areas and burdens the country’s health system. It also affects capital accumulation and productivity negatively. Families and communities are disrupted by the virus and the number of orphans and vulnerable children has increased.

In the past years, prevention and treatment to fight the HIV epidemic were scaled up significantly in the small monarchy. The Swazi government received support for these efforts from the U.S. government President’s Emergency Plan for AIDS Relief program (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Swaziland’s strategy to contain the further spread of HIV is to dose patients with antiretroviral drugs (ARVs) immediately after they have tested positive, regardless of their health status.

ARVs drive down the HIV level in the blood, therefore reducing the risk of transmission of the virus. The concept of treatment-as-prevention aims to contain the further spread of the HI virus, and is “a major part of the solution to ending the HIV epidemic”, according to the World Health Organisation (WHO). The number of adults with HIV in Swaziland who have their viral load suppressed has doubled in the past five years and is now at more than 73 percent, according to the second Swaziland HIV Incidence Measurement Survey.

PEPFAR director Deborah Birx emphasizes that this method does not eliminate HIV in the country, but it can “contract the epidemic on our way to vaccine and a cure.”

The Swazi Ministry of Health has also developed a plan to encourage boys and men to get circumcised voluntarily. In the past years, an increased number of males opted for circumcision. According to the WHO, there is “compelling evidence” that circumcision lower the risk of female-to-male transmissions by 60 percent.

These up-scaled efforts to fight HIV in Swaziland have come to fruition: compared to 2011, the rate of new infections was cut by 44 percent.

In addition to these successes, the incidence survey also brings light to “key gaps that remain in reaching younger men and women with HIV services,” Birx said. People aged 15 to 24 are lagging behind older age groups; they were found to be less likely to know their status, and of those receiving treatment, a quarter did not suppress their infections.

Not only does the information from the survey offer an opportunity for the Swazi government to improve its efforts further and increase focus on the population groups with the greatest need, but it also adds important scientific evidence to the research about the treatment-as-prevention method.

Sibongile Ndlela-Simelane from the Ministry of Health said, in reaction to the study’s outcomes: “We are very encouraged by this progress. We understand that the battle is not over, and therefore we must maintain the momentum.”

Lena Riebl