Small Country, Big Problem: Swaziland

HIV/AIDS in Swaziland
I begin this project with Swaziland for a specific reason - it is the country worst affected by AIDS in the world. The devastation cause by the AIDS epidemic in Swaziland is not hard to observe. A small country of only 1.1 million people in the south of Africa, Swaziland has the highest prevalence rate in the entire world with 1 in 4 people infected. As a result, the life expectancy there is a mere 32 years old - the lowest in the world. HIV was first discovered in the country in 1986 and since that time the damage has been quick and unimaginable.

Mode of Exposure to HIV in Ghana and Swaziland (source)
The HIV/AIDS epidemic has significantly affected the women of the country, especially in the 15-49 age group where the prevalence is 31% compared to 20% in men. Pregnant women have also been greatly impacted by AIDS. In 1992, 3.9% of pregnant women were HIV positive while in 1996, only 4 years later, 26.3% of pregnant women were positive! The prevalence rate only continued to rise until it reached a peak of 42.6% in 2004 (source). Thankfully, as a result of government-run programs and initiatives, the prevalence rate dropped to 39.2% in 2006; however, that is still much higher than in the early stages of the AIDS epidemic. At a time when the AIDS prevalence should have been seen decreasing in the population, Swaziland was still experiencing an unacceptably high prevalence. Having such a high prevalence rate in women is particularly disheartening because if the proper measures are not taken, mothers may pass HIV on to their children through mother-to-child transmission if they are not taking the proper medication. Mothers can pass HIV on to their children during pregnancy, labor, delivery, and through breastfeeding. Although mother-to-child transmission is relatively easy to prevent through medication and other methods, there are still an estimated 430,000 children infected with HIV, most of those acquiring it through mother-to-child-transmission.

Parentless Generation
HIV/AIDS has also had a significant impact of the youth population of the nation. With the low life-expectancy, many children are orphaned at a young age as a direct result of the AIDS epidemic. It is estimated that orphans currently comprise 15% of Swaziland’s population. The age disparity inside the country as a result of AIDS causes many problems. With nearly 40% of the population under 14 years old and only 4% over the age of 65, Swaziland lacks a work force, educated population, and the most crucial age group to the fight against the epidemic.

As a result of the AIDS epidemic, Swaziland has lost its most valuable workforce population, suffers from a ravaged healthcare system that lacks the basic necessities needed to provide for the people, the economic system is in disarray, and proper nutrition is merely a dream for far too many people. All these problems only exacerbate the epidemic, making it extremely difficult for the government and non-governmental organizations to combat its spread.

The government of Swaziland has been trying hard to prevent the spread of AIDS through three main initiatives: condom distribution, behavior change campaigns, and prevention of mother-to-child transmission.

Condoms, Condoms, Condoms
An easy way to promote protection against HIV is clearly condom distribution. Condoms have been widely available in Swaziland since 2000 when 1 million were distributed. The number rose significantly each year, and by 2007 there were 7 million available. Swaziland has even made female condoms relatively accessible, albeit on a much smaller scale, which helps encourage women to take their sexual health into their own hands – giving them the power to protect themselves if the opportunity presents itself. Although condom use has been unpopular, it has been reported that 90% of female sex workers use condoms which goes to show that the condom campaign is working. I'd say that Swaziland deserves an applause for that!

Changing Behavior
One of the other prevention methods is behavioral change. Some of the reasons why HIV is so rampant in Swaziland is because people often have many sexual partners and casual sex is common, especially among truck drivers who travel for a long period of time and have high-risk sexual encounters along their routes.

However, changing behavior is a difficult thing to do. The international charity called AVERTing HIV and AIDS does a great job at depicting the challenging situation in the following description:
In 2001 King Mswati III reinstated a custom that banned all girls under 18 from sexual activity for five years, and required any man who has sex with a virgin to pay a cow to the girl's family. The policy, which required all girls to wear tassels to display their virginity, was widely criticized for demeaning girls and blaming women for the spread of HIV. Interestingly, the King was accused of ignoring his own policy when, in 2001, he became engaged to a 17 year old girl. In 2005, the King called an end to the policy.
Clearly, it is hard to promote behavioral change when the President himself does not follow his own rules. But through advertising awareness campaigns that discourage the common practice of having multiple sexual partners, hopes are that people will begin to change their sexual behavior. Early evidence is showing that the results are promising; studies have shown that over 90% of the population agree with the campaigns and over 75% have stated that the advertisements have made them consider adapting their sexual behavior. Sometimes a little clever advertisement can do a world of good!

Mother-to-Child Transmission
As stated earlier, mother-to-child transmission (MTCT) posses a grave problem in the AIDS epidemic in Swaziland. Thankfully, the country started a program to help prevent MTCT in 2003 by setting up prevention sites inside health facilities around the country – there were 44 up and running in 2004 and by 2008 there were 132! The prevention methods were are working because 73% of pregnant women were tested for HIV at the sites and of those who tested positive, nearly 80% received ARVs to prevent the transmission to their children.

Where Next?
It is obvious that things need to change for Swaziland if they wish to combat the AIDS epidemic and to turn the country around for the better. If the nation wishes to prosper, it needs to regain the middle age group of the country which will not happen until they stop dying of AIDS. In order for that to occur, awareness campaigns need to have an increase in funding from the government so that the Swazi people are properly informed on how to stay protected against HIV. The people of Swaziland realize this. As AVERTing HIV and AIDS recounts, 
When the King chartered a plane to take his 13 wives on an international shopping trip in 2008, hundreds of Swazi women protested, shouting "we need to keep that money for ARVs!"
Without the support of the Swazi government, no hope for progress can made. International pressure needs to be put upon the leaders of Swaziland to ensure healthcare and proper treatment for those already infected with HIV/AIDS, funding for awareness campaigns needs to be increased so that prevention methods can be given the opportunity to make a difference, and HIV testing needs to become more widely available for people so they can be informed on their HIV status (currently only 20% know what their HIV status is). Furthermore, treatment needs to be more accessible for the population currently infected with AIDS. Of those who are in need of antiretroviral therapy, only 42% are receiving them, and that statistic is far less in rural areas where access to essential medicine is sparse. 

In an effort to combat AIDS, the Swazi government signed the Swaziland Partnership Framework which laid out five plans for fighting HIV/AIDS in Swaziland: 
"developing a comprehensive national HIV prevention program; improving the coverage and quality of HIV-related treatment and care; mitigating the impacts of HIV/AIDS with a focus on children; increasing access to high-quality medical MC; and building the human and institutional capacity needed to achieve and sustain these goals" (USAID).
 With the proper actions and support from the international community, I believe that the AIDS prevalence in Swaziland can diminish; however, much work needs to be done first.


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