HIV/AIDS in Swaziland

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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 (adults 15-49 years) in the world as of 2016 (27.2%). [1] [2]

Epidemic rapid spread of infectious disease to a large number of people in a given population within a short period of time

An epidemic is the rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less. For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.

Contents

Prevalence

Prevalence of HIV, total of population ages 15-49. Source: World Bank Prevalence of HIV, total of population ages 15-49.pdf
Prevalence of HIV, total of population ages 15-49. Source: World Bank

HIV/AIDS remains one of the major challenges to Swaziland's socioeconomic development. The epidemic has spread relentlessly in all the parts of the country since the first reported case in 1986. [3]

HIV/AIDS Spectrum of conditions caused by HIV infection

Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV). Following initial infection, a person may not notice any symptoms or may experience a brief period of influenza-like illness. Typically, this is followed by a prolonged period with no symptoms. As the infection progresses, it interferes more with the immune system, increasing the risk of developing common infections such as tuberculosis, as well as other opportunistic infections, and tumors that rarely affect people who have uncompromised immune systems. These late symptoms of infection are referred to as acquired immunodeficiency syndrome (AIDS). This stage is often also associated with unintended weight loss.

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%. [4]

Prenatal care

Prenatal care, also known as antenatal care, is a type of preventive healthcare. Its goal is to provide regular check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy and to promote healthy lifestyles that benefit both mother and child. During check-ups, pregnant women receive medical information over maternal physiological changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins. Recommendations on management and healthy lifestyle changes are also made during regular check-ups. The availability of routine prenatal care, including prenatal screening and diagnosis, has played a part in reducing the frequency of maternal death, miscarriages, birth defects, low birth weight, neonatal infections and other preventable health problems.

The Human Development Index from the UN Development Programme reports that as a consequence of HIV/AIDS, life expectancy in Swaziland has fallen from 61 years in 2000, to 32 years in 2009. [5]

Human Development Index composite statistic of life expectancy, education, and income indices

The Human Development Index (HDI) is a statistic composite index of life expectancy, education, and per capita income indicators, which are used to rank countries into four tiers of human development. A country scores a higher HDI when the lifespan is higher, the education level is higher, and the GNI (PPP) per capita is higher. It was developed by Pakistani economist Mahbub ul Haq, with help from Gustav Ranis of Yale University and Meghnad Desai of the London School of Economics, and was further used to measure a country's development by the United Nations Development Program (UNDP)'s Human Development Report Office.

Life expectancy statistical measure of how long a person or organism may live, based on factors of their life

Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age and other demographic factors including gender. The most commonly used measure of life expectancy is at birth (LEB), which can be defined in two ways. Cohort LEB is the mean length of life of an actual birth cohort and can be computed only for cohorts born many decades ago, so that all their members have died. Period LEB is the mean length of life of a hypothetical cohort assumed to be exposed, from birth through death, to the mortality rates observed at a given year.

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. [6] In 2009, an estimated 7,000 people died from AIDS-related causes. [7] On a total population of approximately 1,185,000 [8] 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. [9]

Cancer disease of uncontrolled, unregulated and abnormal cell growth

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss and a change in bowel movements. While these symptoms may indicate cancer, they can also have other causes. Over 100 types of cancers affect humans.

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". [10]

History

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. [11]

Cultural background

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. [5] 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. [3]

Many thousands of children have been orphaned by AIDS, and only 22% grow up in two-parent families. [12]

National response

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. [4]

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. [4]

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. [13] The plan was reconducted with a new eNSF (National Strategic Framework) for 2014-2018. [14]

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. [14]

HIV-TB co-infection

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. [15] There are roughly 14,000 new TB cases diagnosed each year. [16]

Related Research Articles

Since the first HIV/AIDS case in the Lao People’s Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.

Angola has a large HIV/AIDS infected population, however, it has one of the lowest prevalence rates in the Southern Africa zone. The status of the HIV/AIDS epidemic in Angola is expected to change within the near future due to several forms of behavioral, cultural, and economic characteristics within the country such as lack of knowledge and education, low levels of condom use, the frequency of sex and number of sex partners, economic disparities and migration. There is a significant amount of work being done in Angola to combat the epidemic, but most aid is coming from outside of the country.

HIV/AIDS in Lesotho

HIV/AIDS in Lesotho constitutes a very serious threat to the Basotho people and Lesotho's economic development. Since its initial detection in 1986, HIV/AIDS has spread at alarming rates in Lesotho. In 2000, King Letsie III declared HIV/AIDS a natural disaster. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2016, Lesotho's adult prevalence rate of 25% is the second highest in the world, following Swaziland.

Although Senegal is a relatively underdeveloped country, HIV prevalence in the general population is low at around 0.08 per 1000 people, under 1% of the population. This relatively low prevalence rate is aided by the fact that few people are infected every year– in 2016, 1100 new cases were reported vs 48,000 new cases in Brazil. Senegal's death due to HIV rate, particularly when compared it to its HIV prevalence rate, is relatively high with 1600 deaths in 2016. Almost two times as many women were infected with HIV as men in 2016, and while almost three times as many women were receiving antiretroviral therapy (ARV) as men, only 52% of HIV positive people in Senegal received ARV treatment in 2016.

With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.

HIV/AIDS in Nepal

Nepal's first cases of HIV/AIDS were reported in 1988 and the disease has primarily been transmitted by intravenous drug use and unprotected sex. Among the two, HIV epidemic is largely attributed to sexual transmissions which account for more than 85% of the total new HIV infections.Available data indicate that there was a sharp increase in the number of new infections starting in 1996, coinciding with the outbreak of civil unrest. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and Male Labor Migrants(MLMs) as well as their spouses. Cultural factors have also been shown to play a significant role in the spread of HIV and AIDS in Nepal. Some of these cultural factors are related with social taboos which creates challenges for open discussions regarding sex and sexual habits, as do denial, stigma, and discrimination that surround HIV and AIDS. Other factors such as poverty, low levels of education and literacy, political instability combined with gender inequality make the tasks challenging.

Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.

HIV/AIDS in Bolivia has a less than 1 percent prevalence of Bolivia's adult population estimated to be HIV-positive and therefore the country has one of the lowest HIV prevalence rates in the Latin America and Caribbean region.

Cases of HIV/AIDS in Peru are considered to have reached the level of a concentrated epidemic. According to a population-based survey conducted in Peru’s 24 largest cities in 2002, adult HIV prevalence was estimated to be less than 1 percent. The survey demonstrated that cases are unevenly distributed in the country, affecting mostly young people between the ages of 25 and 34. As of July 2010, the cumulative reported number of persons infected with HIV was 41,638, and there were 26,566 cases of AIDS, according to the Ministry of Health (MOH), and the male/female ratio for AIDS diagnoses in 2009 was 3.02 to 1. The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates 76,000 Peruvians are HIV-positive, meaning that many people at risk do not know their status. There were 3,300 deaths due to AIDS in Peru in 2007, down from 5,600 deaths in 2005.

The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total, with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.

According to the Global Fund, Honduras is the Central American country most adversely affected by the HIV/AIDS epidemic. As of 1998, Honduras had the highest prevalence of HIV out of all seven Central American countries according to a study published by the office of the Honduran Secretary of Public Health. As of that same year, Hondurans made up only 17% of the Central American population, yet Honduras contained 50% of the initial AIDS cases in Central America and 60% of all Central American cases in 2001. In more recent years, new HIV infections have decreased by 29% since 2010 while AIDS-related deaths have increased by 11% since then. HIV/AIDS heavily affects the young, active, working population in Honduras, and HIV/AIDS deaths account for 10% of the overall national mortality rate. As of 2008, AIDS was the leading cause of death among Honduran women of childbearing age and the second-leading cause of hospitalization among both men and women. Sexually transmitted infections are common, and condom use in risky sexual encounters is sporadic and variable. HIV remains a mainly heterosexual epidemic in Honduras, as 90% of emerging infections are attributed to heterosexual transmission. It is estimated that the prevalence of HIV among Honduran adults is 1.5%.

HIV/AIDS in Jamaica has a 1.5 percent prevalence of the adult population estimated to be HIV-positive and no significant change over the last five years and therefore Jamaica appears to have stabilized its HIV/AIDS epidemic.

With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year. But, in 2012 and 2013 it increased to about 600 new cases and in 2014 it reached 880 new cases per year. According to UNAIDS 2016 statistics, there are about 11,000 people currently living with HIV in Egypt. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

Prostitution in Eswatini is illegal, the anti-prostitution laws dating back to 1889, when the country Eswatini was a protectorate of South Africa. Law enforcement is inconsistent, particularly near industrial sites and military bases. Police tend to turn a blind eye to prostitution in clubs. There are periodic clamp-downs by the police.

India HIV/AIDS Alliance organization

Founded in 1999, Alliance India is a non-governmental organisation operating in partnership with civil society, government and communities to support sustained responses to HIV in India that protect rights and improve health. Complementing the Indian national programme, we build capacity, provide technical support and advocate to strengthen the delivery of effective, innovative, community-based HIV programmes to vulnerable populations: sex workers, men who have sex with men (MSM), transgender people, hijras, people who inject drugs (PWID), and people living with HIV.

With an estimated 120,000 people living with HIV/AIDS, the HIV/AIDS epidemic in Colombia is consistent with the epidemic in much of Latin America as a whole, both in terms of prevalence of infection and characteristics of transmission and affected populations. Colombia has a relatively low rate of HIV infection at 0.4%, though certain groups, particularly men who have sex with men, bear the burden of significantly higher rates of infection than the general population. Colombia's health care system and conception of a "right to health," created by the T-760 decision of 2008, have revolutionized access to HIV treatment. Despite this, the quality of health insurance and treatment for HIV has often been disputed.

References

  1. ↑ "Swaziland 2016 Country factsheet". UNAIDS . Retrieved 14 January 2018.
  2. ↑ "Prevalence of HIV, total (% of population ages 15-49)". The World Bank. Retrieved 6 May 2014.
  3. 1 2 "Swaziland HIV/AIDS health profile" (PDF). USAID. September 2008. Archived from the original (PDF) on 2009-09-10. Retrieved 2009-10-21.
  4. 1 2 3 "Health Profile: Swaziland" Archived 2008-08-17 at the Wayback Machine .. United States Agency for International Development (June 2005). PD-icon.svgThis article incorporates text from this source, which is in the public domain.
  5. 1 2 "Swaziland: A culture that encourages HIV/AIDS". Integrated Regional Information Networks (IRIN). 15 April 2009. Retrieved 2009-10-21.
  6. ↑ Swaziland, Mortality Country Fact Sheet 2006. WHO. "Archived copy" (PDF). Archived from the original (PDF) on 2009-08-05. Retrieved 2009-11-23.. Accessed November 22, 2009
  7. ↑ UNAIDS Report on the global AIDS epidemic 2010 Annex 1 - HIV and AIDs estimates and data, 2009 and 2001. UNAIDS. "Archived copy" (PDF). Archived from the original (PDF) on 2012-07-03. Retrieved 2012-09-07.. Accessed October 6, 2011
  8. ↑ World Population Prospects: 2008 Revision. United Nations. http://www.un.org/esa/population/publications/wpp2008/wpp2008_text_tables.pdf. Accessed October 6, 2011
  9. ↑ Causes of death in US, 2006. CDC. https://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf. Accessed November 22, 2009.
  10. ↑ Country programme outline for Swaziland, 2006-2010. United Nations Development Program. http://www.undp.org.sz/index.php?option=com_docman&task=doc_download&gid=19&Itemid=67. Accessed November 22, 2009
  11. ↑ Crush, Jonathan (2010). Migration-Induced HIV and AIDS in Rural Mozambique and Swaziland. Idasa. ISBN   978-1-920409-49-4.
  12. ↑ "GOVERNMENT'S PROGRAMME OF ACTION 2008-2013". The Government of the Kingdom of Swaziland. 27 March 2009. pp. 4–5. Archived from the original on 17 January 2010. Retrieved 2009-10-21.
  13. ↑ "Partnership to Fight HIV/AIDS in Swaziland". Office of U.S. Global AIDS Coordinator and the Bureau of Public Affairs, U.S. State Department. Retrieved 2009-10-21.
  14. 1 2 "SWAZILAND GLOBAL AIDS RESPONSE PROGRESS REPORTING 2014" (PDF). Joint United Nations Programme on HIV and AIDS (UNAIDS). Retrieved 2017-03-23.
  15. ↑ "Swaziland: An MSF Doctors Explains HIV-TB Co-Infection". USA: Doctors Without Borders/Médecins Sans Frontières. October 28, 2009. Archived from the original on July 25, 2011. Retrieved 2009-10-31.
  16. ↑ "HIV-TB in Swaziland: A Deadly Co-Infection Epidemic". USA: Doctors Without Borders/Médecins Sans Frontières. October 28, 2009. Archived from the original on June 21, 2010. Retrieved 2009-10-31.
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