Recent Patterns in Population-Based HIV Prevalence in Swaziland

Abstract

BackgroundThe 2011 Swaziland HIV Incidence Measurement Survey (SHIMS) was conducted as part of a national study to evaluate the scale up of key HIV prevention programs.MethodsFrom a randomly selected sample of all Swazi households, all women and men aged 18-49 were considered eligible, and all consenting adults were enrolled and received HIV testing and counseling. In this analysis, population-based measures of HIV prevalence were produced and compared against similarly measured HIV prevalence estimates from the 2006-7 Swaziland Demographic and Health. Also, measures of HIV service utilization in both HIV infected and uninfected populations were documented and discussed.ResultsHIV prevalence among adults aged 18-49 has remained unchanged between 2006-2011 at 31-32%, with substantial differences in current prevalence between women (39%) and men (24%). In both men and women, between since 2006-7 and 2011, prevalence has fallen in the young age groups and risen in the older age groups. Over a third (38%) of the HIV-infected population was unaware of their infection status, and this differed markedly between men (50%) and women (31%). Of those aware of their HIV-positive status, a higher percentage of men (63%) than women (49%) reported ART use.ConclusionsWhile overall HIV prevalence remains roughly constant, age-specific changes strongly suggest both improved survival of the HIV-infected and a reduction in new HIV infections. Awareness of HIV status and entry into ART services has improved in recent years but remains too low. This study identifies opportunities to improve both HIV preventive and care services in Swaziland.

Identification of misdiagnosed HIV clients in an Early Access to ART for All implementation study in Swaziland

“…HIV is the leading public health concern in Swaziland with HIV prevalence of 32% and annual incidence of 2.4% among 18–49-year-old adults as determined by the 2011 Swaziland HIV Incidence Measurement Survey (SHIMS) [1]. SHIMS also identified substantial differences in prevalence among women (39%) and men (24%) and additionally reported that 38% of HIV-infected individuals were unaware of their HIV status [1].…”

“…SHIMS also identified substantial differences in prevalence among women (39%) and men (24%) and additionally reported that 38% of HIV-infected individuals were unaware of their HIV status [1]. The SHIMS data highlighted the need for an improvement of HIV testing and preventive care services in Swaziland.…”

Gendered childcare norms — evidence from rural Swaziland to inform innovative structural HIV prevention approaches for young women

“…Women have less power to negotiate in sexual relationships, and may risk violence from their intimate partners if they assert agency (Brear & Bessarab, 2012). This gendered imbalance in power is implicated in and demonstrated by women's, and particularly young women's, disproportionate risk of HIV infection (Shannon et al, 2012) (e.g., in females aged 18-24 years it is 26%, compared to 5% for males in the same age group (Bicego et al, 2013)). Women, including young women, perform most of the unpaid care-related labour and may be expected to care for their own or other people's children (Nhleko, 2009).…”

Rethinking the family in the context of care for adolescents living with HIV in Swaziland

“…According to the first and only demographic survey conducted, in (CSO & Macro International, 2008), the population prevalence was 19%: that is, one in five people aged two years and more was infected; the adult prevalence (15-49 years) was 26%, and for those considered to be in the sexually and economically active population age group (18-49 years) it was 31% (CSO & Macro International, 2008). This was still the case in 2013 (Bicego et al, 2013). Although data on adolescents are limited due to age-band reporting (0-14 and 15-49), estimates indicate that in 2014 almost 12,000 Swazi adolescents were living with HIV Joint United Nations Programme on HIV and AIDS (2015).…”

“…Although data on adolescents are limited due to age-band reporting (0-14 and 15-49), estimates indicate that in 2014 almost 12,000 Swazi adolescents were living with HIV Joint United Nations Programme on HIV and AIDS (2015). Furthermore, of the 13,000 people who were newly infected in 2013, 42% were adolescents aged 18-19 years, and this percentage increased to almost 60% when those up to 24 years were counted (Bicego et al, 2013; Ministry of Health [MoH], 2014). The National HTC annual report 2012 further noted that very few adolescents present for testing in the health facilities, despite the successful scale up of HIV testing and counselling (HTC) through decentralisation of services to primary health care facilities and outreach clinics (MoH, 2013).…”