Common Country Assessment - Swaziland, 1997

Contents | Introduction | Poverty Reduction and Sustainable Livelihoods | Advancement/Empowerment of Women | Child Rights/Child Development/Child Protection | Education | Population | Environment | Health | STD/HIV/AIDS | Food Security/Nutrition | Governance and Participation | Institution Building | Summary and Conclusion

Chapter Nine - STD/HIV/AIDS

The Fifth Sentinel Surveillance report¹ paints a horrifying scenario: the pregnant women making antenatal visits are being tested, and 26 percent of them were HIV positive in 1996. With an historic increase of about five percent per annum, indications are that the rate is 31 percent this year, and will be 36 percent in 1998.

Although such subjects are drawn from the sexually active part of the population and the figures cannot therefore be extrapolated nationally, this is hardly cause for much comfort. For example, a 21.9 percent rate indicates that an 18.4 percent rate can be extrapolated nationally to the sexually active population. If that extrapolation can be applied on a pro rata basis, that would indicate a 1996 figure of 22 percent, and a current figure of 26 percent. Saturation level is considered to be around forty percent, which could be reached by 2000 if the current Sentinel projections come true.

Source: Fifth Sentinel Surveillance report

The latency period of Aids varies widely, and seems at least partly dependent on the general health of the HIV carrier, but from these figures it is plausible to assume that about a quarter of the currently sexually active population will be dead within ten years. Moreover, that assumption itself is upon the premise that there will be no further increase in HIV infection within that group - not impossible with radical behaviour changes, but extremely unlikely.

HIV infection across the population is thought to follow a three stage epidemic curve. First, the "pre-epidemic stage" - where the incidence is relatively low but the virus is beginning to spread. The second, "epidemic" stage is reached when the incidence rapidly increases: for example, a doubling every year. In the third "endemic stage", the infection levels start to level-off at the saturation level of the high risk groups, but there is still a high enough incidence of new infections to replace those who die due to Aids. In Central and East Africa, where the prevalence of the disease is already more advanced than in Swaziland, the endemic or "saturation" stage has been observed to occur when the HIV incidence is between 20 to 40 percent of the adult population.³

One means of attempting to come to grips with the implications of Aids is to make a comparison between Swaziland and the ‘hypothetical African country’ modelled in 1992 by the World Bank/WHO.⁴ By coincidence, the figures assumed by the World Bank in 1985 bear some similarities to those of Swaziland in 1990/92. Allowing that all 25-year projections of complex situations can only be broadly indicative at best, we have adjusted that model to Swaziland on a pro rata basis.

However, there are many tragic lessons currently being taught in Central and East Africa, which more directly demonstrate what Swaziland's future will be without the abovementioned radical changes in behaviour, as well as observations that can inform the fight here. One such observation is the link established between HIV infections being transmitted through wounds caused by other STDs on the one hand. On the other hand, tuberculosis has emerged as one of the main opportunistic diseases taking advantage of the deficiency in the auto-immune system, and thereby officially causing the deaths.

The 1996 Sentinel Report confirms that having an STD increases one’s chances of becoming infected with HIV (by 41 percent on the current data: that is, the prevalence of HIV infection among STD patients in the country is 36.6 percent). It also confirms the commonsense but far from trivial perception that the more promiscuous one is, the more likely one is to receive and transmit HIV.

What it does not disclose, however, is either the rate of increase in tuberculosis or the rate of infection in the 0-4 and 5-9 age groups (which could be far higher than the 10-14's minimal levels due to mother-infant transmission and the multiple use of razor blades in the traditional kugata treatment of infants: for example, more than 16 percent of all reported Aids cases were in the 0-4 age group in 1993). Moreover, although the serious STDs of hepatitis B and syphilis are included, more minor STDs such as genital herpes can also be effective as a conduit for HIV and they are not included.

A draft policy on STD, HIV and Aids Prevention and Control is currently before cabinet.

1. SNAP, 1996. Fifth HIV Sentinel Survey: Final Report - 1996. MOHSW. Mbabane.
2. West, 1996, p.142.
3. MHUD, 1996, p.5-5.
4. James Chin, Maria-Antonia Remenyi, Florence Morrison & Rudolph Bulutao. The Global Epidemiology of the HIV/AIDS Pandemic and its Projected Demographic Impact in Africa. WHO, World Health Statistics Quarterly 45, 1992. Quoted in Whiteside and Wood, 1993, p.17.

STD/HIV/AIDS Indicators

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