Hiv/Aids Epidemiology in Swaziland

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Running head: HIV/AIDS Epidemiology in Swaziland

HIV/AIDS Epidemiology in Swaziland
Andrew Jay Mallo
Florida International University

Abstract
Since the first case was reported in 1986, AIDS has disproportionately affected the Kingdom of Swaziland relative to other nations in the region and globally. The high prevalence rate is characteristic of a generalized epidemic. It is estimated that there will be 20,000 to 30,000 new HIV infections each year. The Swazi Ministry of Health and Social Welfare [MoHSW] collects this data every two years, creating a lag of time between data collection and dissemination of information. Based on HIV prevalence studies, the HIV epidemic has disproportionately affected women, is primarily transmitted by heterosexual sex, and is more prevalent in urban areas than in rural areas of the country. There has been a decline in AIDS mortality rate since 2004 which may also correspond with an increase in antiretroviral therapy. An inequality exists between men and women that is a reason between the greater HIV prevalence rate in women. Descriptive studies have shown a relationship between cultural mores and how they influence sexual behavior. High HIV prevalence rates have had a devastating economic and social outcome in Swaziland. The large number of sick and debilitated citizens due to HIV/AIDS has decreased the workforce and has resulted in more poverty. In 2007 HIV claimed the lives of 10,000 Swazis. Despite the high HIV prevalence rates there appears to be some stabilization. There has also been a slight decrease in the AIDS mortality rate. Using condoms, reducing numbers of sexual partners, and broadening access to HIV testing and counseling are evidence-based initiatives that will help reduce the incidence of HIV in Swaziland. HIV/AIDS Epidemiology in Swaziland In 2007 UNAIDS estimated that there were 190,000 Swazis living with HIV, with an adult prevalence rate of 26.1% or 261 per 1000 people (UNAIDS, 2008). This is considered the highest adult prevalence rate in the world. Since the first case was reported in 1986, AIDS has disproportionately affected the Kingdom of Swaziland relative to other nations in the region and globally. The high prevalence rate is characteristic of a generalized epidemic. Southern Africa as a region has been identified as a generalized epidemic: Botswana, Lesotho, South Africa, and Swaziland have adult prevalence rates of 23.9%, 23.2%, 18.1%, and 26.1%, respectively (UNAIDS, 2003).

It is estimated that there will be 20,000 to 30,000 new HIV infections each year (Centers for Disease Control and Prevention, 2008). This is an alarming incidence rate for a nation that is already devastated with the highest prevalence rate in the world. Surveillance of the HIV/AIDS in Swaziland has relied on monitoring HIV prevalence among pregnant women attending antenatal clinics since 1992 and behavioral surveys since 2002. Pregnant women represent a subpopulation that has had unprotected heterosexual sex—the primary method that HIV is spread in Swaziland. The studies are more useful than AIDS case reporting in directing prevention efforts. Changes in the HIV prevalence rate in pregnant women is reflective of what is occurring in the general population. The Swazi Ministry of Health and Social Welfare [MoHSW] collects this data every two years, creating a lag of time between data collection and dissemination of information (Kingdom of Swaziland, 2002). Incidence rates are usually estimates of prevalence rates and are based on models such as the Spectrum model. The Spectrum model predicted an annual adult incidence rate of 3% in 2008 (Swaziland National Emergency Council on HIV and AIDS, 2009). Based on HIV prevalence studies, the HIV epidemic has disproportionately affected women, is primarily transmitted by heterosexual sex, and is more prevalent in urban areas than in rural areas of the country (UNAIDS,...
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