Recent Patterns in Population-Based HIV Prevalence in Swaziland

Centers for Disease Control and Prevention (CDC), Mbabane, Swaziland.
PLoS ONE (Impact Factor: 3.23). 10/2013; 8(10):e77101. DOI: 10.1371/journal.pone.0077101
Source: PubMed


The 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.
From 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.
HIV 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.
While 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.

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Available from: Deborah J Donnell, May 12, 2014
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    • "Adulthood is otherwise predicated on being a respectable provider for one's own children and older relatives, usually by undertaking work as domestic or wage labour to earn forms of wealth. Swaziland is notable for a pernicious HIV epidemic, registering the world's highest prevalence in 2007 and holding the morbid ranking into recent years (Bicego et al. 2013). Nearly one out of three Swazi people is seropositive . "
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    ABSTRACT: How do people envision social reproduction when regular modes of generational succession and continuity are disrupted in the context of HIV/AIDS? How and where can scholars identify local ideas for restoring intergenerational practices of obligation and dependency that produce mutuality rather than conflict across age groups? Expanding from studies of HIV/AIDS and religion in Africa, this article pushes for an analytic engagement with ritual as a space and mode of action to both situate local concerns about and practices for restoring dynamics of social reproduction. It describes how the enduring HIV/AIDS epidemic in Swaziland contoured age patterns of mortality where persons identified socially and chronologically as youth have predeceased their elders. Based on discourse analyses of ethnography at church worship services and life cycle rites between 2008 and 2011, the findings show how both elders and youth understood this crisis of 'generational inversions' as a non-alignment of age groups and articulated projects to restore succession and continuity in vernacular idioms of 'work' as moralised social and ritual action.
    African Journal of AIDS Research 12/2014; 13(4):351-359. DOI:10.2989/16085906.2014.961942 · 0.79 Impact Factor
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    • "The 2006/7 Demographic and Health Survey (DHS) measured HIV prevalence among adults 15 to 49 to be 26% (CSO & Macro International Inc., 2008). The subsequent 2011 Swaziland HIV Incidence Measurement Survey (SHIMS) found that prevalence had remained essentially unchanged (32% among adults 18 to 49), although HIV incidence had declined somewhat in younger age cohorts (Bicego et al., 2013). According to the SHIMS, annual HIV incidence peaks at 3.1% among men ages 30 to 34, and at 4.2% and 4.1% for women ages 20 to 24 and 35 to 39, respectively. "
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    ABSTRACT: Men and women in Swaziland who are engaged in multiple or concurrent sexual partnerships, or who have sexual partners with concurrent partners, face a very high risk of HIV infection. Ninety-four in-depth interviews were conducted with 28 Swazi men and women (14 of each sex) between the ages of 20 and 39 to explore participants' sexual partnership histories, including motivations for sexual relationships which carried high HIV risk. Concurrency was normative, with most men and women having had at least one concurrent sexual partnership, and all women reporting having had at least one partner who had a concurrent partner. Men distinguished sexual partnerships that were just for sex from those that were considered to be 'real relationships', while women represented most of their relationships, even those which included significant financial support, as being based on love. Besides being motivated by love, concurrent sexual partnerships were described as motivated by a lack of sexual satisfaction, a desire for emotional support and/or as a means to exact revenge against a cheating partner. Social and structural factors were also found to play a role in creating an enabling environment for high-risk sexual partnerships. These factors included social pressure and norms; a lack of social trust; poverty and a desire for material goods; and geographical separation of partners.
    African Journal of AIDS Research 04/2014; 13(2). DOI:10.2989/16085906.2014.927781 · 0.79 Impact Factor
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    • "Swaziland is a small nation in southern Africa with the world’s highest HIV prevalence — 32% of adults between the ages of 18 and 49 are currently living with the virus [1]. At national antenatal clinic sentinel surveillance sites, this number peaks at 53.8% of women aged 30–34 [2]. "
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    ABSTRACT: Swaziland has the highest HIV prevalence in the world - 32% of adults are currently living with HIV -- and many Swazis are chronically food insecure -- in 2011 one in four Swazis required food aid from the World Food Programme. In southern Africa, food insecurity has been linked to high-risk sexual behaviors, difficulty with antiretroviral therapy (ART) adherence, higher rates of mother-to-child HIV transmission, and more rapid HIV progression. Sex workers in Swaziland are a population that is most at risk of HIV. Little is known about the context and needs of sex workers in Swaziland who are living with HIV, nor how food insecurity may affect these needs. In-depth interviews were conducted with 20 female sex workers who are living with HIV in Swaziland. Interviews took place in four different regions of the country, and were designed to learn about context, experiences, and health service needs of Swazi sex workers. Hunger was a major and consistent theme in our informants' lives. Women cited their own hunger or that of their children as the impetus to begin sex work, and as a primary motivation to continue to sell sex. Informants used good nutrition and the ability to access "healthy" foods as a strategy to manage their HIV infection. Informants discussed difficulty in adhering to ART when faced with the prospect of taking pills on an empty stomach. Across interviews, discussions of CD4 counts and ART adherence intertwined with discussions of poverty, hunger and healthy foods. Some sex workers felt that they had greater trouble accessing food through social networks as result of both their HIV status and profession. Informants described a risk cycle of hunger, sex work, and HIV infection. The two latter drive an increased need for 'healthy foods' and an alienation from social networks that offer material and emotional support against hunger. Services and interventions for sex workers which address the pathways through which food insecurity generates vulnerability to HIV and social marginalization, build sex workers collective efficacy to mobilize, consider poverty alleviation, and address social and policy level changes are necessary and likely to have the greatest success.
    BMC Public Health 01/2014; 14(1):79. DOI:10.1186/1471-2458-14-79 · 2.26 Impact Factor
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