Swaziland Operational Plan Report Fy 2013

Book excerpt: Swaziland is a landlocked kingdom at the epicenter of the global HIV/AIDS pandemic, struggling to mitigate the world's highest prevalence rates of HIV and TB. Economically, Swaziland is closely tied to South Africa, from which it receives 90 percent of its imports and a large proportion of its public sector financing through the Southern African Customs Union (SACU). Compounding the economic situation and exacerbating the strains on the health and social systems was a precipitous fall in revenue resulting from two-thirds cut of SACU customs receipts in 2009. More than half of the population is under 20 and nearly half of the youth are at extremely high risk of HIV. The 2010 Multiple Indicator Cluster Survey (MICS) reported that 45.1% of children and youth fit the definition of orphaned or vulnerable. Traditional family structures have all but collapsed, with only 22 percent of children raised in two-parent households. Gender-based inequalities, violence, poverty and income disparities persist in the country and create significant barriers to effective HIV prevention interventions and the up-take of care and treatment services. Economic growth and development have been deeply impacted by the health crisis, which literally threatens the future of the kingdom. The 2010 MICS reported high rates of malnutrition, with 40.9 percent of children experiencing moderate to severe stunting. Furthermore, anecdotal reports show that food insecurity is one of the main reasons that eligible individuals will not initiate treatment; they fear not having food to take with ARVs. The Swaziland HIV Incidence Measurement Survey (SHIMS) published in late 2012, provides the best data available to date on the epidemic. SHIMS identified a national HIV prevalence of 31 percent among adults 18-49 years of age. A reanalysis of the 2007 Demographic Health Survey data determined prevalence of 31 percent in adults 18-49, indicating that the HIV prevalence in Swaziland has stabilized in the last five years. Adult incidence is high at 2.4 percent, with a significantly higher incidence for women of 3.1 per cent (1.7. per cent for men).