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Battling to fight the HIV/AIDS epidemic in Swaziland

While the AIDS epidemic is ‘levelling off’ in Swaziland, according to the UNAIDS 2011 report, the country still has the highest adult prevalence of the disease in the world.

An estimated 26% of adults live with HIV/AIDS, which equates to around 170,000 people out of Swaziland’s population of 1.2 million. AIDS-related deaths have left an estimated 60,000 children without one or both parents and the disease accounts for nearly half of deaths among children under five.

In recent years, universal access to treatment has achieved coverage levels of over 70%. And with more than 80% of HIV-positive pregnant women given effective antiretroviral regimens, the number of cases where mother-to-child transmission occurs has dropped drastically. However, health organisations working in the country are extremely concerned that progress in tackling the disease could now falter.

A significant drop in revenue from the Southern African Customs Union, combined with a general economic slowdown and lack of investment, have precipitated a financial crisis in the country. Stocks of anti-retro viral treatments ran dangerously low in 2011 and had to be replenished by the US President’s Emergency Plan for AIDS Relief (PEPFAR). This funding will only guarantee first-line ARVs until the end of this month. Meanwhile, government money has run out to buy the chemicals labs need to test CD4 cell counts, which provides doctors with information about the strength of a patient’s immune system. Without this information, it’s extremely difficult for health professionals to know the correct treatment.

Health experts are also extremely concerned about growing levels of hunger in Swaziland. The country’s financial crisis and rising food prices have put a great strain on poor households. Food insecurity particularly affects HIV/AIDS sufferers, because to work effectively, anti-retroviral treatments need a healthy diet. However, a report by the United Nations Country Team in Swaziland, released last month, says half or rural households and one third of urban ones have cut their daily number of meals or size of meal portions. In rural areas, families are even having to skip meals for an entire day.

In a recent Guardian article, health workers also spoke of cultural problems which have yet to be overcome in tackling the spread of the disease. Many people in Swaziland are still reluctant to use condoms and targets for circumcision (which helps to protect against HIV/AIDS) among the male population are not being met. Men are also frequently reluctant to visit a doctor and have their HIV status checked. One staff nurse told the Guardian reporter that most of her patients were women, because “men don’t come”. Until such issues can be addressed and funding for treatment programmes secured, the disease will continue to take its toll in Swaziland, where according to the UN Children’s Fund (UNICEF) life expectancy has dropped to just 47 years for women and 43 for men.

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