AIDS/HIV Epidemic - Research Paper Example

 Introduction Swaziland is world’s biggest HIV/AIDS epidemic center. The current situation poses serious threat to the economic development of the country. The first case of AIDS was reported in 1986 and since then it has spread in all parts of the country. AIDS has virtually devastated the country. In 2009 alone, around 7000 people died from AIDS. The survival of the country is in jeopardy if some drastic steps are not taken. In Swaziland, It is estimated to have approximately 190,000 cases of HIV positive, which includes 15,000 children under the age of 15. Between 1990 and 2007, average life expectancy of the citizen, as per United Nations Program on HIV/AIDS’s (UNAIDS’s) Epidemic Update 2009, has fallen by half in most part of the country. (Usaid Swaziland 2009) Heterosexual contact, as per UNAIDS, is the main mode of transmission of disease accounting for 94 percent of transmissions. One out of six couples is serodiscordant– a term used to describe a couple in which one is HIV positive and other one is HIV negative. That indicates that a high number of infections occur among long-term partners. (Usaid Swaziland 2009) HIV/AIDS Profile in Swaziland Age wise, 49 percent pregnant women between the age of 25 and 29 years and 12 percent pregnant women in the age group of 15 to 19 years are infected with the disease. Some of the characteristics of HIV profile across the cross section of population according to the 2007 Swaziland Demographic and Health Survey (SDHS) can be described as per the following. Women between 25 and 29 have the highest proportion of infection at 48.9 percent Men between the age 35 and 39 has highest incidence of infections at 44.9 percent There are three HIV-positive adult women against every two HIV-positive adult men More men above age of 35 are HIV positive compared to women; while more women under age 35 are infected compared to men in that age group. A large percentage of new infections (62 percent) occur in females. (Usaid Swaziland 2009) HIV/AIDS in Swaziland Population, 2008 1,200,000 People living with HIV/AIDS, 2007 190,000 Women (15 and above) with HIV/AIDS, 2007 100,000 Children with HIV/AIDS, 2007 15,000 Adult HIV prevalence (%), 2007 26.1 AIDS deaths, 2007 10,000 Source: Population Reference Bureau & UNAIDS URL: http://hivinsite.ucsf.edu/global?page=cr09-wz-00 HIV Testing in Swaziland Only 16 percent of the people between the age 15 and 49 have been tested for HIV and are aware about status. A stigma attached with HIV and AIDS prevent people to go for HIV testing at large. HIV positive status often causes rejection from the families. It is obvious that many people are not inclined to know about their HIV status and again those who know about it will often keep mum about it, not even letting know their sexual partners. (HIV and AIDS in Swaziland) In 2009, A new national testing campaign was started taking support of UNAIDS and part funding from PEPFAR (President’s Emergency Plan for AIDS Relief). It was named as 'love test' and aimed at bringing change in behavior in the country amongst couples to get tested together and repose confidence in each other. The main objective is to move away from the tendency to hide the status from their partner and thus help community to stop further spreading of the HIV. (HIV and AIDS in Swaziland) Cultural Factors behind HIV/AIDS in Swaziland Swazi is a male dominant society and decision like family planning rests with them. Women have reported that they have to continuously bear the burden of childbirth as per the wishes of their husbands and in-laws contrary to their own will. Swazi men strongly defend the practice of ‘kungena’, whereby a lady has to become the wife of her deceased husband's brother, which contributes to the spread of HIV. Even culturally, polygamy is defended in Swaziland because of their preferences for male child who can lead family into next generation. In Swazi culture birth control, family planning and monogamy is considered taboo and seen with suspect. The tendency to increase the population has come from the historic fact when country's population was just one tenth of the present size. It is a belief that nothing should come in the way of procreation and population must increase at all cost. This is what told by Joseph Dlamini, a counselor for youth guidance. As per the study done by UNFPA and Swaziland’s Ministry of Health and Social Welfare, it is not possible to stop spreading AIDS in Swaziland until there is a change in people's thinking about sexual behavior. The consistent efforts done by government and various agencies have failed to curtail the AIDS epidemic in the Swaziland. The reason is that of unsafe sexual behavior and multiple sexual relationships as reported by Thandi Mngomezulu, an HIV counselor based at Manzini. The belief about procreation and propensity to increase the population has brought this devastating effect in Swaziland. (Womensphere 2009) Again, the spread of HIV and their differing rates between women and men can better be explained in their intergenerational sex, practice of multiple sexual partners, and early sexual initiation among girls. The practices and factors such as male dominance over women, a tradition of polygamy and societal values endorsing men's sexual behavior have contributed immensely in spreading AIDS. Moreover, women's economic dependency on men and their inability to make decisions including safer sex is the reason for high incidence of AIDS among the women. High risk sex is a common practice among adults, which is defined as sexual intercourse with two or more partners in a year. In the age group of 15 to 49, it has been found to have 58 percent of men and 44 percent of women having indulged into high-risk intercourse in a single year. Against 2.3 percent of women, 23 percent of men have two or more than two partners in a year. (Usaid Swaziland 2009) Groups at Risk The groups at-risk are girls, truck drivers, sex workers, soldiers, factory workers and employees of public transport system; however, more than one-fourth population are now in clutches of HIV/AIDS and that puts everybody now at high risk. (Usaid Swaziland 2009) Swaziland is also said to have highest tuberculosis cases in the world. In 2008, as per the WHO report, Swaziland is said to have 1,200 cases of tuberculosis per 100,000 people of the country. Of this, 84 percent of adult cases are also infected with HIV positive making the matter more complicated. Infection in Children In 2007, in children, 5 percent of them between the age of 2 and 4 were infected with HIV positive. Further, 20 percent of the children under age 15 were found to be infected from HIV. Besides, 47 percent of children under age 5 die because of HIV/AIDS infection in Swaziland. Orphans and vulnerable children (OVC) account for about 130,000 in numbers in Swaziland. Only 22 percent of the children, under age 18, are found to be living with both parents and about one-third of the children not found to be staying with either parent. Though extended families have absorbed such orphan children yet it has already stretched to the level of breaking point as meeting their needs is becoming increasingly difficult for them. SDHS reports state that 40 percent of households do not receive any external support to meet the basic needs of OVC including a single meal per day. Mostly, elderly people have been found taking care of such OVC but in many cases their own children have been the victims of HIV/AIDS. (Usaid Swaziland 2009) USAID Support In 2009, Swaziland received $13.6 million for essential HIV/AIDS programs. These programs are implemented by PEPFAR who has a back up of President's Global Health Initiative committing $63 billion to support partner countries in health services. In 2009, Swaziland Partnership Framework was signed between the USG and the Government of Swaziland on HIV and AIDS program. Under this framework, a more sustainable approach is being launched to combat HIV/AIDS. It is based on following pillars: 1. To develop a national HIV prevention program. 2. To improve the quality of HIV-related treatment and care 3. To mitigate the impacts of HIV/AIDS keeping focus on children. 4. To build the required institutional and human capacity to meet these objectives. Covering all regions of Swaziland, the PEPFAR program is organized around these pillars of the Partnership Framework. The program is run under the auspices of joint collaboration of the U.S. Departments of Labor, Defense and State along with USAID, and CDC. The program aims at implementing a strategy capable of bringing desired end results on sustainable basis. USAID imparts technical and program management assistance through its HIV/AIDS program based in South Africa. USAID'S major focus areas are human capacity development, prevention, impact mitigation with a special focus on children, and NGO capacity building. In 2009 and 2010, USAID and PEPFAR had several successes. Some of them can be described as per the following. 1. In 2010, successfully circumcised 7,165 boys in a back-to-school circumcision campaign. 2. Through a partnership with UNICEF, reached more than 10,000 preschool-aged children with education, health, food, nutrition and psychosocial services, 3. With abstinence and “be faithful” messages reached more than 320,000 people in a myriad of community-based settings. PEPFAR surpassed all 2009 ‘abstinence- and faithfulness-based’ prevention targets. ‘The Shoulders to Cry On’ which is a child protection project was launched that imparts community-based education about children's rights and brings about a kind of intervention in child abuse cases. This is an important program in the sense that about one-third of girls face sexual violence in Swaziland. (Usaid Swaziland 2009) National Initiative In 2009, Swaziland worked out a formal male circumcision (MC) policy and implementation plan as a method to prevent the transfer of HIV. Currently, only 8 percent of men are circumcised in the country and will require considerable funding to further expand the program. However, this may reduce the costs in the long run. In 2010, PEPFAR awarded Swaziland $27 million to achieve circumcision in the age group between 18 and 49 year old males. This is the first mass circumcision project of its kind to prevent HIV infection in an entire country. Government, private sector and various NGOs will join to see the program is implemented in its full strength for success. Swaziland has gone ahead to provide education to OVC. In 2002, a budget allocation was made to in support of OVC education. In 2009, almost 112,000 children were benefiting from the grant. In 2010, the Government started with universal free primary education. It was found to have only minor differences in school attendance between non-orphans and orphans; however, there are still a lot of challenges to be met with reference to high dropout rates and school retention. Beginning 2003, the Global Fund to Fight AIDS, Tuberculosis and Malaria has so far provided $76.2 million in a bid to fight HIV/AIDS in Swaziland and recently, in 2010, it has provided $7.2 million to strengthen the health system. The U.S Government is one of the largest contributors of the funds to Swaziland; others are European Union, the World Bank and United Nations agencies. Conclusion One cannot deny the fact that Swaziland is in grip of AIDS epidemic. Also, people know that it has reached at serious proportion. Young men and women are dying in large numbers and the numbers tracking orphans are increasing every day. People also know that mortality rate is bound to increase and cause of the infection is also known. Still a lot of people are not infected and if they can remain like that as they are, then perhaps, it can be said that Swaziland has achieved a great wisdom in doing so; however, it may seem to be late but it is not so late that Swaziland cannot reach to its original state of 1980s-a society and community that it was completely free of HIV and AIDS in all respects. References: 1. Usaid Swaziland 2009 21 April 2011 http://www.usaid.gov/our_work/global_health/aids/Countries/africa/swaziland_profile.pdf 2. Swaziland. 21 April 2011 http://hivinsite.ucsf.edu/global?page=cr09-wz-00 3. HIV and AIDS in Swaziland. 21 April 2011. http://www.avert.org/aids-swaziland.htm 4. Womensphere. 21 April 2011. http://womensphere.wordpress.com/2009/05/12/a-culture-that-encourages-hivaids-in-swaziland/ Read More