In Swaziland’s generalized epidemic there is very high prevalence in most of the country and in rural and urban areas.

HIV Epidemic Trends

Swaziland is known for having the highest adult prevalence in the world (26.1%). From 1997 prevalence has been increasing rapidly reaching highs of 42.9 percent in 2004. Although the epidemic seems to have stabilized, this is at very high levels constituting a continuing health crisis. Young women have a worryingly high burden of disease. Notably, HIV prevalence is higher in women than men below age 35, but it is higher among men 35 years and older. Overall the epidemic is faminised – 31% women are infected compared to 21% of men.

HIV Prevalence Swaziland 1990 to 2007 (Epidemiological Fact Sheet on HIV and AIDS Core data on epidemiology and response Swaziland 2008 Update UNAIDS)

ANC Prevalence in 2008 was very high at 42% and increasing in some age groups. As access to treatment increases we may see a second higher plateau in prevalence unless we decrease new infections dramatically.

Latest incidence data showed incidence of 3% in 2008 (down from 6% in 1999) but new infections are projected to increase in the next 5 years. The majority (72%) of new adult infections are in adults and 62% of those females. Low levels of male circumcision (8%), high frequency of multiple partners, and low condom use in long term relationships contribute to high incidence. But 68% of new infections in the adult populations are in those 25 years of age and over, many of whom are married or co-habiting with a steady partner. Modelling of new infections shows that in fact the majority are in people reporting only one sexual partner during the last 12 months. 19% of new infections in 2008 were estimated to be in children (3,147 infections). The high rate could be due to high levels of sexual abuse of children, lack of access to PMTCT and partial efficacy of nevirapine and because mothers fail to breast feed exclusively for 6 months.