Prevention of Mother To Child Transmission

Swaziland has seen striking progress in scaling up prevention of mother-to-child transmission since 2003. The number of PMTCT sites increased from 44 sites in 2004 to 110 in 2006. Progress needs to be sustained while improving PMTCT quality.

Awareness and Behaviour Change

Behaviour indicators show that there is progress (e.g. young people correctly identifying two ways to prevent sexual transmission was 52% for both sexes in the 2007 DHS). In the age group 15-49 years, 23% of men have had sexual intercourse with more than one partner (higher risk sex) in the last 12 months. 56.6% of women and 56.2% of men who had more than one sexual partner used a condom during their last sexual intercourse. Condom use (57% reported use in last sexual encounter) remains a challenge as some community leaders have emphasized abstinence over condom use, and religious and traditional leaders have said condoms are ‘unSwazi.’ Many people in Swaziland agree that it is common for people to have a secret lover, and believe that their spouse has other sexual partners. Research also shows multiple partners are supported by socio-cultural perceptions that a man’s wealth, power and status relate to his ability to have sex with many women.

Prevention: What is Being Done?

Government planning

• The Swaziland National AIDS Programme (SNAP) was set up in 1989. Current response coordinated by the National Emergency Response Council (NERCHA).
• Two multisectoral National HIV and AIDS Strategic Plans (2000-05) and (2006-08)
• A monitoring and evaluation system has been set up by NERCHA and the National Monitoring and Evaluation Framework has been introduced at the regional level.
• Policies and legal frameworks on gender, male circumcision, sexual offences and domestic violence remain to be finalized.

Condom programming
• Condom distribution increased from 1.3 million in 2000 to 6 million in 2004
• Female condoms not widely distributed – less than 20, 000 in 2004
• Free condoms available in key areas including border posts, and truck routes

Behaviour change campaigns
• Recent campaigns promoted abstinence, which could undermine condom promotion. NERCHA launched an awareness campaign “Makhawapheni Uyabulala,” or, “Your secret lover will kill you” – referring to the “secret lovers” of women, widely criticized for putting forward a message of blame of women for the HIV epidemic.
• Likusasa ngelami (The Future is Mine) encouraged delayed sexual debut, keeping to one partner, and faithfulness within marriage.

Male Circumcision (MC)
• National task force set up September 2006
• Currently National MC policy in development
• MC provided in 60% of public health facilities, training of doctors and nurses ongoing
• 40-50 MCs per month in public health facilities, 50-60 MCs in NGO facilities
• MC to be integrated into National Strategic Framework (2009-2014) – targets to reach 1000% of neonates by 2014, to increase from 8% to 60% the number of males (15-24) who are circumcised by 2014