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Overview of HIV Situation andNational HIV Response
in Swaziland
Ms. T Gama
NERCHA
05. MARCH 2013
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Outline….
• Knowing Your Epidemic (KYE)
• Know Your Response (KYR)
• Know Your Funding ( KYF)
• Future of Response to HIV and AIDS
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HIV prevalence among the general population, Swaziland 2006
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HIV incidence rate (15-49 years)
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Men: Prevalence by Age Women: Prevalence by Age
2007 DHS and 2011 SHIMS HIV Prevalence in Swaziland
(ages 18-49)
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Knowing Your Epidemic (KYE)
• SDHS 2007- 15-49 years prevalence (26%) women more affected (31%)
• MICS 2011- youth adopting safer sexual behaviors and increased condom usage
• SHIMS 2012- prevalence (18-49yrs) 31% and incidence 2.38%
• BSS MARPS- baseline on MSM & SW
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Source: Central Statistical Office & Macro International, 2008, p. 222
Overall HIV prevalence
among MSM participants:
17.7%
HIV Prevalence Among MSM Compared to Reproductive Age Swazi Men
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Source: Central Statistical Office & Macro International, 2008, p. 222
Overall HIV prevalence among SW
participants: 70.3%
HIV Prevalence Among SW Compared to Reproductive Age Swazi Women
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Complicated nature of the epidemic
Source: NACs, UNAIDS, The World Bank (2009)
Distribution of New Infections Next 12 Months (Lesotho,
Mozambique, Swaziland & Zambia)
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Epidemic Curves, HIV, AIDS & Impact
27Aug01 -Report I: Epidem’gy & Lit. p. 27
T1 T2 Time
Numbers
A1
A2
HIV prevalence
B1
A
B
AIDS - cumulative
Impact
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Prevention Key to response
A NATION AT WAR WITH HIV&AIDS
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Prevention achievements (MICS 2010)
• Biomedical interventions – Condoms use at high risk sex 48% (male) to
90.6 % and 47.8 (females) 73.1%
– Male Circumcision 7% 2007 to 19 % 2010
– Blood 100% safe
A NATION AT WAR WITH HIV&AIDS
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Treatment of PLHIV
• Over 80% of those in need of treatment accessing treatment
• MTCT reduced from 32% in 2004 to 1.4% in 2012
• Over 80% of children in need of treatment have access
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MOE – Keeping OVC in school
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MOE – School feeding – all schools
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A NATION AT WAR WITH HIV&AIDS
MTAD- KaGogo Social Centres
301 kaGogo Centres have been constructed country wide with volunteers
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A NATION AT WAR WITH HIV&AIDS
MTAD- Shelter for OVC
A total of 143 houses have been constructed for child headed households
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MTAD –NCP in communities
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Sector Response- Workplace
PSHACC
• HIV and AIDS workplace programmes in all Government ministries– Peer educators– Counsellors– Carers
– Male involvement
SWABCHA
• Minimum package of workplace HIV services in private sector
• Most big enterprises with vibrant programmes
• Reach extended to SMME
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Sectors: Urban and FBO
AMICAALL
• Services delivered to all cities and towns
• Mainstreaming HIV programmes
CHURCH FORUM
• Supporting churches to mainstream HIV and AIDS response
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Sectors: PLHIV & Media
SWANNEPHA
• Coordination of service delivery to PLHIV and organizations of PLHIV
• Advocacy and promoting greater Involvement of people living with HIV
MISA
• Coordination of the media sector response to HIV
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Sources of Funds for HIV and AIDS Expenditure, 2005/06- 2009/10
A NATION AT WAR WITH HIV&AIDS
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Sources of Funds for HIV and AIDS Expenditure - 2007/2008, 2008/2009 & 2009/2010 (SZL)
Source
2007/2008
%
2008/2009
%
2009/2010
%
Public Funds
102,612,949
33.32
182,905,780
42.01
231,521,283
39.73
Private Funds
3,255,027
1.06
13,926,289
3.20
19,585,536
3.36
International Funds
202,138,565
65.63
238,542,436
54.79
331,563,887
56.90
Grand Total
308,006,541
100.00
435,374,505
100.00
582,670,706
100.00
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50% in sexual transmission of HIV 50% of HIV among people who inject drugs 50% TB deaths in people living with HIV Ensure no children are born with HIV and reduction of AIDS-related
maternal deaths 15x15 (15 million people on ART by 2015) Mobilize funding (US $22-24 billion per year) 55 Operative Paragraphs in the Political Declaration
HLM June 2011: Bold targets for 2015
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The Future of the Response
The New Investment Framework for the Global
HIV Response
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Trends in Epidemic in Southern Africa
Southern Africa
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
1980 1985 1990 1995 2000 2005 2010
Peo
ple
new
ly i
nfe
cted
wit
h H
IV a
nd
d
eath
s d
ue
to A
IDS
(T
ho
usa
nd
s)
0
2,000
4,000
6,000
8,000
10,000
12,000
Peo
ple
liv
ing
wit
h H
IV (
Th
ou
san
ds)New HIV infections
Deaths due to AIDS
People living w ith HIV
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Aims of the Investment Framework
• Maximize the benefits of the HIV response
• Support more rational resource allocation based on country epidemiology and context
• Encourage countries to prioritize and implement the most effective programmatic activities
• Increase efficiency in HIV prevention,treatment, care and support programming
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Key elements of the investment Framework
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0
5
10
15
20
25
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
6 Basic Programme Activities
• Behavior Change Programmes
• Voluntary male Circumcision
• Treatment (ART) and Care• Programmes for Key
Populations • Condom Promotion and
Distribution• Elimination of new
infection among children
USD (Billions)
Focus on what makes a difference
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The new investment frameworkFocus on what makes a difference
0
5
10
15
20
25
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
USD (Billions)
Critical Enablers: (Social & program enablers ) incl:•Community mobilization•Stigma reduction•Legal environment•Programme management
Basic Programme Activities
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Focus on what makes a difference
0
5
10
15
20
25
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
USD (Billions)
Synergies with broader development sectors, incl:•Gender•Health Systems•Education•Social Protection
Basic Programme Activities
Critical Enablers
Synergies with broader development sectors, incl:•Gender•Health Systems•Education•Social Protection
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Breakdown of Future Costs of HIV
• Fiscal Costs of HIV&AIDS are high and persistent, interpreted as a quasi-liability (like national debt that needs to be served over a long period of time)
• Fiscal cost of HIV&AIDS at 5.5% GDP to rise to 7% of GDP by 2020• Treatment and care is the biggest component
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Demographic and Epidemiological Module
Based on:
• Population Projections
• Scaling-up of access to ART, including numbers of those 1st and 2nd line treatment as per the NSF
• Projections on HIV&AIDS incidence
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Future Costs - Projections
• Fiscal costs of HIV&AIDS absorbs currently 12% of all Govt expenditure (2010) but share to rise to almost 30% and stay at higher level
• Fiscal costs of HIV&AIDs as 15% of all Govt revenue (2010) and to rise to around 20% and stay at higher level
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Future Costs of an Infection• Costs of new infection occurring in 2010 through to 2050= E92,600 (3.8
times GDP pc)• Costs of a new infection occurring in 2010, ie: Out of all new infections in
2010, some will not be diagnosed, they will die and leave orphans, some will go on treatment then move on to 2nd line or not, etc… So that on average these are the costs of a new infection
• Other cots mostly on mitigation (largely orphans)
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The Case for Swaziland…
• UNGASS commitments… political commitments by Government and partners!
• Gender related conventions and declarations ratified and domesticated … need for more legislation to guide operations.
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In summary…
• Outstanding successes in HIV response
• Infection rates reducing
• More people surviving, living productive lives
• Fewer OVC
• Sustaining the gains … increased demand on domestic resources.
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Conclusions
• Fiscal costs of HIV/AIDs are extremely high and persistent
• Even if external level of financing is maintained HIV and AIDS is an extraordinary fiscal challenge to Swaziland
• Swaziland has the highest fiscal burden of HIV/AIDS of all countries survey at 293% of GDP. This compares to 212% GDP for Uganda, 192% of GDP for Botswana and 37% for South Africa.
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Role of the Media
• Inform, educate, communicate and disseminate accurate information on HIV and AIDS and gender
• Provide platform for dialogue and exchange of views within Government sectors and beyond
• Ensuring Government action is in compliance to signed conventions and declarations and policies
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A NATION AT WAR WITH HIV&AIDS
Siyabonga