Overview of HIV Situation andNational HIV Response

in Swaziland

Ms. T Gama

NERCHA

05. MARCH 2013

Outline….

• Knowing Your Epidemic (KYE)

• Know Your Response (KYR)

• Know Your Funding ( KYF)

• Future of Response to HIV and AIDS

HIV prevalence among the general population, Swaziland 2006

HIV incidence rate (15-49 years)

Men: Prevalence by Age Women: Prevalence by Age

2007 DHS and 2011 SHIMS HIV Prevalence in Swaziland

(ages 18-49)

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

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

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

Complicated nature of the epidemic

Source: NACs, UNAIDS, The World Bank (2009)

Distribution of New Infections Next 12 Months (Lesotho,

Mozambique, Swaziland & Zambia)

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

Prevention Key to response

A NATION AT WAR WITH HIV&AIDS

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

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

MOE – Keeping OVC in school

MOE – School feeding – all schools

A NATION AT WAR WITH HIV&AIDS

MTAD- KaGogo Social Centres

301 kaGogo Centres have been constructed country wide with volunteers

A NATION AT WAR WITH HIV&AIDS

MTAD- Shelter for OVC

A total of 143 houses have been constructed for child headed households

MTAD –NCP in communities

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

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

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

Sources of Funds for HIV and AIDS Expenditure, 2005/06- 2009/10

A NATION AT WAR WITH HIV&AIDS

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

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

The Future of the Response

The New Investment Framework for the Global

HIV Response

Trends in Epidemic in Southern Africa

Southern Africa

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200

400

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1,200

1,400

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ple

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Deaths due to AIDS

People living w ith HIV

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

Key elements of the investment Framework

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

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

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

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

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

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

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)

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.

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.

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.

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

A NATION AT WAR WITH HIV&AIDS

Siyabonga