R 031328Z MAR 09
FM AMEMBASSY MBABANE
TO SECSTATE WASHDC 3444
INFO SOUTHERN AF DEVELOPMENT COMMUNITY
CDC ATLANTA GA

UNCLAS MBABANE 000052 
 
 
DEPT FOR AF/S (MHARRIS); OGAC (CHOLMES,JTIMBERLAKE); DRL (NWILETT); 
INL (RYOUSEY); PLEASE PASS TO USAID (BENJAMIN GUSTAFSON, ROSALIND 
BEST); CDC FOR DR. STEFAN WIKTOR 
 
E.O. 12958: N/A 
TAGS: PGOV PREL KDEM PHUM KTIP WZ
SUBJECT:  HIV PREVALENCE RATE IN SWAZILAND SAMPLE RISES, BUT 
INTERPRETATIONS DIFFER 
 
¶1.  SUMMARY:  On February 24th at a national public forum, 
Swaziland's Minister of Health Benedict Xaba released findings of 
the latest HIV Sentinel Surveillance Survey of a sample of pregnant 
women presenting at health clinics around the country.  The late 
2008 survey data show that HIV prevalence in this sample stands at 
42 percent, compared with 39 percent in 2006 and 43 percent in 2004, 
and that there is no significant difference by marital status, level 
of education, or residence (rural/urban).  The government 
interpretation is that the data indicate the prevalence rate has 
stabilized, because treatment allows HIV positive persons to live 
longer, and bear children.  However, it is admitted that younger 
women in particular continue to show a high rate of new infections, 
and Swaziland maintains the unfortunate distinction of having the 
world's highest HIV prevalence.  Prevention efforts and approaches 
to change behavior must be given priority if this devastating rate 
of infection is ever going to decrease.  END SUMMARY. 
 
¶2.  Even taking into account sampling variability, the survey 
results do not present a positive picture of the nation's efforts to 
reduce new HIV infections.  Derrick von Wissel, the government's 
Director of the National Response Council on HIV and AIDS (NERCHA) 
is quoted as dismissing views that the national AIDS strategies have 
failed, however.  He reportedly said that the rate has stabilized, 
and that the only way a prevalence rate in a non-curable disease 
goes down is when people die -- that the small recent rise in 
prevalence is evidently due to successful efforts to treat AIDS 
cases with life-saving anti-retroviral drugs.  The information 
available at this time does not indicate what percentage of these 
women are on ARVs, nor for how long.  Those women who presented with 
a first pregnancy reportedly had a significantly lower HIV 
prevalence than those with previous prenancies, and Mr. von Wissel 
stated that the repot indicated teenage pregnancy had dropped 
"consierably."  However,  data also indicate that new HI 
infections, especially in the younger age group (ages 15-24), are 
still occurring at the alarmin rate of 26 percent, and that HIV 
prevention in he vulnerable population of young women has not ben 
successful. 
 
¶3.  Because of the nature of th data, the precise rate of 
incidence, a far bettr and more direct measure of new infections, 
cannt be ascertained.  The results of this survey showno 
significant differences by educational level, marital status or 
residence (rural or urban), but that may be an effect of high 
prevalence and needs to be examined further.  The GOKS, on one hand, 
says the rise is not significant and indicates a leveling off of the 
prevalence rate, since in 2004 it was 43 percent.  "Stabilizing" at 
this rate, however, is not acceptable -- the rate is actually over 
49 percent among those aged 30-34.  The IMF reported that Swazi 
worker productivity is being affected by approximately 25 percent of 
laborers being absent one or more times per month.  This rate is 
higher than other southern Africa countries and is attributed to 
HIV/AIDS in the worker or immediate family. 
 
¶4.  Health Minister Xaba expressed disappointment with the results, 
stating HIV/AIDS education campaigns are not working and that HIV 
prevention efforts need to be accelerated.  This is consistent with 
the U.S. Mission/PEPFAR program observations that current prevention 
programs in Swaziland are rarely evidence driven, are poorly managed 
and coordinated, and are not systematically evaluated using reliable 
behavioral and serological information. 
 
¶5.  While the Minister and other leaders have routinely pointed to 
the youth as a principle target group for intervention, available 
evidence in Swaziland and in many other southern African settings 
strongly indicate that while youth programs should be continued and 
strengthened, two other approaches (not discussed at this National 
Forum) hold more promise in stemming a rise in new infections -- 
male circumcision and reduction of multiple, concurrent partnering 
(MCP). 
 
COMMENT 
 
¶6.  First, recent evidence in the region indicates that national 
campaigns which respond to an existing demand for high quality 
medical male circumcision services have the potential to cut HIV 
incidence by as much as 60 percent.  Second, patterns of sexual 
behavior that include high levels of concurrent partnering, 
supported by long standing social and cultural attitudes, are at the 
root of the endemic, resulting in extreme HIV rates in the region. 
While interventions to delay sexual activity in youth will continue 
to play an important role in national HIV prevention programming, it 
is now clear that broader social transformation is key to improving 
sexual health in general, and to turn the tide of the HIV epidemic. 
This involves changing norms around women's roles and MCPs. 
 
¶7.  For these evidence-based approaches to find traction in 
Swaziland, it is understood that Swazi leaders need to play a major 
role in beginning and then sustaining changes in sexual behavior in 
the population.  The Ambassador and PEPFAR have embarked on a 
Partnership Framework with the GOKS to improve HIV-prevention 
programming, and focus on medical male circumcision and MCPs.  In 
the National HIV/AIDS Strategic Framework (2009-2014), completed 
this month, these key interventions are highlighted. 
 
¶8.  The U.S. Mission/PEPFAR program looks forward to supporting the 
GOKS by utilizing its resources to support these critical efforts. 
Without a significant, sustained response to the HIV epidemic, 
Swaziland will lose any ground it has gained over recent years in 
the push for enhanced democratization and development, as the 
productive capacity of Swazis decreases.  As pointed out in the 2011 
Mission Strategic Plan, we also believe that to change norms 
requires a more democratic political framework that promotes 
responsible individual behavior, and universal education.  All three 
efforts must be supported concurrently.  This is a pivotal point for 
the GOKS and the USG to ensure that Swaziland is not dismantled by a 
health crisis which might be alleviated, given adequate resources, 
effective program management, and political will. 
 
PARKER