Overview of hiv situation and national hiv response in swaziland
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Overview of HIV Situation and National 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.

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Overview of hiv situation and national hiv response in swaziland

Overview of HIV Situation andNational HIV Response in Swaziland

Ms. T Gama

NERCHA

05. MARCH 2013


Outline

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 prevalence among the general population, Swaziland 2006


Hiv incidence rate 15 49 years

HIV incidence rate (15-49 years)


2007 dhs and 2011 shims hiv prevalence in swaziland ages 18 49

2007 DHS and 2011 SHIMS HIV Prevalence in Swaziland (ages 18-49)

Women: Prevalence by Age

Men: Prevalence by Age


Knowing your epidemic kye

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


Hiv prevalence among msm compared to reproductive age swazi men

HIV Prevalence Among MSM Compared to Reproductive Age Swazi Men

Overall HIV prevalence among MSM participants: 17.7%

Source: Central Statistical Office & Macro International, 2008, p. 222


Hiv prevalence among sw compared to reproductive age swazi women

HIV Prevalence Among SW Compared to Reproductive Age Swazi Women

Overall HIV prevalence among SW participants: 70.3%

Source: Central Statistical Office & Macro International, 2008, p. 222


Complicated nature of the epidemic

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

Complicated nature of the epidemic

Distribution of New Infections Next 12 Months (Lesotho, Mozambique, Swaziland & Zambia)


Epidemic curves hiv aids impact

Epidemic Curves, HIV, AIDS & Impact

Numbers

HIV

prevalence

Impact

A

2

A

1

A

AIDS

- cumulative

B

B

1

T

T

Time

1

2

27Aug01 -Report I:

Epidem’gy

& Lit.

p.

27


Prevention key to response

Prevention Key to response

“Close the tap instead of mopping the floors”

A NATION AT WAR WITH HIV&AIDS


Prevention achievements mics 2010

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

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 – Keeping OVC in school


Moe school feeding all schools

MOE – School feeding – all schools


Mtad kagogo social centres

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

MTAD- Shelter for OVC

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

A NATION AT WAR WITH HIV&AIDS


Mtad ncp in communities

MTAD –NCP in communities


Sector response workplace

Sector Response- Workplace

PSHACC

SWABCHA

Minimum package of workplace HIV services in private sector

Most big enterprises with vibrant programmes

Reach extended to SMME

  • HIV and AIDS workplace programmes in all Government ministries

    • Peer educators

    • Counsellors

    • Carers

    • Male involvement


Sectors urban and fbo

Sectors: Urban and FBO

AMICAALL

CHURCH FORUM

Supporting churches to mainstream HIV and AIDS response

  • Services delivered to all cities and towns

  • Mainstreaming HIV programmes


Sectors plhiv media

Sectors: PLHIV & Media

SWANNEPHA

MISA

Coordination of the media sector response to HIV

  • Coordination of service delivery to PLHIV and organizations of PLHIV

  • Advocacy and promoting greater Involvement of people living with HIV


Sources of funds for hiv and aids expenditure 2005 06 2009 10

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

Sources of Funds for HIV and AIDS Expenditure - 2007/2008, 2008/2009 & 2009/2010 (SZL)


Overview of hiv situation and national hiv response in swaziland

50%  in sexual transmission of HIV

50%  of HIV among people who inject drugs

50% TB deathsin 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 Future of the Response

The New Investment Framework for the Global HIV Response


Trends in epidemic in southern africa

Trends in Epidemic in Southern Africa


Aims of the investment framework

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

Key elements of the investment Framework


Overview of hiv situation and national hiv response in swaziland

  • 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

Focus on what makes a difference

USD (Billions)


The new investment framework focus on what makes a difference

  • Critical Enablers:

  • (Social & program enablers ) incl:

  • Community mobilization

  • Stigma reduction

  • Legal environment

  • Programme management

The new investment frameworkFocus on what makes a difference

USD (Billions)

Basic Programme

Activities


Focus on what makes a difference

  • Synergies with broader

  • development sectors, incl:

  • Gender

  • Health Systems

  • Education

  • Social Protection

  • Synergies with broader

  • development sectors, incl:

  • Gender

  • Health Systems

  • Education

  • Social Protection

Focus on what makes a difference

USD (Billions)

Critical Enablers

Basic Programme

Activities


Breakdown of future costs of hiv

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

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

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

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

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

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

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

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


Siyabonga

Siyabonga

A NATION AT WAR WITH HIV&AIDS


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