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Swaziland, a landlocked country, has a declining population of approximately 1.17 million people. An estimated 76 percent of its people live in rural areas. Although Swaziland is classified as a “middle-income” country, there are great disparities between the rich and the poor. Nearly 70 percent of the population lives below the poverty line and the unemployment rate is 40 percent.
Swaziland’s public health care system consists of six national hospitals and more than 200 health centers and clinics. The country’s health care system suffers from chronic personnel shortages, particularly in remote and rural areas. There are an estimated 122 nurses and doctors per 100,000 people, well below the World Health Organization recommendation of 250 nurses and doctors per 100,000 people. Poverty, poor nutrition, and a high disease burden combine to limit life expectancy to an average of 37 years of age.
Swaziland is now the country with the highest adult HIV seroprevalence rates in the world at 26 percent. In 2008, the HIV infection rate among pregnant women was 42 percent. HIV has also orphaned an estimated 56,000 children in the country. Since 1986, the government of Swaziland has been actively engaged in responding to HIV/AIDS, issuing three strategic plans to combat the pandemic in 2001, 2006, and 2009. Barriers, however, persist to HIV prevention, treatment, care, and support, including limited prevention education, HIV/AIDS stigmatization, limited access to services, inadequate laboratory services, and lack of trained staff.
ICAP in Swaziland
Since January 2006, the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University’s Mailman School of Public Health has been supporting activities in Swaziland to provide care and treatment for pregnant women, children, and their families, including services to prevent mother-to-child transmission (PMTCT) of HIV and reduce HIV-related morbidity and mortality. In addition, ICAP provides technical and clinical assistance to the Ministry of Health and health facilities in the development of family-focused, multidisciplinary HIV/AIDS prevention, care, and treatment programs. In 2009, ICAP was awarded a new five-year grant from the U.S. Centers for Disease Control and Prevention to support the rapid scale up of decentralized HIV care and treatment services in the Kingdom of Swaziland.
ICAP-supported activities in Swaziland include:
- Support to develop systems and services to provide de-centralized HIV care and treatment in three regions (Hhohho, Manzini, Lubombo)
- Enhanced PMTCT/MTCT-Plus services for HIV-infected pregnant women, including provision of antiretroviral therapy (ART)
- Family-centered HIV/AIDS prevention, care, and treatment, including provision of ART
- Pediatric HIV/AIDS care and treatment, including early infant diagnosis and ART provision
- Linkages to tuberculosis (TB) control programs for TB/HIV co-infected patients
- Ongoing clinical training, mentoring, and quality improvement in delivering HIV/AIDS care and treatment, ART, and monitoring and evaluation
- Strengthening medical records systems
- Adherence and psychosocial support, and the development of follow-up systems
- Enhancing laboratory and pharmacy services
- Community linkages for care and treatment programs
- Development of managerial and technical capacity to administer HIV/AIDS programs
- Support for improved nursing capacity, including pre-service education support, in-service training support and nursing wellness and retention strategies
- Support of the Swaziland HIV Incidence Measurement Survey (SHIMS)