Overview of HIV Situation and National HIV Response in Swaziland

1. Overview of HIV Situation andNational HIV Response in Swaziland Ms. T Gama NERCHA 05. MARCH 2013

2. Outline…. • Knowing Your Epidemic (KYE) • Know Your Response (KYR) • Know Your Funding ( KYF) • Future of Response to HIV and AIDS

3. HIV prevalence among the general population, Swaziland 2006

4. HIV incidence rate (15-49 years)

5. 2007 DHS and 2011 SHIMS HIV Prevalence in Swaziland (ages 18-49) Women: Prevalence by Age Men: Prevalence by Age

6. 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

7. 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

8. 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

9. Source: NACs, UNAIDS, The World Bank (2009) Complicated nature of the epidemic Distribution of New Infections Next 12 Months (Lesotho, Mozambique, Swaziland & Zambia)

10. 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

11. Prevention Key to response “Close the tap instead of mopping the floors” A NATION AT WAR WITH HIV&AIDS

12. 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

13. 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

14. MOE – Keeping OVC in school

15. MOE – School feeding – all schools

16. MTAD- KaGogo Social Centres 301 kaGogo Centres have been constructed country wide with volunteers A NATION AT WAR WITH HIV&AIDS

17. MTAD- Shelter for OVC A total of 143 houses have been constructed for child headed households A NATION AT WAR WITH HIV&AIDS

18. MTAD –NCP in communities

19. 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

20. 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

21. 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

22. Sources of Funds for HIV and AIDS Expenditure, 2005/06- 2009/10 A NATION AT WAR WITH HIV&AIDS

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

24. 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

25. The Future of the Response The New Investment Framework for the Global HIV Response

26. Trends in Epidemic in Southern Africa

27. 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

28. Key elements of the investment Framework

29. 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)

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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)

36. 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.

37. 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.

38. 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.

39. 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

40. Siyabonga A NATION AT WAR WITH HIV&AIDS