Of the nearly 2,000 women surveyed who attended antenatal clinics in all four of the country’s regions, 42 percent tested HIV positive in 2008, up 3 percent from the last survey conducted in 2006.
Antenatal surveys have been carried out by Swaziland’s Ministry of Health and Social Welfare every two years since 1992, when the infection rate was 3.9 percent.
By 2002, Swaziland’s HIV prevalence among pregnant women had reached 38.4 percent, peaking in 2004 at 42.6 percent before decreasing slightly in 2006, only to rebound in the last two years.
Rural areas previously had higher infection rates, but the latest survey found that HIV levels were roughly the same throughout the country.
In a report summarising the survey findings, government downplayed the prevalence increase as "not significant" and described the rates as "showing some stabilisation after rapidly increasing through the 1990s and slowing down after 2004".
"It’s true that the numbers have stabilised," commented Sipiwe Hlope, an AIDS activist who runs Swazis for Positive Living (SWAPOL), an organization that supports women living with HIV, "but at a disastrous level that is not declining."
The average life expectancy of Swaziland’s one million people has plummeted to just 37 years since the AIDS crisis began.
After the new surveillance figures were released last week, health officials explained that the increase in prevalence did not necessarily indicate a rise in new infections, but could mean that more people were surviving with the virus.
"There are a number of reasons why you see such prevalence," UNAIDS Country Representative Sophia Mukasa-Monico told IRIN/PlusNews. "It reflects more people on drugs; people who are living, thanks to ARVs [antiretrovirals], instead of dying."
It’s true that the numbers have stabilised, but at a disastrous level that is not decliningThe report noted that HIV prevalence among pregnant women in the 25 to 39 age group had been rising steadily over the years, partly due to new infections, but also to the "probable survival of HIV-infected persons, following the advent of PMTCT [prevention of mother-to-child transmission], antiretroviral therapy and the management of opportunistic infections."
The United Nations Children’s Fund (UNICEF) has extended the lives of many Swazi women with its PMTCT programme, in which more than two-thirds of pregnant women receive medication to protect their unborn infants from HIV, up from 5 percent when it started in 2003.
The impact of ARV treatment is less likely to be a factor in the infection rate among younger women, most of whom would have contracted the virus fairly recently.
"Existing data clearly indicates continuity in new infections among the young population (15 – 24) with sharp increases noted between the ages of 19 and 23," the government report noted. "This shows that younger women, in particular, continue to be vulnerable to HIV infection."
The United Nations Development Programme has reported that condom usage is still low among Swazis, and that traditional practices such as polygamy, which can contribute to the spread of HIV, continue.
"We are succeeding at the clinical level with PMTCT and with ARVs, but at the social level – at changing people’s behaviour – this is where the work must be done," said Mukasa-Monico.
The health ministry recommended an acceleration of current HIV prevention efforts but offered no new solutions to Swaziland’s AIDS problem other than urging more data collection.
Its report concluded: "There is a need to carry out further research and synthesis of existing data to understand the epidemic better and clearly determine relevant interventions."
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