\doc\web\99\14\swazaids.txt In 1998 a baseline HIV/AIDS survey was conducted in Swaziland's four regional hospitals in two urban and two ru-ral areas.' This found that 49.5% of in-patients were infected with HIV, and reaffirmed the serious threat posed by HIV and AIDS to the Kingdom of Swaziland. From: "Taylor, John (JH)" To: "'arthurhu@halcyon.com'" Subject: you probably didnt read all the way to the end of what I sent ear ler, so resending Date sent: Thu, 16 Sep 1999 20:34:28 +0200 The HIV/AIDS burden on Swaziland's health care sector > > In 1998 a baseline HIV/AIDS survey was conducted in Swaziland's four > regional hospitals in two urban and two ru-ral areas.' This found that > 49.5% of in-patients were infected with HIV, and reaffirmed the serious > threat posed by HIV and AIDS to the Kingdom of Swaziland. > Trends in HIV prevalence in 1986 Swaziland realised the presence of HIV > when the first AIDS case was seen. It was a case of 'just one person" out > of an estimated total population of 800 000. Life expectancy during this > period was 65 years for females and 61 for males. It seemed that Swaziland > was moving along a sound development trajectory. Then in 1992 the first > sentinel sur-veillance on pregnant women found that 3.9% of women were > HIV-positive; by 1998 this had risen to 31.6%. > It was believed that this situation would have a significant impact > on the country's health services. Partly as a result of the sentinel > surveillance data, therefore, in 1998 the Ministry for Health and Social > Welfare conducted the baseline survey at the country's regional hospitals, > > The purposes of the survey were: > > to determine the prevalence by age, sex and rural-urban residence; and > ? to establish a baseline for monitoring future trends. > , > The method used was to test and complete a questionnaire for all > patients being admitted to non-maternity wards for the first time during a > 30-day study period in June/July 1998. > There were a number of other significant findings. HIV prevalence by > hospital ranged from 45.7% in Mbabane (the capital) to 53.4% in Good > Shepherd Hospital. Indeed, the two rural hospitals reflected higher HIV > prevalence rates than the urban ones. In addition, patients at all > hospitals were asked whether they were urban or rural residents Overall > HIV prevalence was 45.5% for urban dwellers and 53% among rural residents. > > This finding is counter-intuitive, as we would expect to find higher > levels of HIV in urban populations. What it may point to is that people > who fall ill are returning to their rural homes. If this is the case then > itwill have serious implications for rural poverty - not only are the > homesteads having to cope with increased demand for resources, but they > also face the loss of income from remittances. > HIV prevalence rates by age are shown in Figure 1 > There are no surprises in these data -although it is assumed that the > majority of those infected in the 1 O-l 9 age band are at the upper limit, > otherwise it might point to a problem of child abuse. It is, however, > extremely worrying to note that two-thirds of patients aged 20-39 are > HIV-positive. > 1 Figure 1 HIV prevalence.by age among inpatients (%) > > 0-9 40% > 10-19 21% > 20-29 63% > 30-39 60% > 40-49 55% > 50-59 40% > 60+ 15% > > > > > > > The impact of HIV Levels of ill health and rates of mortality have shown a > marked increase during the past decade. This has been assumed to be linked > with rising HIV prevalence, although in the absence of HIV testing of > patients and death certificates reflecting the cause of death, there has > so far been no proof of this. > > The survey found a huge burden of disease as a result of HIV. Of the > total number of patients tested, 49.5% were infected. The breakdown of HIV > infection levels by ward ofad-mission is detailed in Table I, > > Table 1 HIV prevalence by ward (%) > I > Medical 55.8 > Paedratric 44.6 > Surgical 37.6 > Private 35.9 > > > > The report notes that there has been an increase in mortality among > hospital patients, which was assumed to be due to HIV infection. It is > clear that this is indeed the case. > The SNAP is to be congratulated for this study. Not only does it > provide a baseline but also provides directions for future work. > References > > 1 Swaziland National AIDS/STDs Programme (1998), Report on HIV > Prevalence among In-patients in Selected Hospitals, Mbabane: Ministry of > Health and Social Welfare