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)"
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
> 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 (%)
> 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.
> 1 Swaziland National AIDS/STDs Programme (1998), Report on HIV
> Prevalence among In-patients in Selected Hospitals, Mbabane: Ministry of
> Health and Social Welfare