Eswatini HIV Estimates and Projections Report 2021

HIV estimates and projections are generated by the Spectrum and Naomi mathematical models. Spectrum and Naomi models have become a standard tool used to interpret HIV surveillance systems and HIV programmes in many settings and used to model the HIV epidemic and demographic, social, and economic impacts of programme interventions. The provide population impact and demand data to support planning and decision-making processes.

The Eswatini estimation process was led by a multi-sectoral national estimates and projections task team coordinated by NERCHA. The most recent demographic, survey, and programme data was populated into the model to produce estimates for 2020 and projections to 2023. A national stakeholder meeting was convened to validate the 2020 estimates and projections. The 2020 estimates and projections are summarised below:

1. HIV incidence -  The 2021 estimates and projections show that HIV incidence among people aged 15 to 49 is L0% in 2020 and is expected to decline to 0.8% by 2023. Incidence is higher amongst females compared to males throughout the years under projections.
2. New HIV Infections - New HIV infections among adults 15 years and older is estimated at 4,500 in 2020 and projected to decline slightly to 4,000 by 2023. In 2020, new HIV infections are higher among female adolescents and young adults, aged 15 to 24 (1,600), compared to other population groups. New infections are higher in females compared to males across all age groups.
3. HIV Prevalance - HIV prevalance for the age group 15-49 is estimated to be 26.8% in 2020 and projected to decline to 24.4% in 2023. HIV prevalance is higher in Manzini region (29,1%) compared to Lubombo (28,5%), Hhohho (27,2%), and Shiselweni (26,2%).
4. HIV Population - In 2020 the total number of people living with HIV is estimated to be 200,000 (76,700 males and 123,400 females) and is projected to be 199,000 (75,000 males and 124,000 females) in 2023.
5. Treatment coverage - In 2020 the total number of adults (15+) receiving HIV treatment is 191,070 (71,983 males and 119,086 females). The total number of children aged 0 - 14 receiving treatment is 8,912.
6. PMTCT - The number of HIV positive pregnant women needing ART is projected to decline from 9,300 in 2020 to 7,800 in 2023. PMTCT coverage is at 95% in 2020. In 2020, the MTCT rate at 6 weeks of age is estimated at 2,1% and projected to remain at 2,1% in 2023. The final transmission rate (at the end of breastfeeding) is estimated at 3,7% in 2020 and projected to remain the same in 2023.
7. AIDS Mortality - AIDS related deaths are projected to decline from 2,400 in 2020 to 1,900 in 2023. Between 2020 and 2023, AIDS related deaths are higher among females compared to males. AIDS related deaths were estimated at 210 among children aged 0 - 14 years in 2020.
8. AIDS Orphanhood - AIDS orphanhood will subside largely due to declining AIDS related deaths. AIDS orphans are projected to decline to 40,000 in 2023 from 53,000 in 2020.
9. HIV treatment cascade - >95% of all people living with HIV know their HIV status, >95% of people with diagnosed HIV infection are on antiretroviral therapy, and 95% of all people receiving antiretroviral therapy are virally suppressed.