The Swaziland HIV/AIDS Investment Case

Last updated
Wednesday, November 24, 2021 - 17:12


Swaziland, a relatively small country with a population of just above one million people, has a very high prevalence of 26% (1 in every 4 adults aged 15 - 49 years old) with an incidence of 2.4% and high (80%) rates of TB/HIV co-infection. New HIV infections are likely to occur among young women aged 18 - 24, older women aged 35 - 39 years and men aged 30 - 34. Women have a higher HIV prevalence than men of 31% and 20%, respectively, almost 1 in 2 children (45%) below the age of 18 is either orphaned or vulnerable.

Swaziland made significant progress in reducing HIV incidence and AIDS-related mortality by more than 25% and 35% respectively in the last 10 years. Some 101, 730 (87%) of the 117, 044 eligible people also translated as 49% of all people living with HIV are now accessing treatment with Government financing virtually all ARVs stocks. Transmission of HIV from mother to child at 6 - 8 weeks has been reduced to 3% as over 80% of pregnant women access prevention of mother to child transmission (PMTCT) services. HIV prevalence among young people has been substantially reduced by 54% and 20% among young men and women aged 20 - 24 respectively.


The long term fiscal liability of the HIV burden in Swaziland and the limited global resources for the HIV response present a need for smart investments in interventions that will maximise impact, benefits and efficiencies. The country's HIV blue print, eNSF 2014-2018, aims to reduce HIV incidence by almost 50%, to avert a third of AIDS-related deaths, and improve the efficiency and effectiveness of the national response by 2018. The Umgubudla builds from the eNSF and sets a pathway towards the national vision of attaining an AIDS-free Swaziland by 2022, which is also aligned to the global objective of ending AIDS by 2030.

The Umgubudla HIV Investment Case prioritises scaling up of five eNSF programmes and recommends the implementation of identified game-changers whose impact will significantly avert new HIV infections, reduce AIDS-related deaths and at the same time yield financial savings in the long run.

The five SHIC programmes are:

1. Accelerate Scale-up of antiretroviral therapy (ART) for People Living with HIV
2. Scale-up Voluntary Medical Male Circumcision (VMMC)
3. Scale-up Innovative HIV Prevention approaches for girls and young women
4. Accelerate elimination of mother to child Transmission of HIV (EMTCT)
5. Intensify TB/HIV co-infection diagnosis and treatment

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