This document shall be known as the Second National Multisectoral HIV and AIDS Strategic Plan. It represents the intention of the Kingdom of Swaziland to extend the national response to the AIDS epidemic beyond 2005 and to provide a framework for
resource mobilization and coordination of all HIV and AIDS activities in the country. It is based on findings of a joint review of the 2000-2005 National HIV and AIDS Strategic Plan as well as countrywide consultations on drivers of the epidemic, how the epidemic is affecting individuals, communities and the country at large as well as what can be done differently. Consequently, all responding entities are obliged to act within the parameters of this plan and in support of its dictates in line with the
principle of the “three ones” which calls for one national coordinating body; one national strategic plan and one national monitoring and evaluation framework.
In reading this plan it is important to note that it was developed in the context of the Millennium Development Goals (MDGs) and the United Nations General Assembly Special Session on HIV and AIDS (UNGASS), the declaration on HIV and AIDS including a program of action which was adopted in April 2001 in Abuja in Nigeria, the Maseru Declaration on HIV and AIDS adopted by the SADC Summit in 2003, the New Partnership for Africa’s Development (NEPAD) adopted in July 2001, Common Country Assessment and United Nations Development Assistance Framework as well as many other international and regional conventions that call for improved
political commitment and the respect for human rights and the rule of law to which the country is signatory. It was also developed at a time when the country had just adopted a new constitutional dispensation and as part of many other government planning and development policies. This plan is therefore expected to interface closely with these important policies and plans of the country which among others include the: National Policy on HIV and AIDS; government policy outline on economic empowerment and development commonly known as the Smart Program on Economic Empowerment and Development (SPEED); draft National Policy on Children, 2003; draft Decentralization Policy; National Development Strategy (NDS); The Poverty Reduction Strategy and Action Plan, Health Sector Response to HIV/AIDS Plan in Swaziland 2003 – 2005; National Population Policy; draft social welfare policy; draft national policy on children including orphans and vulnerable children, Project Implementation Manual for Social Protection of Vulnerable Children
including Orphans; National HIV/AIDS Communication Strategy for Swaziland 2004 and the Public Sector HIV/AIDS Strategic Plan, 2006 – 2008.
National demographic and socio-economic profile
Geographical setting — The Kingdom of Swaziland is a southern African country which shares borders with the Republic of South Africa on the north, west and south and with the Republic of Mozambique on the east. The country extends over a land mass of 17, 364 square kilometres.
Demographic and health profile — The country is host to a population of over 978,238 people, 78% of which live in rural Swaziland. The population of the country is generally young, with children under the age of 15 years and persons who are
aged 65 years and above respectively accounting for 46 % and approximately 3% of the total population. The last national census (1997), estimated the population to be growing at a rate of 2.8% in 1997 compared to 3.2% in 1986. The Total Fertility Rate
(TFR) has been declining over the years. It was reported to be 4.5 live births per 1000 women in 1997 compared to 5.4 in 1991 and 6.4 in 1986. Prior to the demographic impact of the AIDS epidemic, the quality of life of people living in the country had improved significantly from a life expectancy at birth of 44 years in 1966 to 60 years by 1997 with females (63 years) living slightly longer than males (58 years). The Crude Death Rate was on the decline from 18.5 per 1,000 in 1976 to 7.6/1000 in 1997. Infant mortality had dropped to 78 /1000 live births in 1997 compared to 99 in 1986, while Under-five mortality had decreased to 106/1000 live births in 1997 from 140 in 1986.
Education profile — According to the education statistics report of 2004, the country has a total of 546 primary schools and 218,352 students. Boys are slightly more (51.7%) than girls at the primary school level. Girls in secondary and high schools are respectively slightly more (50.5% and 50.3%) than boys. At university level, males are slightly more (51.9%) than female students. The 1997 census recorded literacy to be 81.3% with males having slightly higher rates (82.6%) than women
(80.2%). Literacy levels were estimated much higher (92%) among young people who are aged 15 – 24 years compared to older generations of the population. Primary school enrolment stood at 230,000 in 2002 with 82% residing in rural Swaziland. Gender disparities in enrolment are very small. The teacher-pupil ratio was 1:34 at primary school and 1:18 at secondary and high school. Urban schools have a higher pupil-to-teacher ratio than rural schools.
Economic profile — The economy of the country is primarily agrarian even though the manufacturing sector has grown over the years. The economy is very closely linked to the economy of the Republic of South Africa. While the country experienced
high economic growth levels of 9% on average in the late 1980s, in recent years the economic growth has seriously slowed down reaching an average rate of 3.4% in the period 1990-1992. However, the World Bank classifies the country as a lower middle
income country with a GDP per capita income of US$1,387 (1999). Despite being perceived to be having a reasonable resource base compared to many developing countries, the majority of people (69%) in the country are classified as poor possibly due to poor distribution of available resources and rising unemployment which is estimated at 29%. Fifty-six point four percent (56.4%) of the wealth is estimated to be held by 20% of the population compared to only 4.3% being held by the poorest 20% of the population. While the country appears to have made a lot of economic development progress in the past, there is no doubt that these achievements are being significantly curtailed by the effects of the AIDS pandemic and difficulties in attracting meaningful direct foreign investment.
Outline of the document
The document is presented in five chapters of which this Background information on the country is chapter one. The description of the past and current situation of HIV and AIDS in the country is chapter two. Chapter three describes the international, regional and national responses to the epidemic. Chapter four presents the vision and mission statement, strategic issues, objectives, strategies, indicators. Implementation of the national response covering coordination, funding, monitoring
and evaluation and revision of the strategic plan is presented in chapter five. Overall, this document provides strategic guidance under four thematic areas of response which are designated as: Management; prevention; Care Support and Treatment and Impact Mitigation. Under management, the document presents sub-thematic areas in institutional arrangements; planning and program development; advocacy and communication; resource mobilization and management; community mobilization; research as well as monitoring and evaluation. Prevention has sub-thematic areas in: behaviour change communication; blood safety; prevention of mother to child plus, prevention of HIV and AIDS at the work place; condom logistics and management; sexually transmitted infection and clinical management; post exposure prophylaxis and universal precautions and HIV/AIDS Testing and Counselling. Impact mitigation includes the following sub thematic areas: legal, ethical and social rights provision and protection; social protection and livelihood support; counselling and emotional care; food security support; educational support; community driven impact mitigation program and mainstreaming of HIV, gender, disability and positive socio-cultural norms in impact mitigation interventions. The care, support and treatment thematic area covers these sub-thematic areas: antiretroviral therapy; management of opportunistic infections and pre-antiretroviral therapy; management of tuberculosis; home-based care; palliative care; counselling and testing as well as traditional and alternative practice.