HIV/AIDS Epidemic Affecting Swaziland's Population

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Preliminary results of Swaziland's national census released lastmonth found that since 1997, the country's population has decreasedby 17,489 people to 912,229, and many experts have attributeddemographic changes to the HIV/AIDS epidemic, Toronto's Globeand Mail reports. The government has not finalized theresults of the census, but if the figure holds, it would mean thatthe country is 300,000 people below what was projected as the likelyrate of growth 20 years ago, according to the Globe and Mail.

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The country grew by more than 200,000 people from 1986 to1997, Solomon Dlamini, head of the national university's departmentof demography and statistics, said, adding, "But it's the periodbetween these two censuses (1997 and 2007) when the [HIV/AIDS]epidemic reached its apex." Swaziland has the highest HIVprevalence in the world: 26% of adults, 49% of young women betweenthe ages of 25 and 29 and 43% of pregnant women are HIV-positive.According to the Globe and Mail, the population declinecould be attributed both to people dying of AIDS-related conditionsand because HIV infection lowers the number of children women have.

"I don't think anybody quite realized what the depth ofHIV would be in Swaziland." Derek von Wissell, director of theNational EmergencyResponse Council on HIV/AIDS, said, adding, "Even if theyundercounted by 10%, we're down 25% from where we should be."However, Rob Dorrington, a professor of actuarial science at theUniversity of CapeTown, said, "Experience has taught me to be skeptical ofcensus data in general." He added, "It is not unusual forthere to be an undercount of children and of men [in a census], anddeaths would have to have been implausibly high, given the estimatedlevel of prevalence, for one to be able to detect this through thechange in the numbers counted by the census." Amos Zwane,Swaziland's senior statistician, wrote in his preliminary report onthe census that "a population decline or stagnation was notexpected and this result is most surprising." He said that hisoffice is going to search for a logical explanation and will notspeculate on the cause until it produces final numbers in the middleof 2008.

According to the Globe and Mail, a"toxic mix" of factors has fueled the country's HIVepidemic, including a highly virulent strain of the diseasecirculating among residents; a culture that "condones, evenencourages" promiscuity and polygamy among men and denies womenthe right to negotiate condom use; a "limited economy" thatrelies on sending men to work in South Africa for long periods oftime; and a "playboy" king with an "ever-expandingstable" of wives who has denied the magnitude of the problem,according to the Globe and Mail. In addition, thecountry's understaffed and underfunded health system could not treatpeople when the epidemic hit in the 1990s and, as a result, "achinglyslow progress" has been achieved in delivering antiretroviraldrugs to those in need, the Globe and Mail reports. Therates of new HIV cases have begun to decrease minimally among youngpeople, but the rates remain stable or are increasing among people intheir 30s. About one-third of people who need antiretrovirals aregetting the drugs (Nolen, Globe and Mail, 12/22/07).

Reprinted with permission fromkaisernetwork.org.You can view the entire KaiserDaily HIV/AIDS Report, search the archives, and signup for email delivery at kaisernetwork.org/email. The Kaiser Daily HIV/AIDS Report is publishedfor kaisernetwork.org, a free service of The Henry J. Kaiser FamilyFoundation.

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