Swaziland

Responding to HIV & AIDS in Swaziland

In 2008, HIV&AIDS remains one of the greatest barriers to human development in Swaziland. According to the preliminary results of the Swaziland Demographic Health Survey of 2006, an estimated 18% of the population are living with HIV&AIDS. Prevalence in the age group 15-49 is as high as 26%. Estimated HIV prevalence amongst women attending antenatal clinics had reached an unprecedented 42.6% in 2004. This declined somewhat to 39.2% in 2006.

As the epidemic matures in Swaziland, its impact is increasingly being felt. In 2003, there were an estimated 17,000 HIV&AIDS related deaths.  There are an estimated 69,000 orphans and vulnerable children in Swaziland, a number expected to nearly double in the next five years. Institutional capacity to deliver essential social services is being compromised by HIV&AIDS related staff attrition at a time when demand for such services is highest.

The face of HIV/AIDS in Swaziland is also more and more that of a woman. In Swaziland, women between the ages of 15 and 49 constitute more than half of all infections. It is these same women that are also the backbone of communities, maintaining households, generating income and shouldering the burden of caring for sick family members.

The synergistic link between HIV/AIDS and poverty must also be recognized. HIV/AIDS is further entrenching households in vicious cycle of poverty, while poverty, exacerbated by the recurrent drought that has plagued the country for the last several years, is increasing the vulnerability of families to HIV infection and undermining the coping abilities of HIV/AIDS affected households and communities. Sixty-nine percent of the population is living below the poverty line, the majority once again being women.

The national response to the HIV&AIDS pandemic

Government's Response

Immediately after 1986, when the first AIDS case was identified, government established the Swaziland National AIDS Prevention and Control Programme (NAPCP) within the Ministry of Health and Social Welfare. The NAPCP was the predecessor of the Swaziland National AIDS/STI Programme (SNAP). SNAP, together with a number of health related NGO’s, undertook awareness campaigns, condom distribution programmes, blood screening and establishment of support centers. Sentinel surveillance of HIV has also been undertaken every two years since 1992 by SNAP. 

His Majesty King Mswati III declared HIV/AIDS a national disaster in 1999.  In order to foster a multi-sectoral response to the epidemic, a Crisis Management and Technical Committee (CMTC) was placed in the Deputy Prime Ministers Office.  This committee, in its 3-year term of office, stimulated a multi-sectoral response to HIV/AIDS. It also prepared and developed a National Strategic Plan for HIV and AIDS for the period 2000-2005.

In December 2001, government established a new coordination mechanism named the National Emergency Response Committee on HIV/AIDS (NERCHA), which replaced the CMTC. NERCHA was given the mandate to coordinate and mobilize resources for an expanded response to the epidemic. Government has demonstrated commitment to the national response to HIV/AIDS by placing the National Coordination Mechanism in the Prime Ministers Office.  A budget line was established in 2001 and an annual budget allocation has been made since then. In 2003, the committee was elevated to the level of a Council. 

In late 2004, the process of reviewing the national response to HIV/AIDS in Swaziland began. A report was made public in early 2005 identifying achievements, gaps, constraints, challenges, opportunities and lessons learnt.  The findings within the report served to inform the development of the National HIV and AIDS Policy, and elaboration of the Second National Multi-sectoral HIV and AIDS Strategic Plan and National Programme of Action for the Multi-sectoral Response to HIV and AIDS 2006-2008. These documents were finalized in late 2005 as well as the National Monitoring and Evaluation Strategy.   To read more on the national response click on this link NERCHA

Civil Society's Response

Community based organisations including non-governmental organizations (NGOs), faith based organisations (FBOs) and independent institutions have made significant contributions to effectively address the HIV and AIDS epidemic in Swaziland. These bodies have been actively engaged in all aspects of prevention, care and support, impact mitigation and more recently, treatment. 
An HIV/AIDS Consortium was established within the Coordinating Assembly of Non-government Organizations (CANGO). The consortium consists of all NGOs involved in activities related to HIV/AIDS. The goal of the consortium is to coordinate and solicit funds for HIV/AIDS activities. 
The first organization of people living with HIV was  established in 1993, and currently there are a number of such organizations in the country. Late 2004 saw the launch of the Swaziland National Network of People Living with HIV and AIDS (SWANNEPHA) as an umbrella body for such organisations. Although denial, silence and stigma continue to be a problem in Swaziland, it is hoped that increasing the meaningful involvement of people living with HIV in all aspects of the response to HIV and AIDS in Swaziland will change this. To read more on civil society response click on this link CANGO

The Private Sector

The Business Coalition Against HIV and AIDS (BCHA) was launched to respond to the high prevalence of HIV/AIDS in the workplace. The BCHA is a substructure of the Federation of Swaziland Employers and Chamber of Commerce and its objectives are to:

• Assist employers to deal with individuals who have HIV/AIDS in the same manner as those with any other chronic or debilitating illness;
• Provide information to employees on HIV/AIDS, its magnitude, impact and preventive measures;
• Assist in the implementation of non-discriminatory policies, procedures and practices in managing individuals who have HIV/AIDS;
• Support companies to assist those who have tested HIV negative to remain negative;
• Assist employees infected with HIV/AIDS to remain productive for as long as possible
• Assist companies to have clearly defined policies and procedures which will reflect local practices, procedures, culture and legislation; 
• Join forces with other organizations to counter HIV/AIDS and alleviate its impact by sharing the results of our internal research and supporting their efforts where appropriate

The BCHA has developed a charter to which a number of private sector establishments are signatory and in early 2005 also launched an HIV/AIDS workplace programme.

 

UNITED NATIONS SUPPORT TO NATIONAL HIV/AIDS RESPONSE
Project Sheet:   UN system response to HIV/AIDS strengthened and intensified.

UN Theme group on HIV/AIDS

UN Agencies including WHO, UNDP, UNICEF, FAO, WFP, UNESCO, UNFPA and the UNAIDS Secretariat are members of the UN Theme Group on HIV/AIDS. The UN Theme Group has supported government in the development of national frameworks and policies for improved management of the national response to HIV and AIDS, advocacy activities, training and capacity building initiatives, research, and increasing availability and accessibility of HIV/AIDS services.


Joint UN Programming

The UN Theme Group jointly undertook a UNF/UNIFIP funded project targeting adolescents in the country.  Areas of focus included, capacity development of youth NGO’s, provision of youth-friendly services, orphans care and support for people living with HIV/AIDS as well as community mobilization.  UN agencies involved in this project were UNDP, UNICEF, WHO, and UNFPA.  Each of the agencies undertook activities in line with their corporate mandates.
Building on this experience, UNDP, WHO, UNAIDS, UNFPA, FAO, WFP, and UNESCO in collaboration with their partners, are currently developing joint programmes in the areas of:

• HIV/AIDS prevention;
• Impact mitigation;
• Care, support and treatment; and
• Management of the National Response

UNDP INTERVENTIONS
Project Sheet:    Improved capacity to lead and manage the response to HIV/AIDS at all levels

UNDP recognizes that HIV/AIDS is a major challenge in sustaining the gains made in the fight against poverty in Swaziland; hence effectively addressing the HIV/AIDS epidemic is crucial. In 2006 UNDP has continued to support the Government of Swaziland in addressing the fight against HIV/AIDS, including the areas of poverty reduction and capacity management. Among other initiatives, UNDP has supported:

• Training and capacity building for Government, NGOs, the Private Sector; organizations for people living with HIV, community based organizations including faith based organizations and Lutsango Lwaka Ngwane; and Traditional Healers, youth, women and media practitioners.
• Advocacy activities aimed at education and creation of public awareness on issues of HIV/AIDS such as gender focused responses, ethical issues, human right, and involvement of Local Authorities in the national response.
• Development of a framework for community-based care;
• Research which include studies on Gender focused responses to HIV/AIDS, Human Rights, Ethical issues and HIV/AIDS in Swaziland,
• Impact assessment of HIV/AIDS on the Education Sector and the public sector. Formulation of the National Multi-sectoral Strategic Plan for HIV and AIDS.

Overall objective:

The overall objective of UNDP's HIV/AIDS programme is to support Government's efforts to halt the spread of the HIV/AIDS epidemic and to strengthen capacity for improved service delivery through:

• Reduced risk behavior in the population, especially among vulnerable groups, through behaviour/attitude change initiatives;
• Increased access to services and supplies by the most vulnerable people through SACI/SWACI; and
• Improvement in systems and structures at all levels (e.g. planning, coordination, partnerships, monitoring & evaluation, resource utilization), that will provide increased capacity to manage the national response to HIV and AIDS.

The HIV and AIDS programme places particular emphasis on addressing gender disparities bearing in mind that these disparities in Swaziland have exacerbated women's vulnerability, leading to the feminization of both poverty and HIV/AIDS. The human rights of women as service providers and caretakers in coping with HIV/AIDS will be protected through legislation as part of our law reform programme.

Strategies

Strategies used to make progress towards achieving the objective of UNDP's HIV/AIDS programme include:

• Capacity Building
• Advocacy, Policy and Legislation
• Communication for Change

1. Leadership and capacity development to address HIV&AIDS

AIDS-related deaths amongt the most productive segments of the population are undermining the capacities of the family, community and Government to respond to, and control the challenges they face from a range of inter-related crises. The strategies to support these responses include effective planning of capacity building and institutional strengthening for co-ordination and implementation at both centralized and decentralized levels for effective service delivery.

High- level Coordination

UNDP recognizes the importance of leadership at all levels in the fight against HIV/AIDS. UNDP will contribute to developing capacity for monitoring and evaluating the national response and support NERCHA in strengthening its role as a coordinating body for the national response. UNDP has also served as a member of the Country Coordinating Mechanism for implementation of activities funded under the Global Fund to Fight AIDS, TB and Malaria.

Leadership for Results with Commitment

UNDP is assisting the Government in developing capacity for strong leadership at strategic points of both the public and private sectors as well as in building capacity to mainstream HIV/AIDS into development programmes. In 2002, the Country Office launched the Leadership for Results Programme focusing on:

Leadership and capacity development:

Promoting leadership at all levels, and developing the capacity of governments, civil society, development partners, communities and individuals to effectively respond to the epidemic. Senior and middle level leaders in Government and civil society, including women and youth have been trained as change agents to mobilize institutional transformation and HIV & AIDS mainstreaming.

Development planning, implementation and HIV&AIDS responses: Strengthening development planning and systems to comprehensively address HIV&AIDS at national, district and community levels. Training at community level has strengthened the ability of local community members to influence planning and budget allocation processes.

Advocacy and communication:Generating a society-wide response that is gender-sensitive and respectful of the rights of people living with HIV/AIDS through advocacy and communication. Artists and media have been mobilized to play a role in creating awareness of the underlying factors driving the epidemic, and to influence a public response.

Community Capacity Enhancement - Community Conversations (CCE-CC): The CCE-CC methodology has been implemented in Swaziland since 2002. The methodology has been implemented through partnerships with implementing agencies in Government and civil society, including youth, women, Faith based organizations and community leaders. UNDP has provided capacity building and trained trainers and facilitators among NGOs who have mainstreamed the approach in their development programming.

Specialized institutional arrangements

Specialized institutional arrangements such as Local Authorities and Municipalities must be assisted to develop capacity to effectively plan and implement prevention, care and support and mitigation activities. Since UNDP had already started working with such institutions under the Alliance of Mayors Initiative for Community Action on AIDS at Local level (AMICAALL), there is a need to continue to integrate their activities to the wider national response. There is also a need to develop a framework for enhancing grassroots participation in the national response through developing capacity at Tinkundla (constituency) level.

The United Nations Volunteer Programme

The United Nations Volunteers Programme supports peace and the achievement of the Millennium Development Goals (MDGs) in Swaziland through the promotion of volunteerism, including the mobilization of volunteers.

In this regard, the UNV Programme in Swaziland continues to serve the causes of peace and development through the Swaziland Capacity Initiative (SWACI) which is a framework promoting responses to a number of critical capacity issues. This framework calls for a new sense of urgency to meet capacity needs that will facilitate achievements of the MDGs.

The SWACI UNV effort has been mainly geared towards the rapid programming and deployment of at least ten (10) United Nations volunteers specialists from various professional backgrounds such as Medicine, Management, Agriculture, Local Governance and Development Planning.

Many of these specialists have been engaged in different Ministries such as Education, Health, Public Service and Information, Agriculture, the Prime Minister's Office and other Institutions in Swaziland and have contributed significantly to alleviating the acute Human Resource problems posed by the aids epidemic in this part of Southern Africa.

The UNV Programme, noting the contribution of International UNV specialists under the SWACI initiative, plans on extending the spirit of volunteerism through a National Volunteers Framework which is currently being put in place to ensure that Swaziland can stabilize and meet the human resource needs being posed by the aids epidemic.

These efforts are expected to provide the impetus that will drive the Nation towards achieving the Millennium Development Goals. Click here to read more about the UNV

2. Advocacy, Policy and Legislation

Advocacy

The country office has an established a Human Development Forum, which promotes advocacy efforts aimed at stimulating policy dialogue for good governance and poverty reduction. This activity will continue to be supported with a view to promoting full participation of stakeholders in contributing towards consensus building around priority issues, policies and actions. Another area of focus for UNDP is supporting organisations of people living with HIV in developing advocacy skills for positive prevention and meaningful participation in decision making.

Research

The importance of carrying out research led interventions cannot be overemphasized. Stakeholders in the fight against HIV/AIDS need to be assisted to develop capacity for carrying out baseline studies, monitoring and evaluative studies, behavioral studies, impact assessment studies and research operations. UNDP is supporting partners in strengthening the links between research, policy and programme development.

Policy formulation

The creation of an enabling environment through policy formulation and implementation is a key priority in UNDP's work in the area of HIV/AIDS. UNDP has supported national efforts in the joint review of the national response to HIV and AIDS. This review covered the period from 200-2005. UNDP also actively engaged in the development of the National HIV/AIDS Policy, National Multi-sectoral HIV/AIDS Strategic Plan as well as the National Program of Action for the Multi-sectoral Response to HIV/AIDS. Current areas of UNDP focus include policy formulation related to stigma and discrimination.

3. Communication for change

UNDP also recognizes the important role Information, Education and Communication play in the fight against HIV/AIDS in the country. The media especially is a powerful tool for reaching large numbers of people and to promote long term behavior change. In view of lessons learnt in previous IEC interventions UNDP has supported the development of the National HIV/AIDS Communication Strategy for Swaziland that employs multimedia techniques including information technology.

The UNDP works closely with the media in an effect to promote professionalism, accuracy and ethical treatment as well as promote information for ART awareness and compliance.

For more information on this programme, contact Mandisa Zwane-Machakata , Programme Associate.