AIDS stats must be seen in context, say authorities

Statistics showing that Swaziland has the highest HIV infection rate in world need to be put into context, officials told Plusnews. "It is good for Botswana that it has managed to lower its HIV infection rate, but this does not mean Swaziland's has risen. The rate is the same, though it is alarming," Dr Derek von Wissell, director of the National Emergency Response Committee on HIV/AIDS (NERCHA), told Plusnews. The news that Swaziland had supplanted Botswana as the country with the highest HIV prevalence among its population caused a stir in the tiny kingdom. Initial reports from the local press indicated that the government disputed the statitics. An official with the Ministry of Health and Social Welfare said these reports were inaccurate and clarified the ministry's reaction. "It was a misrepresentation to say we disputed the statistics. Our position is that Botswana's data is current, while ours is two years old. We must wait until we take new surveys mid-year. Our infection rate may go down, but it may have also gone up." Based on a biennial Sentinal Surveillance study of pregnant women receiving care at health facilities in 2002, Swaziland's HIV-infection rate for adults aged 18 to 49 was pegged at 38.6 percent. Stephen Lewis, the UN Secretary-General's Special Envoy for HIV/AIDS in Africa, told King Mswati last week that because Botswana had lowered its infection rate to 37.5 percent, Swaziland had the unwanted distinction of having a national population more highly infected by the HI virus than any other country. Botswana's official figures show a slightly lower infection rate, 37.4 percent, according to a health ministry report listing the results of a 2003 Sentinal Surveillance study done in that country. In some demographics, progress in reducing HIV infections had been encouraging. Among the population group most at risk - young people between 20 and 24 years - infections had doubled from 20.5 percent to 42.8 percent in the six years between 1992 and 1998. Five years later, prevalence had dropped to 38.6 percent. In Swaziland, 45 percent of the same age group was HIV positive. However, some Swazi health officials noted anomalies in the data. They pointed out that an overall figure for the country's adult population disguised progress made in individual regions and population groups. For instance, according to the new report on Botswana, in the second highest at-risk age group - people between 25 and 29 - more than half, or 54.1 percent, were HIV-positive. In Swaziland, 47.7 percent of that group were infected. "In more than two-thirds of Botswana the prevalence was over 30 percent, and in over one-third of the country the prevalence exceeded 40 percent," said the report. Swazi health officials said that regions where HIV prevalence exceeded 40 percent comprised less than one-third of their country. "Statistics are important as guidelines, and to base policy and programmes, but they need to be understood. Otherwise people will be confused and ignore them, or latch onto one frightening statistic and panic," said Beauty Dlamini, a nurse at a government hospital in the capital, Mbabane. Health experts said denial of the extent of the disease, and the personal risk all sexually active people faced, had led to the burgeoning national infection rate in Swaziland.