Has Swaziland turned the corner in the fight against AIDS?

The Swazi government expressed cautious optimism after a survey found that 39.2 percent of women visiting antenatal clinics tested positive for HIV, indicating that the infection rate was dropping.

Medical data from pregnant women is used as a barometer of HIV/AIDS prevalence among the country's about one million people and although the figure was above the 38.6 percent recorded in 2002, it was down from the 42.6 percent reached in 2004.

The Sero-Surveillance Survey, conducted every two years, has charted the rise of the disease that now infects a third of the sexually active population aged between 15 and 49. It began in 1992 and in its first year found HIV prevalence of 4 percent among pregnant women.

Prime Minister Themba Dlamini presented the new figures on 1 December, World AIDS Day, to the country that now records the highest percentage of infection in the world, making the disease an uncomfortable international issue. Government spokesman Percy Simelane has disputed the relevance of earlier antenatal surveys, saying it was the government's position that because only sexually active women were included in the survey, the results were not representative.

Countries worldwide use the Sero-Surveillance Survey as a statistical basis for measuring the presence of HIV/AIDS, but Swaziland's health workers believe a more accurate picture will be provided by a Demographic Health Study (DHS).

The study, now being conducted by UNAIDS and the National Emergency Response Council on HIV/AIDS (NERCHA), uses a research base that randomly selects Swazi households and then conducts face-to-face interviews and voluntary, anonymous blood tests of household members.

"The true prevalence rate for the country will probably lie above the DHS but below the Sero-Surveillance study of pregnant women," said Patti Whitely, of UNAIDS in Swaziland, which put the national HIV infection rate among those between the ages of 15 and 49 at an estimated 33.4 percent in 2005.

Of the 2,467 pregnant women aged 15 to 49 who participated in the 2006 Sero-Surveillance Study, 966 tested positive for HIV.

The decline in HIV infections was recorded in urban and rural areas in all four regions of Swaziland and in all age groups, with the sharpest reduction occurring among those aged 25 to 29 years, from 56 percent in 2004 to 48 percent in 2006.

People aged 15 to 24, considered one of the age brackets most vulnerable to new infections, saw the prevalence rate fall from 39.4 percent in 2004 to 34.8 percent in 2006, a reduction the Ministry of Health described as significant.

"We are cautiously optimistic that this decline demonstrates that our prevention strategies are beginning to take hold," NERCHA director Derek von Wissell said. "We need to step up our fight against this disease and push even harder to continue the prevalence rate decline."

The survey found that pregnant girls in the age bracket from 15 to 19 years experienced a drop in HIV infections from 29.3 percent to 26 percent between 2004 and 2006.

In his World AIDS Day statement the prime minister stressed caution in assuming that the corner had been turned in the fight against new infections. "This is not time to celebrate and relax. We must now renew our vigour and intensify our efforts to bring this disease to an end in the country."

However, a spokesperson for the Swaziland AIDS Support Organisation (SASO), the country's first support group for people living with HIV and AIDS, disputed the new figures. "We do not believe that HIV in this country has decreased because the behaviour has not changed one bit."

jh/go/he