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GLASS HALF EMPTY OR HALF FULL?
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THE clear question emerging from the 11th HIV Sentinel Surveillance Amongst Pregnant Women is whether, when it comes to progress addressing AIDS in our country, the glass is half empty or half full.
The good news: Swaziland’s HIV prevalence rate has stabilised. Glass half full. The bad news: the national prevalence rate remains disturbingly high, according to the latest survey tracking the spread of AIDS since 1992. Glass half empty.
Health officials who have overseen a reduction in HIV transmissions from pregnant mothers to their infants and some other useful programmes are noting some successes in their fields. Glass half full.
But reviewing the data on pregnant women released last week, health officials whose prevention efforts have failed to stem the disease’s advance are hard-pressed to offer new remedies. Glass half empty.
The data is this: 42% of pregnant women tested at antenatal clinics in 2008 were HIV positive, up 3% since the previous survey was conducted. To the layperson, this sounds like the disease is spreading, not stabalising. However, the health ministry report said the 3% rise is “insignificant.”
And yet, the HIV prevalence rate in the whole of Swaziland when the survey was first taken in 1992 was only 3%. The survey is the longest-running scientific data collection exercise in the country, and uses information on pregnant and lactating women to extrapolate the impact of HIV on the larger society.
For the survey last year, the Ministry of Health and Social Welfare conducted the survey of 1 876 women in the country’s four regions. About 84% were rural residents, which is consistent with where the majority of the population lives in this country.
A ‘homogeneity’ has also taken root here: whereas in the past underdeveloped regions had seen higher HIV prevalence rates, now prevalence levels are roughly the same throughout the country, from Hhohho to Shiselweni.
“The HIV prevalence in Swaziland remains high with some indication of stability. The current findings and trends show that HIV prevalence is homogeneously distributed in the country,” said the report.
It is hard to imagine now that only two years ago, when there seemed no need for a national survey to determine HIV levels, AIDS was more a rumour than a medical problem. But, how quickly that changed: from an infection rate of 3% in 1992, the number rose to 38.4% in 2002, peaked at 42.6% in 2004 and decreased to 39.2% in 2006, only to rebound during the past two years.
UNAIDS Country Representative Sophia Mukasa-Monico noted: “There was a drop in prevalence in the 15-19 age group, and it appears stable, but it is still the highest in the world.” Prevalence amongst pregnant teenage girls 15 to 19 years old decreased from 30% in 2002 to 25% in 2006, and currently remains at 25%.
“It is the same situation with the HIV prevalence rate. At 42% it is stable but not decreasing. Should we celebrate with a prevalence of 42%?” Mukasa-Monico said.
However, she like other health officials noted the “glass half full” aspect to the statistics. “There are a number of reasons why you see such prevalence. It reflects more people on drugs, people who are living thanks to ARVs instead of dying.
“More of the population than would otherwise be the case remains alive through drugs,” she said. This is also the position of Nercha, and may account for the prevalence of HIV amongst pregnant women aged 20 to 24 rising from 39 to 45 during the past two years.
For older pregnant women, aged 25 to 39 and who experienced a rise in prevalence from 10% in 1994 to 38% in 2004, the current rate is 42%. UNAIDS credits the work of the United Nation’s Children’s Fund (UNICEF) for extending the lives of many Swazi women through its Prevention of Mother-to-Child Transmission (PMTCT) programme.
More than two-thirds of pregnant women receive medication to protect their unborn infants from HIV, up from 5% when the programme was new in 2003.
The health ministry agrees, with its report on the latest survey data. “The HIV prevalence in the age group 25 to 39 shows a steady increase over the years. This can be attributed not only to new infections occurring but also probable survival of HIV infected persons following the advent of PMTCT, antiretroviral therapy and management of opportunistic infections.” But for younger mothers, the situation is bleak.
“Existing data clearly indicates continuity in new infections among the young population (15 – 24) with sharp increases noted between the ages of 19 and 23. This shows that younger women in particular continue to be vulnerable to HIV infection; hence the epidemic levels continue to remain high,” the ministry report stated. It is possible that prevalence rates will rise even further as more people opt for ARVs.
“The ARV rollout is going on schedule. We’ll have universal access on schedule. But at a cost. As more people receive treatment, the financial cost will be high,” said Mukasa-Monico.
“We are succeeding at the clinical level, with PMTCT, with blood and with ARVs. But at the social level, at changing people’s behaviour, this is where the work must be done,” she said. If ever there was a “good news/bad news” report, it is the current HIV Sentinel Surveillance Amongst Pregnant Women.
But on the whole it is encouraging – by noting alarming data, the report makes the case against complacency and for the need of urgency; but by presenting evidence of prevalence stability and clinical successes, the survey offers hope to health workers and shows their efforts have not been in vain.
The good news: Swaziland’s HIV prevalence rate has stabilised. Glass half full. The bad news: the national prevalence rate remains disturbingly high, according to the latest survey tracking the spread of AIDS since 1992. Glass half empty.
Health officials who have overseen a reduction in HIV transmissions from pregnant mothers to their infants and some other useful programmes are noting some successes in their fields. Glass half full.
But reviewing the data on pregnant women released last week, health officials whose prevention efforts have failed to stem the disease’s advance are hard-pressed to offer new remedies. Glass half empty.
The data is this: 42% of pregnant women tested at antenatal clinics in 2008 were HIV positive, up 3% since the previous survey was conducted. To the layperson, this sounds like the disease is spreading, not stabalising. However, the health ministry report said the 3% rise is “insignificant.”
And yet, the HIV prevalence rate in the whole of Swaziland when the survey was first taken in 1992 was only 3%. The survey is the longest-running scientific data collection exercise in the country, and uses information on pregnant and lactating women to extrapolate the impact of HIV on the larger society.
For the survey last year, the Ministry of Health and Social Welfare conducted the survey of 1 876 women in the country’s four regions. About 84% were rural residents, which is consistent with where the majority of the population lives in this country.
A ‘homogeneity’ has also taken root here: whereas in the past underdeveloped regions had seen higher HIV prevalence rates, now prevalence levels are roughly the same throughout the country, from Hhohho to Shiselweni.
“The HIV prevalence in Swaziland remains high with some indication of stability. The current findings and trends show that HIV prevalence is homogeneously distributed in the country,” said the report.
It is hard to imagine now that only two years ago, when there seemed no need for a national survey to determine HIV levels, AIDS was more a rumour than a medical problem. But, how quickly that changed: from an infection rate of 3% in 1992, the number rose to 38.4% in 2002, peaked at 42.6% in 2004 and decreased to 39.2% in 2006, only to rebound during the past two years.
UNAIDS Country Representative Sophia Mukasa-Monico noted: “There was a drop in prevalence in the 15-19 age group, and it appears stable, but it is still the highest in the world.” Prevalence amongst pregnant teenage girls 15 to 19 years old decreased from 30% in 2002 to 25% in 2006, and currently remains at 25%.
“It is the same situation with the HIV prevalence rate. At 42% it is stable but not decreasing. Should we celebrate with a prevalence of 42%?” Mukasa-Monico said.
However, she like other health officials noted the “glass half full” aspect to the statistics. “There are a number of reasons why you see such prevalence. It reflects more people on drugs, people who are living thanks to ARVs instead of dying.
“More of the population than would otherwise be the case remains alive through drugs,” she said. This is also the position of Nercha, and may account for the prevalence of HIV amongst pregnant women aged 20 to 24 rising from 39 to 45 during the past two years.
For older pregnant women, aged 25 to 39 and who experienced a rise in prevalence from 10% in 1994 to 38% in 2004, the current rate is 42%. UNAIDS credits the work of the United Nation’s Children’s Fund (UNICEF) for extending the lives of many Swazi women through its Prevention of Mother-to-Child Transmission (PMTCT) programme.
More than two-thirds of pregnant women receive medication to protect their unborn infants from HIV, up from 5% when the programme was new in 2003.
The health ministry agrees, with its report on the latest survey data. “The HIV prevalence in the age group 25 to 39 shows a steady increase over the years. This can be attributed not only to new infections occurring but also probable survival of HIV infected persons following the advent of PMTCT, antiretroviral therapy and management of opportunistic infections.” But for younger mothers, the situation is bleak.
“Existing data clearly indicates continuity in new infections among the young population (15 – 24) with sharp increases noted between the ages of 19 and 23. This shows that younger women in particular continue to be vulnerable to HIV infection; hence the epidemic levels continue to remain high,” the ministry report stated. It is possible that prevalence rates will rise even further as more people opt for ARVs.
“The ARV rollout is going on schedule. We’ll have universal access on schedule. But at a cost. As more people receive treatment, the financial cost will be high,” said Mukasa-Monico.
“We are succeeding at the clinical level, with PMTCT, with blood and with ARVs. But at the social level, at changing people’s behaviour, this is where the work must be done,” she said. If ever there was a “good news/bad news” report, it is the current HIV Sentinel Surveillance Amongst Pregnant Women.
But on the whole it is encouraging – by noting alarming data, the report makes the case against complacency and for the need of urgency; but by presenting evidence of prevalence stability and clinical successes, the survey offers hope to health workers and shows their efforts have not been in vain.
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