Swaziland has the dubious distinction of having the second highest HIV prevalence rate in the world, and there are no signs that  its epidemic is stabilising.

According to last year’€™s antenatal survey, 38.6% of pregnant Swazi women are HIV positive. This is marinally lower than Botswana’€™s rate of 38.8%.

Since its formation two years ago, the country’€™s National Emergency Response Committee on HIV/AIDS has been grappling with what can be done about the epidemic. It recently asked the University of Natal’€™s Health, Economics and AIDS Research Division (HEARD) to assist it to identify problems and policy gaps.

According to HEARD’€™s Professor Alan Whiteside, the Swazi antenatal figures are reliable, with each positive result being subjected to a second test.

In addition, the results are corroborated by a large survey of 4 183 mainly male workers at the Royal Swazi Sugar Corporation conducted last year which revealed an infection rate of 37.5%.

“What is unique about Swaziland is how uniformly bad the epidemic is. There is little difference between rural and urban areas,” says Whiteside.

According to Whiteside’€™s research, one of the key driving factors of the epidemic is the fact that many Swazi citizens are migrant workers, seeking jobs in South Africa. There is also great mobility between rural and urban areas.

In addition, many youth people drop out of school but face no work opportunities or recreation, and women lack decision-making power.

“Of great concern is the breakdown in socio-cultural norms. There is a tendency for leaders

to say ‘€˜do as I say not as I do’€™,” he adds.

The rate of sexually transmitted infections (STIs) is also high, and STIs that cause broken skin make it easier for HIV to enter a person’€™s body.

Whiteside notes that the country’€™s government has shown commitment to addressing the disease, being the first SADC country to mention HIV/AIDS in its development plans.

However, it is contrained by “lack of capacity, bureaucracy and innovative ideas”.

But it is hard to develop innovative ideas in the face of results from a large behavioural survey conducted this year which shows that “Swazi people are highly knowledgeable about HIV/AIDS though this knowledge has not translated into desirable behaviour change”.

In addition, when the Family Life Association of Swaziland asked young girls what they expect from their boyfriends, the most common response was money (36.2%) and sex (30.4%), Most boys (38.8%) said girls expected money.

However, Whiteside believes Swaziland can still turn the tide against HIV/AIDS, provided that government is prepared to address the epidemic in an open and democratic manner.

“Our conclusion is that the epidemic in Swaziland is very serious, but we know what is going on. There are some gaps in the research that need to be addressed but there is enough information available now to act.

“The biggest issues are around poverty and culture. The issue of culture needs to be addressed squarely but sensitively and by the Swazi people.”