Swaziland has a generalized, widespread HIV epidemic, with a high HIV prevalence rate of 27% among adults aged 15-49 (SHIMS,2017). This has left many Swazi families broken, hundreds of thousands of orphaned and vulnerable children and many young people without the stable family support structures they need.
Since the first reported case of HIV/AIDS in 1987 and the highest recorded incidence of the epidemic in the 1990s and early 2000s, new HIV infections are declining as a result of a coordinated national and international response, but we still have a long way to go in order to realise an AIDS-free generation. In a patriarchal culture like Swaziland’s, men are often expected to be in control, to be strong, healthy and to lead. As a result of such social expectations, men are far less likely to test for HIV, or initiate and adhere to anti-retroviral treatment when they are diagnosed with the disease. Unsurprisingly, then, whilst the majority of people living with HIV are female, the majority of AIDS-related deaths are male (UNAIDS data, 2015).
Whilst the HIV incidence rate among adults aged 18-49 is now estimated as 1.39%, comprising of 1.02% men and 1.70% women, respectively (SHIMS 2017). The largest national study on HIV incidence, SHIMS (2017) also reveals that the peak incidence of HIV infections is borne by women aged 18-24 and 30-34 and men aged 30-34, indicating the current trend of intergenerational relationships between older men and younger women. The national response to these health challenges have been varied and focused both on prevention, through awareness and behaviour change campaigns, increased HTC, condom use and efficacy campaigns, VMMC, treatment as prevention, PMTCT, PrEP, as well as through treatment initiatives, such as differentiated care models, strengthening linkages and referrals to health care facilities. These programmes have gone a long way in reducing and stabilizing the prevalence rate, in line with national and international agendas to end AIDS by 2030.
The PEPFAR fact sheet shows that Swaziland is leading in the 90-90-90 goal on controlling the HIV epidemic. This is an international project that tracks the progress of individual countries in how they are doing in inhabitants above the age of 15 (a) 90 % of the population Knowing their HIV status, (b) 90 % of HIV positive people are on ART treatment, and (c) 90% of those in treatment have the HIV virus supressed. According to their results, Swaziland is at 85% for (a), 87% for (b), and 92% for (c), it is now listed as the country with the highest results, closely followed by Zimbabwe, Malawi, and Zambia. These results confirm that “HIV infections were nearly halved and HIV viral load suppression has doubled in the country since 2011”.
Kwakha Indvodza’s work with young men complements this response by addressing behaviour change and HIV prevention as a key strategy in the national and international goals of eliminating AIDS by 2030. By working directly with men, we encourage men to consider the harmful social expectations of their gender and to reconsider the narratives about their masculinity in ways that will let them express themselves freely and learn about issues on HIV prevention, care and treatment, sexual health and other health issues, such as diet and hygiene.
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