HIV/AIDS Epidemic Affecting Swaziland's Population, Experts Say

Preliminary results of Swaziland's national census released last month found that since 1997, the country's population has decreased by 17,489 people to 912,229, and many experts have attributed demographic changes to the HIV/AIDS epidemic, Toronto's Globe and Mail reports. The government has not finalized the results of the census, but if the figure holds, it would mean that the country is 300,000 people below what was projected as the likely rate of growth 20 years ago, according to the Globe and Mail.

The country grew by more than 200,000 people from 1986 to 1997, Solomon Dlamini, head of the national university's department of demography and statistics, said, adding, "But it's the period between these two censuses (1997 and 2007) when the [HIV/AIDS] epidemic reached its apex." Swaziland has the highest HIV prevalence in the world: 26% of adults, 49% of young women between the ages of 25 and 29 and 43% of pregnant women are HIV-positive. According to the Globe and Mail, the population decline could be attributed both to people dying of AIDS-related conditions and because HIV infection lowers the number of children women have.

"I don't think anybody quite realized what the depth of HIV would be in Swaziland." Derek von Wissell, director of the National Emergency Response Council on HIV/AIDS, said, adding, "Even if they undercounted by 10%, we're down 25% from where we should be." However, Rob Dorrington, a professor of actuarial science at the University of Cape Town, said, "Experience has taught me to be skeptical of census data in general." He added, "It is not unusual for there to be an undercount of children and of men [in a census], and deaths would have to have been implausibly high, given the estimated level of prevalence, for one to be able to detect this through the change in the numbers counted by the census." Amos Zwane, Swaziland's senior statistician, wrote in his preliminary report on the census that "a population decline or stagnation was not expected and this result is most surprising." He said that his office is going to search for a logical explanation and will not speculate on the cause until it produces final numbers in the middle of 2008.

According to the Globe and Mail, a "toxic mix" of factors has fueled the country's HIV epidemic, including a highly virulent strain of the disease circulating among residents; a culture that "condones, even encourages" promiscuity and polygamy among men and denies women the right to negotiate condom use; a "limited economy" that relies on sending men to work in South Africa for long periods of time; and a "playboy" king with an "ever-expanding stable" of wives who has denied the magnitude of the problem, according to the Globe and Mail. In addition, the country's understaffed and underfunded health system could not treat people when the epidemic hit in the 1990s and, as a result, "achingly slow progress" has been achieved in delivering antiretroviral drugs to those in need, the Globe and Mail reports. The rates of new HIV cases have begun to decrease minimally among young people, but the rates remain stable or are increasing among people in their 30s. About one-third of people who need antiretrovirals are getting the drugs (Nolen, Globe and Mail, 12/22/07).

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