Background

HIV/AIDS is still one of the major challenges to the country's socio-economic development. The epidemic has continued to spread relentlessly in all the parts of the country. However, government, local, non-governmental organization and international par partners continue to commit themselves to fight the scourge. The biennial HIV sentinel surveys among pregnant women aged 15-49 years attending antenatal care in various health facilities in the country have regularly been conducted in the last decade to monitor the magnitude and the progress of the epidemic. This leaflet highlights the findings of the 8 sentinel survey carried in the year 2002 and shows trends of the HIV epidemic in Swaziland since 1992 to 2002.

The objectives of the sentinel surveillance were the following:

• To determine the prevalence of HIV, Syphilis and Hepatitis B infections among pregnant women attending antenatal care services 
• To monitor trends of HIV. Syphilis and Hepatitis B among pregnant women
• To determine the distribution of HIV, Syphilis and Hepatitis B in different age groups, marital status and educational status among pregnant women 
• To determine the prevalence of HIV, Syphilis and Hepatitis B between the 4 regions and by urban/rural strata
• To collect HIV data that will enable HIV/AIDS projections in the future

Methodology

This survey involved HIV screening of pregnant women aged 15-49 years who had visited antenatal care for the first time for the cur rent pregnancy from selected health facilities around the country's for regions. The total collected sample size in this survey was 2,787 respondents. An anonymous and unlinked procedure was used for the HIV testing except for syphilis and hepatitis B testing. Anonymous and unlinked means that HIV results cannot be linked to individual pregnant women as their personal identifiers, such as names were not recorded.

Sentinel Sites

A total of 17 sites were selected based on the geographical distribution taking into account all the four regions in the country. Other selection criterion included; presence of health facilities offering antenatal care ser vices, existence of facilities for storing of blood specimens, ability and preparedness of antenatal care facilities to participate in the survey and the health facility having been used before in the precious surveys.

HIV Testing

All samples were collected from sites and sent to the National Referral Laboratory for testing. Each sample was tested for HIV using access ELISA. Any serum sample found to be reactive was re-tested on the ELYSIS ELISA. If found reactive again it was then considered to be HIV antibody positive. Strict quality assurance procedures were adhered to, to ensure reliable results. Quality Control was done internally at the National Laboratory Control Quality Control Section and externally at the National Blood Transfusion Services.

Results

Despite the efforts made in the response to the epidemic in the country, HIV prevalence among pregnant women attending antenatal care clinics (ANC) continue to show increasing HIV infection trends.

Out of the 2,787 blood samples tested in 2002, the HIV prevalence among ANC pregnant women (ANC) was 38.6%. HIV infection levels have increased from 3.9% in 1992, 15.2% in 1994, 26.3% in 1996, 31.6% in1998, 34.2% in 2000 and now 38.6% this year 2002. The urgent need for expanding and scaling up the HIV/AIDS response cannot be over emphasized. For this to happen, it requires adequate mobilization and strategic allocation of resources and concerted efforts and commitment at all levels including the communities themselves to fight this epidemic.