Following the detection of the first HIV cases in 1986, the Kingdom of Swaziland established a National AIDS Programme (SNAP) in the Ministry of Health in 1989 to respond to the epidemic. One of the main objectives of the programme was to create awareness about HIV and AIDS through Information, Education and Communication. In 1998, cabinet approved a National HIV and AIDS policy. In 1999, His Majesty King Mswati III declared HIV and AIDS a National Disaster. Consequently a Crisis Management and Technical Committee (CMTC) was constituted. Since 2001, the national response has been coordinated by the National Emergency Response Council (NERCHA).

Swaziland has developed two Multisectoral National HIV and AIDS Strategic Plans (2000-05) and (2006-08), the second with a costed action plan. Both NSPs have undergone joint reviews to guide planning. For (2008-13) the national response will be guided by a National Strategic Framework.

Key Achievements

Swaziland has developed systems to drive and manage the national response to HIV. The response is a collective effort of government, multilateral and bilateral donors, national and international non governmental organisations, community-based organisations, faith-based organizations, the private sector and organisations of people living with HIV.

The institutionalization of National Emergency Response Council on HIV/AIDS (NERCHA) as the leading organisation that coordinates the response to HIV is a major achievement. Swaziland has also formulated and launched an HIV and AIDS policy, a multisectoral National Strategic Plan (2006-08), as well as a costed action plan. The National Monitoring and Evaluation Framework has become entrenched and decentralized to the regional level to improve documenting and reporting. With these three pillars in place, Swaziland is now fully operating under the "Three Ones" principles.

Swaziland has made progress in preventing the spread of HIV through behaviour change campaigns that address issues such as multiple sexual partners and intergenerational sex. Significant progress has also been made in scaling up prevention of mother-to-child transmission since the beginning of service implementation in 2003. HIV testing among pregnant women increased from 15% in 2004 to 66% in 2006, and in 2007, 65% of the HIV-positive pregnant women received antiretroviral treatment to reduce the risk of mother-to-child transmission. However, prevention efforts continue to be hampered by limited behaviour change in the population at large.

Swaziland began the roll-out of antiretroviral treatment in 2003 and by the middle of 2007, there were 21 sites providing treatment across the country. At the end of 2007 there were 25,000 people receiving antiretroviral treatment, which is equivalent to 42% coverage.

Considerable efforts have been made to mitigate the impact of the HIV epidemic on orphans and vulnerable children by providing education, food, health, psychosocial support and shelter. The government is addressing the situation of orphans through policy and the development of the National Action Plan for Children. In 2007 it was estimated that approximately 108,000 children were orphaned and or vulnerable.[1] The ratio of school enrolment between orphans and non-orphans was 90:93 and traditional structures have been revived to care for the children in their communities.

Funding for HIV has increased considerably. The government spending on HIV and in 2006/7 accounted for 30% of the total expenditure on HIV/AIDS (USD 49 million) in the country. The remainder came from external sources, the major one being the Global Fund to Fight AIDS, Tuberculosis and Malaria

The monitoring and evaluation systems have developed and important new research data is available in the country. Swaziland has conducted its first demographic and health survey in 2006/7, carried out the national assessment on AIDS spending, modes of transmission survey, vulnerability assessment and has laid out Universal Access targets and roadmap. Stakeholders are conducting routine reporting of non-health data through the Swaziland HIV/AIDS Programme Monitoring Systems (SHAPMOS) and health-data through the health sector monitoring and evaluation system.

Key Challenges

• The drivers of the epidemic, which include multiple concurrent partnerships, intergenerational sex, low condom use, low HIV testing and disclosure levels, and high prevalence of sexually transmitted infections, as well as gender roles and population mobility at macro level are yet to be addressed in a strategic manner
• Human resource capacity: skilled and semi skilled manpower is generally lacking, hence hindering the performance of the health sector and the civil society response and absorptive capacity of the country.
• Coordination of the response and strategic planning: despite decentralization efforts the regional capacity in planning is still insufficient and unclear roles of partners and lack ofinternalisation of the principles of multi-sectoral planning and budgeting limits the effectiveness of the response.
• Policy development: the process of developing and adopting HIV related policies is slow.
• Monitoring and Evaluation and Research: although Swaziland has made significant strides toward the operationalisation of a monitoring and evaluation framework, the quality and use of data for policy and planning remain a challenge

• National Strategic Plan
• National Emergency Response Council on HIV/AIDS (NERCHA)Swaziland National Youth Council baseline survey for BCC strategy for HIV and AIDS prevention among youth people aged 10-30 years in Swaziland
• National AIDS Spending Assessment (NASA) 2005-2006 / 2006-2007
• PMTCT and Paediatric Care and Treatment Fact Sheet