Study Context

The HIV epidemic in Swaziland was declared a national disaster in 1999. It is the Kingdom’s leading public health concern. Swaziland has the highest HIV prevalence and incidence in the world estimated at 26%1 and 2.66%2 respectively among 15-49 year olds. Unprotected heterosexual transmission accounts for 94% of all new HIV infections3. Moreover, risk of perinatal transmission is high with over two-fifths (41%) of pregnant women testing HIV-positive4. As a generalized epidemic, HIV has affected all geographic, social, and economic strata in society.

In response to the severity of the HIV epidemic, national efforts have emphasized the scale-up of a combination prevention approach to HIV, including HIV testing and counseling, social and behavior change communications, HIV care and ART services, and PMTCT. In addition, because several randomized clinical trials showed a 60% reduction in HIV heterosexual acquisition in circumcised compared to uncircumcised men5, the MOH launched a male circumcision campaign in 2011 known as “Soka Uncobe” —meaning “conquer through circumcision.” With only eight percent of Swazi men being circumcised6, this campaign aimed to increase the uptake of voluntary medical male circumcision (MC) to 80% coverage among HIV-uninfected men, ages 15-49 years.

1 Central Statistical Office (CSO) [Swaziland], and Macro International Inc. Swaziland Demographic and Health Survey 2006-07. Mbabane, Swaziland: Central Statistical Office and Macro International Inc; 2008.

2 UNAIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic. Geneva: UNAIDS; 2010.

3 Ministry of Health. Swaziland HIV Prevention Response and Modes of Transmission Analysis. Mbabane, Swaziland: Ministry of Health, 2009.

4 Ministry of Health. 12th National HIV Serosurveillance among Women Attending Antenatal Care Services in Swaziland 2010. Mbabane, Swaziland: Ministry of Health; 2011.

5 WHO/UNAIDS. New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications. Geneva: World Health Organization; 2007.

6 Op. cit. 1