Evaluation of HIV/AIDS education and prevention initiatives in Swaziland

BACKGROUND: Swaziland has one of the highest adult HIV prevalence rates in the world (38.8%). A slight decrease in 2006 may indicate that education and prevention initiatives are working. Still, little research has summarized the range and efficacy of these efforts in Swaziland. This study investigated initiatives across public health sectors to find strengths, weaknesses, and accomplishments, and to identify challenges. METHODS: A structured literature review of 13 organizations and 7 key informant interviews focused on mission statements, organizational goals, initiatives, and challenges. The national coordinating body, National Emergency Response Council on HIV/AIDS (NERCHA) formed the backbone of the comparison. RESULTS: Six of the 13 organizations were dedicated solely to HIV/AIDS. Four organizations cited “education” or “prevention” within the organization's mission statement. Two set specific HIV education goals, while one organization noted HIV reduction as a goal. Prevention efforts focused on voluntary HIV testing, sexual reproductive health and condom distribution. Commonly cited challenges included lack of resources and lack of personnel. Key informants highlighted problems with tracking and evaluation, stigma and fear, and competition with other organizations. NERCHA created the National Strategic Plan to increase cohesion among organizations. CONCLUSIONS: Education and prevention initiatives are vital to stemming the HIV/AIDS pandemic. A continued need for innovative outreach efforts in Swaziland is imperative, especially with respect to the careful use of limited resources. Increased community, enhanced political leadership, and a personal commitment by the Swazi people are key steps to reversing the epidemic.