Swaziland’s HIV and AIDS response suffers from severe deficits in infrastructure and human resources. The scale of the epidemic has stressed an already overburdened healthcare system that faces a severe lack of skilled personnel, crumbling facilities, inadequate equipment and an inefficient supply chain for drugs and other commodities. Social norms such as gender inequality and stigma continue to fuel the spread of the disease, a vertical service delivery approach limits patient access, and insufficient systems and capacities are hampering evidence driven decision-making. The country is also battling the highest TB incidence in the world, further stretching limited manpower and resources.

Critical interventions for HIV prevention

• Create a comprehensive, evidence-based national prevention program that promotes effective social and behavior change through both the public sector and civil society.
• Promote strong sexual prevention programs focused on partner reduction and gender issues through faith-based and community-based organizations, schools, youth centers, and traditional rural ruling structures.
• Rapidly expand medical male circumcision to reach 15-24 year old males.
• Expand existing PMTCT services, and improve their integration with other HIV related services to strenghen local capacity and ensure sustainability of high quality PMTCT services.

Critical interventions for HIV Care and Treatment

• Rapidly decentralize and improve the quality of HIV and TB related care and treatment services as part of a comprehensive care package to ensure that greater numbers of PLWHA have timely and effective access to quality services.
• Develop policies and national guidelines in support of a comprehensive pre ART, ART, nutrition, and an end-of-life care package.
• Build up existing community-based health care structures to further support the continuum of care concept and to increase the involvement of client families.

Critical interventions for Systems Strengthening and Capacity Building

• Strengthen human resource capacity at the national and district level in the areas of human resource management, policy reforms, recruitment, retention and training.
• Provide resources and technical assistance to strengthen the organizational and operational capacity of key national and district stakeholders, community and faith-based organizations working in HIV/AIDS, global fund recipients and PLWHA groups.
• Strengthen national laboratory and pharmaceutical capacity and services and supply chain systems through technical assistance, training and supervision.
• Improve Strategic Information and Monitoring and Evaluation capacity including supporting the delivery of key information products.