HIV estimates and projections are generated by the Spectrum mathematical model whose components include the AIDS Impact Model (AIM) and GOALS model that links program goals and funding. Spectrum has become a standard tool used to interpret HIV surveillance systems and HIV programmes in many settings and used to model HIV epidemic and demographic, social, and economic impacts of programme interventions. It provides population impact and demand data to support planning, and decision-making processes. The Eswatini estimation process was led by a multi-sectoral national estimates and projections task team coordinated by NERCHA. Most recent demographic, survey and programme data was populated into the model to produce estimates for 2018 and projections to 2024. A national stakeholder meeting was convened to validate the 2018 estimates and projections. The 2018 estimates and projections are summarised below:
1. HIV Incidence
The 2018 estimates and projections show that HIV incidence among people aged 15 to 49 is 1.54% in 2018 and is expected to decline to 1.24% by 2024. Incidence is higher amongst females compared males throughout the years under projections.
2. New HIV Infections
New HIV infections among adults 15 years and older is estimated at 7,000 in 2018 and projected to decline slightly to 6,400 by 2024. In 2018, new HIV infections are estimated to be higher among adolescents and young people, aged 15 to 24 (2,700), compared to other population groups. New HIV infections are higher in females compared to males across all age groups.
3. HIV Prevalence
HIV prevalence for the age group 15-49 is estimated to be 27.26% in 2018 and projected to decline to 24.34% in 2024. HIV prevalence is higher in Lubombo region (29,62%) compared to Hhohho (26,21%), Manzini (27,19%), and Shiselweni (27,00%).
4. HIV Population
In 2018 the total number of people living with HIV is estimated to be 205,700 [11,300 children ages 0-14 years and 194,400 adults] and is projected to increase to 221,600 [7, 700 for children and 213, 900 for adults] in 2024.
The number of HIV positive pregnant women needing ART is projected to decline from 10,900 in 2018 to 8,500 in 2024. In 2018, the MTCT rate at 6 weeks of age is estimated at 4.45% and projected to remain the same by 2024. The final transmission rate (at the end of breastfeeding) is estimated at 7.8% in 2018 and projected to be 4.87% by 2024.
6. AIDS Mortality
AIDS-related deaths are projected to decline from 2,400 in 2018 to 1,900 in 2024. Between 2018 and 2024, AIDS-related deaths are higher among females compared to males. AIDS-related deaths were estimated at 300 among children, 0-14 years in 2018 and projected to decline to 100 by 2024.
7. AIDS Orphanhood
AIDS orphanhood will subside largely due to declining AIDS-related deaths. AIDS orphans are projected to decline to 28 000 by 2024 from 45 200 in 2018.