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A study to determine the links between HIV/AIDS, current demographic status and livelihoods in rural Swaziland
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Executive summary
The Swaziland Vulnerability Assessment Committee carried out a nationwide survey of rural
areas in Swaziland to analyse the linkages between HIV/AIDS, the demographic trends of the
country and how livelihoods and food security status may be changing as a result.
Stakeholders of the Swazi VAC are keen to get a more accurate understanding of the impact
of HIV/AIDS on mortality and morbidity around the country to support policy decisionmaking
and programmatic interventions (including targeting) at a period when high
HIV/AIDS prevalence rates indicate that normal demographic trends cannot be assumed. The
field survey focused solely on rural areas and was carried out in May and June 2003 with staff
from CSO. A random sample census was carried out in 15% of enumeration areas in the
country with samples across all regional, agro-ecological and food economy / livelihood
areas. Questions focused on household demography, morbidity and mortality levels as well
as food and income sources. The study used morbidity, mortality and orphan levels as proxy
indicators of HIV/AIDS impact. The shortcomings of this are discussed in Chapter 2. The
large sample size (18,528 HHs) allows the disaggregation of data down to Inkhundla level.
Expected demographic transition trends found in developing countries represented by a shift
from high mortality and fertility levels to low mortality and fertility levels over a period of
decades has been ruled out in Swaziland as a result of HIV/AIDS. Swaziland has entered
uncharted territory. Previously declining mortality levels have increased markedly since the
mid-1990s reversing a positive trend of development. Mortality has increased dramatically
among the age group 0-4 and the previously healthy age group between 20 and 50. The long
term decline in fertility levels continues (primarily as a result of normal development
processes) and is likely to be entrenched by the HIV epidemic. The decline in fertility and the
rise in mortality are the main determinants behind the lessening of the population growth rate
in Swaziland. Between 1997 and 2003 the rural population growth rate is estimated at 2.01%
compared to a growth rate of 2.9% between 1986 and 1997. Ever-increasing mortality at
younger ages has reduced life expectancy, possibly down to as low as 40 years. This study
projects an annual increase in deaths with an annual total of 31,830 deaths in 2010 (without
ARVs). The current crude death rate of 25.8 will increase to 26.8 by 2010 with a total
population of 1,190,000. The study shows that females are suffering the brunt of the disease
with much higher levels of chronic illness and projected mortality. Against expectations
(assuming an increase in AIDS related deaths) the age dependency ratio of the country
continues to decrease (improve) because of the steady decline in fertility levels. However,
when factoring in levels of chronic illness around the country (which are used as a proxy for
HIV/AIDS) the 'effective' dependency ratio provides important insights into vulnerability of
households and areas in rural Swaziland. The Lowveld and Lomahasha areas have the
highest (worst) effective dependency ratios. Orphan levels in the country are high. Overall,
3.2% of rural children less than 15 years are double orphans and there are approximately
19,206 (6%) maternal orphans in the rural areas. Further analysis of the data set is
recommended and will provide geographic and socio-economic disaggregation of findings.
An initial analysis of the impact of HIV/AIDS on rural livelihood patterns implies that there is
a qualitative shift occurring whereby households affected are changing their income sources
to cope/compensate for losses of income from crops sales and remittances. In contrast to
income sources, household's ranking of the importance of different food sources does not
appear to be related to (proxy) HIV/AIDS status. This finding is intuitively challenging and
further investigation is recommended. No strong consistency in the relationship between
HIV/AIDS proxy indicators and cropping areas, inputs or yields was detected. Whilst the
data tentatively indicates that affected households are in general "more" protective of tubers
than non-affected households and are less concerned (or able) to preserve or increase cash
crop and cereal production. Overall, further analysis of the current data set is recommended
to improve our understanding of the impact of HIV/AIDS on rural food security/livelihoods.
Summary of demographic findings in rural Swaziland in 2003
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The rural population growth rate between 1997 and 2003 has been 2.0% (and is likely to
decline further in future).
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The rural population is approximately 807,000 (not including institutions e.g. army/police
camps in rural areas).
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The survey confirms that fertility levels are declining with a greater percentage of the
population in the age group 15 to 64 years than those above and below.
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43.7% of population aged 0-14 years
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52.6% of population aged 15-64 years
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3.7% of population aged 65+ years
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The current age dependency ratio (at a level of 90) has improved mostly because of a
significant decline in the fertility rate.
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The effective dependency ratio is highest in the Lowveld and Lomahasha areas (this
variant of the dependency ratio incorporates levels of chronic illness).
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Female morbidity is higher than male morbidity at all ages and starts at a much younger
age.
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The survey confirms that mortality rates are rapidly increasing. The current mortality rate
is 25.8 (per 1,000).
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Female mortality is higher than male at the younger age groups (20-29 years).
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Overall 78.3% of deaths were preceded by a bout(s) of chronic illness.
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Orphan numbers are growing:
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2.3% (totalling 7,400) of rural children (0-15 years) have lost both parents
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5.9% (totalling 19,206) of rural children (0-15 years) are maternal orphans
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Maternal orphan rates are highest for children between 10 years
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The population is projected to grow to 1,190,000 by 2010 (this could be an underestimate
considering the modelling predicted a population growth rate much less than the 2.0%
found during the study).
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The crude death rate is projected to increase to 26.8% by 2010 (totalling 31,830 deaths in
that year).
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