There are significant disparities in the prevalence, morbidity and mortality rates of women in Swaziland in comparison to Australia when regarding human immunodeficiency virus, acquired immunodeficiency syndrome (HIV/AIDS) There are a multiplicity of risk factors associated with these significantly different statistics between the two, including education and gender, which also impact individuals in their respective countries. The current statistics in regards to HIV AIDS. In 2017, it was estimated that there were 27, 545 people with HIV in Australia (Paynter, 2019) A survey in 2011 showed that 32% of the Swazi population between the ages of 18 and 49 were living with HIV (Cohen, 2017)
There are multiple risk factors that may present themselves and make individuals more likely to contract HIV/AIDS. These risk factors differ between Australia and Swaziland, and can be attributed to the social determinants of health; specifially focusing on the determinants of gender and education, this essay will be looking to presenting issues such as child marriage, health literacy, access to treatment and the social stigma of women with HIV/AIDS. Child marriage is a significant risk factor for young girls in Swaziland ; child marriage is cultural solution to a poverty problem and exposes young girls to contracting HIV/AIDS from men in unprotected sex or rape. This is a risk factor that can be attributed to the social determinant of gender. Child marriage is most prevalent in Lubombo (where 14% of women aged 20-49 were married before the age of 18) and Hhohho (12%) (Fitzgerald, 2017).In many contexts, early sexual debut – including that which takes place within child marriages – is associated with increased lifetime risk of HIV infection (Girls Not Brides, 2019) Young girls in these marriages are often left with no autonomy over their bodies and therefore have an increased likely hood of contracting HIV/AIDS as they cannot decide on who their sexual partner is or who they are potentially sleeping with also, if polygamy is practiced by the man. Child marriage was criminalised by the Australian government in march of 2013 and there is currently no available data in regards to child marriage in Australia; this is not currently a risk factor in Australia for HIV/AIDS. In regards to accessing the appropriate treatment for HIV/AIDS, many individuals may be too ashamed to access the care that they require. A survey conducted by the Swaziland Network for People Living with HIV/AIDS (SWANEPHA), discovered that 45% of people in Swaziland who know they are HIV-positive refuse to go to clinics to receive treatment as they do not want to be recognised as having HIV/AIDS (Cohen, 2017)
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HIV/AIDS can be spread through various body fluids, including vaginal fluids, semen and breast milk. Unprotected sex is a very major risk factor for the transmission of HIV/AIDS and is significantly impacted by the social determinant of education. Education and the implementation of sex education could potentially decrease the transmission of HIV/AIDS through the use of condoms. In Australia, 78% of the female population has obtained a secondary schooling,('Australia Gross Enrolment Ratio Primary And Secondary Both Sexes Percent', n.d.) compared to Swaziland where 37% of the female population has obtained secondary schooling (UNICEF, 2006) If a person is not educated on a particular issue, unless exposed to it by another part of their daily life, they are most likely to be unaware of it and therefore not be able to recognise or avoid the risk factors that increase the likely-hood of that issue presenting itself. HIV/AIDS programs have been implemented into Swaziland school by UNICEF, Nxumalo et al. (2014) suggest that HIV/AIDS educational programmes and campaigns targeted at students and the youth must be presented in a way that is motivating and stimulating, or they will fail to yield the desired results; According to the Australia Federation of AIDS Organisations (AFAO) It is essential to provide an effective level of sexuality education in schools to promote the sexual health of all young Australians (Paynter, 2019)
In Australia in 2015, 108 of the 1,025 people diagnosed with HIV were female - indicating that females made up 9.5% of those recognised as HIV positive that year (Taaffe, 2013), compared to Swaziland in 2015 where the 190 000 adults who screened as HIV positive, 120 000 (63.16%) were women(UNAIDS, 2015), wherein 39.2 percent of pregnant women who were screened presented as HIV positive. (Fitzgerald, 2017) HIV transmission at birth and approximately 17,000 children are exposed to HIV infection at birth annually (UNICEF, 2006) Education is the key to effective prevention, but unfortunately poor health literacy may lead to mothers who are carriers passing HIV/AIDS onto their children, through vaginal birth or breast feeding. If women do not seek AVT, or if they are unaware they carry HIV/AIDS, passing the disease onto others can happen by mistake and in children often lead to death through a very compromised immune system. The passing on of HIV/AIDS to children may also be prevented by appropriate access to healthcare and where to receive it. These women face the double disadvantage of not being aware of how to prevent HIV/AIDS, but also being too scared to receive treatment due to severe social stigma of those with HIV/AIDS.
It is important when liaising with countries facing long term, poverty challenges that the source of the problem is recognised before implementing any other forms of intervention. Working with communities for 10-15 years or more is crucial in ensuring that there is the potential for long term changes. Increasing primary and secondary school retention rates for particularly girls in Swaziland may remove them from situations such as child marriage, allow them to become independent and gain employment, increase their health literacy and positively influence their sexual health choices. By providing safe school buildings and facilities, trained educators and up to date curriculum this may be implemented and provide long term change. Educating parents in Swaziland on the importance of education for themselves and their children, the ways HIV/AIDS can be transmitted and where to receive treatment through either one on one care or health clinics may also benefit communities. Providing vocational training for individuals who find themselves unemployed or unable to obtain education may also allow the community to participate in activities together, empower individuals who have tested positive for HIV/AIDS and break the social stigma also. Although Australian women do not experience the same likely-hood of contracting HIV/AIDS, education and prevention is still key in ensuring that these statistics do not increase. Regular sexual education in secondary schools, universities and work-places may be implemented and provide individuals with an increased health literacy in regards to the prevention of HIV/AIDS. Signs and posters in bathroom stalls in public places providing help lines, or access to a health professional if an individual is concerned about their current HIV/AIDS status or has any concerns about their health may also be beneficial.
Overall, It is clear to see that significant disparities between gender as well as education can impact on an individual's likelihood to contract HIV/AIDS, and that there are also significant differences in the experiences of these determinants between women in Swaziland and Australia. In Swaziland, these problems are being challenged by multiple organisations such as UNICEF, UNAIDS and others who are working to eradicate the high levels of HIV/AIDS experienced by women and children. In Australia, there are also many organisations such as the AFAO who aim to provide education and support for all individuals.
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