Eswatini Measures Strides Towards HIV Epidemic through SHIMS2, Demonstrating Epidemic Control is Possible

Leadership from the Ministry of Health – Eswatini, ICAP at Columbia University, NERCHA and SHIMS2 investigators with officiating dignitaries of the SHIMS2 Final Report Commissioning

The Government of the Kingdom of Eswatini (GKoE) remains the country with the highest HIV prevalence in the world, with nearly 1 in 3 adults (15 years and older) living with HIV. Over the last decade, the expansion of HIV testing and increase in the number of individuals living with HIV on antiretroviral treatment has demonstrated substantial progress in the nation’s HIV response.

Providing the latest update on the status of the epidemic, the final report and results of the second Swaziland (Eswatini) HIV Incidence Measurement Survey (SHIMS2) were commissioned by the government and disseminated on May 9, 2019, at a meeting in Ezulwini, Eswatini. The meeting was officiated by high-level officials from the GKOE and the United States Government agencies.

The meeting also marked the launch of a new survey, SHIMS3 2020, scheduled for completion by World AIDS Day 2020.

The United States Ambassador to Eswatini, Lisa Peterson (R), the Minister of Health Eswatini, Lizzy Nkosi (second to R), and Director of Central Statistical Office Eswatini, Amos Zwane (M) commission the start of the new SHIMS survey

SHIMS2 was a population-based HIV impact assessment (PHIA) survey led by the GKoE’s Ministry of Health, in close collaboration with the Central Statistics Office, ICAP at Columbia University, and the U.S. Centers for Disease Control and Prevention (CDC), with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR). In 2011, Eswatini’s first nationally representative HIV incidence survey, SHIMS1, was also carried out through this partnership.

Findings from SHIMS1 and SHIMS2 show that between 2011 to 2016, HIV incidence decreased by 44% and the prevalence of viral load suppression more than doubled. These advancements demonstrate that national HIV programs and treatment as prevention can reduce new HIV infections even in countries highly impacted by HIV, such as Eswatini. Speaking at the meeting, Ms. Lisa Peterson, the United States Ambassador to Eswatini, lauded the successful implementation of SHIMS2, including progress towards 90-90-90 targets and dedicated work of the GKoE’s treatment programs. “Through the findings of SHIMS1 and SHIMS2, Eswatini has provided evidence that epidemic control of HIV is possible,” she noted.

SHIMS2 also found that, in 2016, 27.0% of adults (15 years and older) in Eswatini were living with HIV and 87% of them knew their status. Of those who knew their status, most (88.8%) were on antiretroviral therapy (ART), and among those on ART, most were virally suppressed (91.4%). These results demonstrate that Eswatini has nearly completed the 90-90-90 targets, with the potential to reach 95-95-95 by 2020.

The GKoE’s Minister of Health, the Honorable Senator Lizzie Nkosi, emphasized that “the SHIMS2 final report can be used to support the adoption of HIV mitigation strategies that may allow for the epidemic control of HIV in Eswatini.”

Group discussion at the SHIMS2 tehnical meeting on the implications and policy direction of the final report results

After the commissioning of the SHIMS2 final report and launch of SHIMS3 2020, a technical meeting was held to discuss and translate the report findings to address gaps and inform health policies. The technical meeting was well-attended by clinicians, programmers, and civil society representatives, including people living with HIV, from across the country. Through group discussions, participants developed recommendations on how to apply SHIMS2 findings to existing national policies and programs on HIV prevention, testing, care and treatment.

ICAP’s David Hoos, MD, the PHIA project director, applauded the success of the HIV response in Eswatini and the government’s commitment to end the epidemic. “SHIMS2 showed the impressive progress achieved in the Kingdom with a significant decrease in HIV incidence, which occurred concurrently with a dramatic rise in HIV treatment coverage with impressive increase in HIV viral load suppression. This is the largest population-level validation of ‘treatment as prevention’ and the epidemiologic potential of the 90-90-90 targets,” he said.

For additional information and access to the final report, visit:

SHIMS2 was a population-based HIV impact assessment (PHIA) survey led by the GKoE’s Ministry of Health, in close collaboration with the Central Statistics Office, ICAP at Columbia University, and the U.S. Centers for Disease Control and Prevention (CDC), with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR). SHIMS2 provides an unprecedented understanding of the reach and impact of Eswatini’s HIV programs using nationally-representative, household-based surveys. This partnership also conducted the first SHIMS in 2011 to measure HIV incidence among adults 18-49 years. 

SHIMS2 Summary Sheet: Preliminary Findings, July 2017

Swaziland HIV Incidence Measurement Survey 2: A Population-Based HIV Impact Assessment

The Swaziland HIV Incidence Measurement Survey 2 (SHIMS2) was a household-based national survey conducted between August 2016 and March 2017 to measure the impact of Swaziland’s national HIV response on HIV incidence and viral load suppression. SHIMS2 offered household-based HIV counseling and testing with return of results and collected information about uptake of HIV care and treatment services. This is the second survey to estimate national HIV incidence and viral load suppression. Previous measurements were conducted in SHIMS1 in 2011.

Click the link below to view the results summary sheet.

SHIMS2 Summary Sheet: Preliminary Findings (Updated in November 2017)

Press Release: Swaziland Survey Shows Impressive Progress in Confronting the HIV Epidemic




Curran Kennedy
ICAP at Columbia University

PARIS, July 24, 2017                                 

Key findings from the second Swaziland HIV Incidence Measurement Survey, SHIMS2, reveal impressive progress in confronting the HIV epidemic in the country. Results show a doubling in population viral load suppression since 2011 and a decrease by nearly half in the rate of new HIV infections. The findings were released today at a press conference held by the Prime Minister’s office in Mbabane, Swaziland and at the International Aids Society (IAS) 2017 Conference in Paris, France.

“Because of the severe HIV epidemic in Swaziland, it was critical for us to implement a combination HIV prevention package, scale up HIV care and treatment services, and engage in ongoing measurement of HIV incidence in order to assess the impact of these efforts,” said Senator Sibongile Ndlela-Simelane, the honorable Minister of Health, Swaziland. “The results of the SHIMS2 survey reveal a dramatic improvement in the state of the epidemic in Swaziland and we are very encouraged by this progress. We understand that the battle is not over, and therefore we must maintain the momentum.”

The data come from one of the population-based HIV impact assessment (PHIA) surveys led by the Government of the Kingdom of Swaziland (GKoS) through the Ministry of Health (MOH) and Central Statistical Office (CSO). The survey (SHIMS2) was implemented by ICAP at Columbia University and the US Centers for Disease Control and Prevention (CDC), with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR).

SHIMS2 is the second national incidence survey to be conducted in Swaziland, following the 2011 survey (SHIMS1) among adults 18-49 years of age.

In SHIMS2, over 14,000 children and adults participated in this nationally representative survey by agreeing to be interviewed and providing a blood sample for HIV testing.

Key SHIMS2 survey results include:

  • The annual rate of new HIV infections (“HIV incidence”) among adults ages 15 years and older was 1.36 percent: 1.70 percent among females and 1.02 percent among males. Among adults 18-49 years, HIV incidence was 1.39 percent, nearly half of the prior HIV incidence rate in 2011 2.48 percent.
  • The percentage of the adult population living with HIV (“HIV prevalence”) was 27.0 percent: 32.5 percent among females and 20.4 percent among males. The HIV prevalence among adults 18-49 years was 30.5 percent, similar to the 2011 HIV prevalence of 32.1 percent.
  • The percentage of all HIV-positive adults with viral load suppression (VLS), an indication that the infection is under control, was 73.1 percent: 76.0 percent among females and 67.6 percent among males. VLS was estimated using all people living with HIV (PLHIV) as a denominator, regardless of knowing their HIV status or use of antiretroviral drugs. Among all HIV+ adults aged 18-49 years, twice as many had VLS in SHIMS2 as compared to SHIMS1 (71.3 percent compared to 34.8 percent in 2011).
  • The percentage of all HIV-positive adults who knew their HIV status was 84.7%; of these individuals, 87.4% reported current use of antiretroviral treatment and, among those reporting treatment, 91.9 percent had VLS. These results indicate Swaziland has made substantial progress toward achieving all three of the “90-90-90’ targets set by UNAIDS to help end the HIV epidemic.

The progress represented by the findings is attributed to the expansion of HIV testing in the country as well as a substantial increase in the number of HIV-positive individuals on antiretroviral drugs from 2011 to 2016. This is combined with other HIV control interventions expanded in the country.

“These remarkable findings from Swaziland add to the evidence base that we are beginning to control the HIV epidemic in several high-burden countries,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “They both demonstrate our extraordinary progress in ensuring that older HIV-positive adults are on life-saving treatment and virally suppressed as well as reveal key gaps that remain in reaching younger men and women with HIV services.”

“An amazing array of partnerships lasting over a decade – from collaboration within and between governments to coordination across international organizations and implementers – have brought us to an incredible level of success in the work on HIV and AIDS in Swaziland,” said Lisa J. Peterson, US Ambassador to Swaziland. “These partnerships are about people bringing their time and talents together to effect change. Thanks to these joint efforts, the SHIMS 2 data show that many more people will have the opportunity to share their own time and talents with their families and communities. It is especially important that we sustain and strengthen our collective engagement with Swaziland’s youth to ensure that we achieve an AIDS-free generation.”

“The partnership with the Swazi Ministry of Health was fundamental to the success of the survey,” said Shannon Hader, MD, MPH, director of the CDC’s Division of Global HIV & TB. “As we’ve seen in other countries, the PHIA findings will help the Ministry of Health and its partners to focus resources on urgent program priorities to achieve epidemic control.”

“The findings from SHIMS2 are a testimony to the remarkable commitment by the Government of Swaziland in confronting the HIV epidemic,” said Wafaa El-Sadr, MD, MPH, MPA, director of ICAP. “It is a demonstration that all the efforts put into the scale-up of HIV prevention, care and treatment services have borne fruit. ICAP is honored to have played a role in helping to support this successful scale-up.”

“Each Population-based HIV Impact Assessment – PHIA – survey provides a ‘report card’ on how each country is doing in responding to its epidemic as well as a blueprint for future response,” said Jessica Justman, MD, ICAP’s senior technical director and principal investigator of all of ICAP’s PHIA projects, including SHIMS1 and SHIMS2. “Swaziland has made notable progress and is poised to continue making great strides forward with the implementation of test and start and ongoing scale-up of routine viral load monitoring. The SHIMS2 results will help focus efforts and prioritize specific populations in need of urgent attention and innovative approaches.”

Other collaborating governmental entities in Swaziland included the Health Research Unit, Swaziland Health Laboratory Services (SHLS), Swaziland National AIDS Program (SNAP), Health Promotion Unit, Health Management Information System, Environmental Health Department, and National Emergency Response Council on HIV/AIDS (NERCHA).

Additional details on SHIMS2 are available in the summary sheet released by the Swaziland Ministry of Health and the websites for the Ministry of Health , CDC/PEPFAR and, and ICAPs PHIA Project:

About ICAP at Columbia University

ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs and over 1.3 million have received antiretroviral therapy through such support.