The Kingdom of Swaziland is a mountainous country of spectacular natural beauty that is beset by immense socioeconomic challenges. A precipitous fiscal downturn has further strained a nation already burdened with the world's highest HIV and TB rates. Life expectancy has dropped to a staggering 43 years, and each day local newspapers print dozens of obituaries of Swazis taken in the prime of life.
Against this backdrop, we at the U.S. Embassy and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) partnered with King Mswati III and the Ministry of Health to launch the Swazi government's Soka Uncobe (meaning to circumcise is to conquer in siSwati) male circumcision campaign. On Friday, July 15th, the King said to an audience of 3,000, including the Queen Mother and senior members of the royal family, that the country was at war with the common enemy of HIV and declared, “Soka Uncobe must be the motto now for all men to go for male circumcision.”
Soka Uncobe is a plan to provide voluntary medical male circumcision gratis to all Swazi males. King Mswati III cautioned that circumcision does not prevent contracting HIV, but rather reduces a male's risk of acquiring it through heterosexual sex by more than 60 percent, and could lower new infections for all Swazis by 75 percent over the next decade. In a time of hardship, the King's public support for male circumcision for HIV prevention marked a historic moment for the country. Success in the male circumcision initiative will deliver the promise of a healthier life for tens of thousands of Swazi citizens.
Supporting the Soka Uncobe campaign meets a pledge we made in the Swaziland - United States PEPFAR Partnership Framework to work together with the government and people of Swaziland to defeat HIV/AIDS. Prevention is a cornerstone of the PEPFAR Partnership Framework, both technically and financially. We are working to promote a combination approach to prevention. This approach links social and behavior change activities, such as condom use, with more clinical interventions such as male circumcision, scaling up treatment, and preventing mother-to-child transmission of HIV. In collaboration with the Ministry of Health, the successes in HIV prevention are mounting:
- Swaziland now has more than 65,000 people on HIV treatment, which reduces the risk of infecting HIV negative partners by 96 percent;
- Last year, more than 25,000 pregnant women were provided with health services for the prevention of mother-to-child transmission of HIV, positioning Swaziland to be one of the first countries in Africa to virtually eliminate HIV infections in newborn babies; and
- More than 28,000 Swazi men and boys have been circumcised, which reduces their risk of acquiring HIV by over 60 percent.
Since 2006, with funding from PEPFAR and others, Swaziland has been scaling up male circumcision as part of the National Strategic Framework on HIV/AIDS (NSF). Soka Uncobe is an ambitious, Cabinet-approved program to increase the impact of the NSF male circumcision goals. From the national perspective, a successful Soka Uncobe male circumcision campaign could avert nearly 90,000 new HIV infections and save over $600 million in the next decade. If Swaziland is successful, it will take a giant step toward meeting the UN declaration of zero new HIV infections by 2020.
As Head of State and steward of Swazi culture, King Mswati III's endorsement of Soka Uncobe should give the government's program the imprimatur of cultural acceptability and a boost of new clients. The King's eldest brother, Prince Matsisela, who has championed the effort by example by undergoing circumcision at the age of 79, was encouraged, “I hope that since Their Majesties have come out to support the initiative a lot of Swazis will circumcise because it has its benefits.” Beyond circumcision, at the numerous Soka Uncobe sites throughout the country, men and their partners will receive high quality HIV testing and counseling on healthy sexual practices. Those who test positive for HIV will be referred directly to the support they need to live a healthy life. All men will have the choice to be circumcised and this choice may save their lives.
In his speech, King Mswati III said that the success of Soka Uncobe was of paramount importance to the future of Swaziland and thanked the American government for its support. At a time when America is facing tough financial choices of its own, we believe our role in the Soka Uncobe campaign is a smart investment that will allow the Swazi people to lead healthier, happier lives. We are privileged to carry out this work on behalf of the American people.