In a country with the highest HIV infection rate in the world and the lowest life expectancy, experts are still at a loss as to why Swazis have resisted all attempts to change the behaviours that put them at risk from the virus.
The ABC (Abstain, Be Faithful, Condomise) approach has guided Swaziland's HIV prevention efforts for years, but has dismally failed to slow the spread of the virus.
"If you look at the increase of HIV in the country while we've been applying the ABC concept all these years, then it is evident that ABC is not the answer," said Dr Derek von Wissell, Director of the National Emergency Response Council on HIV/AIDS (NERCHA).
Von Wissell has called for new approaches and is hoping to get some answers from a countrywide study looking into Swazis' sexual behaviour being undertaken with the assistance of the World Bank.
Results from the study may reveal what motivates sexual risk-taking, and suggest ways to curtail it. "Ultimately, behaviour is what has to change ... because ... commitment to relationships is very low - we need to look at the nature of relationships," he told IRIN/PlusNews.
Only about 30 percent of sexually active men aged 15 to 49 are in committed relationships, according to statistics quoted by von Wissell. The remaining 70 percent of men are "free agents", to whom the Be Faithful component of the ABC approach does not apply.
Abstinence - the A in the ABC approach – is still valued in Swazi society, but only up to a point. "Girls still talk of preserving virginity, but pressures are put on girls to engage in sex," said von Wissell.
"Below 15 years of age, HIV prevalence is very low ... But as girls grow it really gets active - in the 20 to 24 age group, HIV is 38 percent. Once you become sexually active, abstinence goes out the window."
|If you look at the increase of HIV in the country while we've been applying the ABC concept...then it is evident that ABC is not the answer|
He added that condoms - the C in ABC - were the ideal prevention method, but were not being used consistently.
Findings from the sexual behaviour study will be available next year, and will guide the design of new programmes.
The need for a new approach is borne out by the latest grim statistics. Despite a huge increase in resources devoted to the HIV/AIDS response in the past decade, average life expectancy in Swaziland has dropped from 60 to 43 years, and in 2009 AIDS accounted for over 7,000 deaths in a population of just one million, according to NERCHA.
"We need to challenge the conventional thinking, and not slavishly follow what has been done," said von Wissell. "We need to find new ways to prevent infections."
See also: SWAZILAND: AIDS epidemic shows no sign of slowing