Swaziland

This story was first published by News24.com

Eswatini is one of the countries which has been most affected by HIV. At the peak of the epidemic in 2015, almost one out of three people were living with HIV. In 1995, when there was no antiretroviral treatment for people living with HIV, 73 000 people were living with HIV. 2400 people died of AIDS that year. Worried about the rising number of infections and deaths, communities of people living with HIV mobilized to press that antiretroviral treatment be made available for people living with HIV.

One of the key campaigners for access was Hannie Dlamini. Dlamini is now 50 years old and has been living with HIV for 32 years, after finding out about his HIV positive status at the age of 18. He was one of the first people in Eswatini to publicly declare his positive HIV status in 1995 at a time when the stigma and misinformation around HIV was rife.

Dlamini rallied together other people living with HIV as well as non-governmental organizations working to end AIDS in Eswatini, to ensure that everyone living with HIV and in need of treatment had access to it. They formed a community-led organization called Swaziland AIDS Support Organization (SASO) as a support group for people living with HIV. SASO also provided healthy living information for people living with HIV.

“When we asked the government [in 2002] for ARVs in Eswatini we did a pilot project with NECHA [National Emergency Response Council on HIV/AIDS], to see if people would use the drugs.” Dlamini says the response was overwhelming, with many people keen to start the lifesaving treatment. “We initially planned to enrol 200 people on treatment but the demand was 630.” said Dlamini.

Today, Eswatini is one of the countries which has achieved the ambitious 95-95-95 targets (95% of people living with HIV who know their HIV status, 95% of people who know that they are living with HIV are on life-saving antiretroviral treatment, and 95% of people who are on treatment are virally suppressed). This achievement has put the country a step closer to ending AIDS as a public health threat, thanks to the work of community-led organizations, authorities and global partners like UNAIDS, the United States President's Emergency Plan For AIDS Relief (PEPFAR) and the Global Fund to fight AIDS, TB and Malaria who are working with the government and local communities to end AIDS.

Eswatini’s HIV response strategy includes ongoing nationwide testing and treatment campaigns, use of self-testing kits to encourage more people to take up testing at the comfort of their homes, antiretroviral treatment, male circumcision and pre-exposure prophylaxis (medicine to prevent HIV) and other prevention measures. Community organizations such as Kwakha Indvodza are also key in encouraging men to take full responsibility for their wellbeing and reducing toxic masculinity and gender-based violence which are some of the drivers of HIV.

The driving role of communities in Eswatini to end AIDS is acknowledged by the health authorities. According to Dr. Michel Morisho, HIV management specialist at Mbabane Government Hospital, the government “could not have achieved the 95-95-95 without communities.”

Dr. Morisho says as part of the country’s strategy to end AIDS, HIV testing and treatment are part of disease management for every patient who presents at health facilities for any illness. “When people come to the hospital for whatever, or check up, we offer an HIV test to allow them to know their HIV status,” he said. Dr. Morisho added that treatment is important to bring down viral load and is helping people living with HIV to stay healthy. Eswatini is striving to achieve 100-100-100 [in the number of people who know their HIV status, are on treatment and are virally suppressed].” People who are virally suppressed cannot transmit HIV, thus helping in HIV prevention efforts.

Young women living with HIV have also stepped up to fight the spread of HIV in the country, volunteering their time as peer educators to educate young people about HIV and supporting people newly infected to stay on treatment to live healthily and long lives. Ntsiki Shabangu is a 28-year-old young woman living with HIV. She was diagnosed with HIV in 2015, at the age of 19. She opened up about her status in 2017 and is now working with the Eswatini Network of Young Positives, a local non-governmental organisation working to end AIDS among young people providing counselling and HIV awareness training . Ntsiki believes that: “When you share your story, you bring hope to young people.”

While Eswatini is on the path to end AIDS, the country is facing other health burdens associated with aging, including non-communicable diseases such as diabetes and cancer. People living with HIV are not often more affected by these illnesses. Some people living with HIV in Eswatini have developed these comorbidities, which presents the need for the strengthening of the healthcare system to provide easily accessible holistic disease management and treatment along with HIV services to improve the quality of life for people living with HIV. As Thembi Nkambule, a woman who has been on HIV treatment for more than 20 years said: “Most of us are sick. Most of us are presenting with kidney issues. We are presenting with hypertension; we are presenting with sugar diabetes. We have a lot of issues.”

To protect the gains that have been made against HIV in Eswatini, the government should invest more resources in building a resilient healthcare infrastructure to strengthen the system to better meet the health needs of people living with HIV and to prepare for future pandemics. Community-led organisations should also be placed at the centre of HIV response and supported, both financially and politically, to reach more people who need HIV services to end the epidemic by 2030 as a public health threat.

GENEVA, 14 December 2020—UNAIDS is saddened by the death of the Prime Minister of Eswatini, Ambrose Dlamini, who has died after testing positive for the new coronavirus.

“The HIV response has lost a champion,” said Winnie Byanyima, UNAIDS Executive Director. “He was a friend of UNAIDS and helped to steer his country to great successes in the HIV response. We will miss him.”

Mr Dlamini took an active role in the response to HIV in Eswatini, and the National AIDS Council and the Country Coordinating Mechanism in Eswatini of the Global Fund to Fight AIDS, Tuberculosis and Malaria reported directly to him.

Mr Dlamini was present for the launch of Seizing the moment, a UNAIDS report on the global AIDS epidemic, in July 2020, at which he spoke about Eswatini’s success in surpassing the 90–90–90 targets, whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.

“We have achieved 95–95–95,” he said. “We cannot rest on our successes, nor be discouraged by setbacks. We must ensure that no one is left behind. We must close the gaps. We are aiming for 100–100–100,” he added.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

A delegation of the UNAIDS Programme Coordinating Board (PCB) visited Swaziland from 14 to 16 November to get insight into the country’s national AIDS response. During the visit, the delegation met the Acting Prime Minister, the Minister of Health and other representatives of the government, civil society, the private sector and development partners. The meetings with the political leadership clearly displayed the commitment to the response from the highest political level, from the King down.

During the meetings, the close collaboration between the United States President’s Emergency Plan for AIDS Relief and UNAIDS, based on UNAIDS’ role as the key link between the Prime Minister’s Office, the Ministry of Health and the broader political leadership, and with key civil society stakeholders, was noted. The critical role of the Joint Programme in preparing the recent concept note submitted for an application for financing by the Global Fund to Fight AIDS, Tuberculosis and Malaria for the AIDS response in Swaziland was also discussed.

The delegation engaged with representatives of civil society organizations and youth groups, and discussed disclosure of HIV status with them, hearing about the difficulties in disclosure, particularly for young people. The increasing, but still quite low levels of, reporting of sexual and gender-based violence and the importance of providing the types of flavoured condoms that appeal to young people were also discussed, as was the difficulty in funding the critical prevention work of civil society organizations.

The delegation complimented officials and representatives for their contribution to the sizeable scale-up of access to treatment and the significant number of people living with HIV who are virally suppressed. However, with 171 000 people living with HIV on life-saving treatment in 2016 and pilots being undertaken with pre-exposure prophylaxis, it was noted that the cost of treatment and prevention services is high and will remain so for many years.

The visit also explored the role of the private sector in the country, which has been significant. In a visit to the Royal Swaziland Sugar Corporation in Simunye, the delegation learned about how, in a spirit of corporate social responsibility, the company’s clinics provide health services to all staff, including seasonal staff, and their families, as well as surrounding communities. HIV counselling, testing and treatment are among the services provided.

The delegation heard about the possibility of further expanding the company’s engagement and its role in the surrounding community, including its prevention work, which particularly focuses on young women and adolescent girls, who are at higher risk of HIV infection.

During the country visit, the delegation also met with prison staff, development partners, media representatives and the United Nations country team. Throughout the visit, the delegation was supported by Zwelethu Mnisi, the Permanent Representative of Swaziland to the United Nations.

New study shows results delivered thanks to focused efforts in collaboration with United States President’s Emergency Plan for AIDS Relief

MBABANE/GENEVA, 24 July 2017—UNAIDS congratulates the Kingdom of Swaziland on the findings of the Swaziland HIV Incidence Measurement Survey (SHIMS 2) announced by Prime Minister Barnabas Sibusiso Dlamini today in Mbabane, Swaziland that 73% of the adult population aged 15 years and older are virally suppressed—76% of adult women and 68% of adult men. The survey, part of the Population-based HIV Impact Assessments (PHIA), was conducted with funding from United States President’s Emergency Plan for AIDS Relief (PEPFAR).

“Swaziland has demonstrated to the world that shared responsibility and global solidarity produces results,” said UNAIDS Executive Director, Michel Sidibé. “Working together with PEPFAR and partners, Swaziland is saving lives and on track to control the epidemic.”

SHIMS 2 findings on, viral load suppression among adults of 15 years and older of 73% affirms UNAIDS estimates of 68% [54%–77%].  Compared to the 2011 SHIMS1 survey which had a similar design, the survey results suggest that the rate of new HIV infections among adults (ages 18-49 years) has decreased by half from 2.5% in 2011 to 1.4% in 2016 (2.0% for adult women and 0.9% for adult men). This is similar to the decline in incidence among adult ages 15-49 as published by UNAIDS: from 2.5% [2.3%–2.6%] in 2011 to 1.7% [1.4%–2.0%] in 2016.

In 2016, UNAIDS estimated that 220 000 [200 000—230 000] people were living with HIV in Swaziland, and that new HIV infections were reduced from 12 000 [12 000—13 000] in 2011 to 8800 [7300—11 000] in 2016. Prevention of mother to child coverage in Swaziland has been between 90 and 100% since 2011 and was estimated to be 95% [81%–>95%] in 2016. As a result fewer than 1000 children became infected with HIV in Swaziland in 2016. 

“UNAIDS welcomes the Swaziland PHIA results as further affirmation of the validity and accuracy of our modelling estimates.” said Mr Sidibé.

The data from the SHIMS2 are part of the PHIA, funded by PEPFAR and conducted by the U.S. Centers for Disease Control and Prevention (CDC) and ICAP at Columbia University’s Mailman School of Public Health. In addition to the Swaziland survey, similar data from Malawi, Zambia and Zimbabwe were gathered through critical household surveys, in collaboration with local governmental and non-governmental partners in 2016.

UNAIDS congratulates PEPFAR for their unwavering commitment to the global AIDS response. PEPFAR works with more than 50 countries, to maintain access to life-saving treatment, provide services for orphans and vulnerable children, ensure that the most vulnerable and key populations have access to services to prevent and treat HIV and accelerate progress toward the end of the AIDS epidemic.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The Centre for HIV/AIDS Prevention Services (CHAPS) leads a consortium that supports the Swaziland Ministry of Health to implement the national strategic voluntary medical male circumcision plan, which is part of the country’s efforts to keep men and boys free from HIV.

The centre’s work demonstrates how voluntary medical male circumcision programmes can be an important entry point to expanded health programming for men and boys, helping to ensure they are reached with a broad spectrum of vital health messages.

Swaziland has been particularly affected by the AIDS epidemic. In 2015, more than a quarter of 15-49-year-olds were living with HIV. As part of efforts to reduce new HIV infections, Swaziland has developed a plan that it hopes will help to keep young men and boys free from HIV.

Swaziland estimates that its Male Circumcision Strategic and Operational Plan for HIV Prevention 2014–2018 will avert 31 000 new HIV infections by 2028, which will result in cost savings of approximately US$ 370 million by 2035.  

Studies have shown medical male circumcision to be around 60% effective in preventing female-to-male sexual transmission of HIV. Swaziland is taking a new and innovative approach to engaging men and boys in HIV prevention efforts and encouraging them to take up the offer of voluntary medical male circumcision to help protect them from becoming infected with HIV.

Lihawu three-day camps

In April 2016, CHAPS and Kwakha Indvodza, a male mentoring project in Swaziland, piloted a new initiative to encourage young men and adolescent boys to become respectful and responsible adults. The initiative, Lihawu (“shield”), is a three-day camp where 25 to 30 adolescent boys and young men aged 15–29 years are guided, mentored and encouraged to hold open and honest discussions about sexuality, sex and sexual health, relationships, gender equality and respect.

The camps are rooted in a Bantu rite of passage tradition and promote the Swazi cultural heritage of ubuntu. They use the traditional Swazi lisango, men’s meeting spaces, where they take part in challenges, games and goal-setting, as well as talking openly about the values of traditional and modern practices.

The camps also provide the opportunity for the men and boys to talk about HIV and participants are offered voluntary HIV counselling and testing. Voluntary medical male circumcision is also offered to participants should they wish to undergo the procedure to help protect them against HIV infection.

To date, more than 350 adolescent boys and young men have participated in Lihawu camps, with many taking up the opportunity to have an HIV test. People testing positive for HIV are directly linked to treatment and care programmes as part of the camp’s services. The Lihawu camps have also seen an uptake in voluntary medical male circumcision, with almost half of all participants opting for the procedure.

Saving lives through soccer

CHAPS also run a successful soccer programme to disseminate information about HIV prevention in the hope of increasing uptake of voluntary medical male circumcision in Swaziland. Through support from the United States President’s Emergency Plan for AIDS Relief, uptake among 15–29-year-olds increased from 2770 in 2015 to 4490 in 2016.

The centre has also appointed a local hero, international soccer player Dennis Yuki Masina, as an ambassador for voluntary medical male circumcision.

Empowering health advisers

CHAPS has also conceptualized and rolled out a unique training programme for health outreach workers. The programme uses best practices and tools from a number of sectors to empower outreach workers as a trusted source of health-care information in the community, particularly on HIV prevention, treatment, care and support and tuberculosis. The health advisers are equipped with a number of approaches to engage people, especially older men, and link them to essential health services, including voluntary medical male circumcision for HIV prevention.

Swaziland’s Prime Minister, Barnabas Sibusiso Dlamini, has launched the country’s Umgubudla HIV Investment Case, which aims to implement King Mswati III’s vision of ending the country’s AIDS epidemic by 2022. Umgubudla means roadway or water stream. 

The investment case identifies five areas for prioritized high-impact action: accelerating access to HIV treatment; increasing the number of voluntary medical male circumcision procedures; expanding HIV prevention programmes for adolescent girls; the prevention of mother-to-child transmission of HIV; and managing coinfection cases of HIV and tuberculosis.

Mr Dlamini launched the new strategy during the country’s first National AIDS Conference, which was organized by Swaziland’s National Emergency Response Council on HIV and AIDS and the Ministry of Health and was held from 12 to 14 July. Partners included the Swaziland AIDS Research Network, UNAIDS, the United Nations Children’s Fund and the Balsillie School of International Affairs.    

During a visit to Swaziland, UNAIDS Executive Director Michel Sidibé met His Majesty King Mswati III and discussed the country’s ongoing response to the AIDS epidemic. Mr Sidibé commended His Majesty for his personal leadership and commitment to Fast-Track the end of the AIDS epidemic.

Mr Sidibé praised the country for increasing domestic resources for the AIDS response through the Swaziland HIV Investment Case. As investment is scaled up, more people are accessing antiretroviral therapy, with coverage estimated at 60% of adults and 43% of children living with HIV.

Swaziland has also successfully expanded services to prevent mother-to-child transmission of HIV, with new child HIV infections reduced by 63% between 2009 and 2014. The country has achieved the goal of 90% of pregnant women living with HIV receiving antiretroviral medicines. This should further reduce the mother-to-child transmission of HIV rate, which stands at 1% at six weeks of age and 8% at the end of breastfeeding.

During his visit, Mr Sidibé also met the acting Prime Minister, Paul Dlamini, and the Minister of Health, Sibongile Ndlela Simelane. He underlined the importance of leaving no one behind in the AIDS response, including women, girls and key populations, and stressed the importance of prevention in the ongoing response to the epidemic.

During the courtesy call to the King, Mr Sidibé invited His Majesty to attend the United Nations General Assembly High-Level Meeting on Ending AIDS, which will take place from 8 to 10 June in New York, United States of America. 

Oral pre-exposure HIV prophylaxis (PrEP) has been shown to be up to 90% effective in preventing HIV infection among people who take it consistently. However, the United States of America is the only country in which PrEP is licensed and recommended for use within HIV prevention programmes. 

In order to find ways to bridge the gaps between evidence and policy-making processes, UNAIDS, AVAC and WHO organized a meeting during the 2014 HIV Research for Prevention (HIV R4P) conference, which is taking place from 28 to 31 October in Cape Town, South Africa. HIV R4P is the world’s first scientific meeting dedicated exclusively to biomedical HIV prevention research.

Participants

The meeting brought together representatives of ministries of health and national AIDS councils from Kenya, Mozambique, South Africa, Uganda and Zimbabwe, PrEP researchers and participants from research and demonstration sites where PrEP is currently being delivered, funders and drug manufacturers, and HIV activists.

Key messages

• PrEP is being used in several demonstration projects across eastern and southern Africa, covering a wide range of populations, including serodiscordant couples in Kenya and Uganda, sex workers in Zimbabwe and men who have sex with men in Kenya and South Africa.
• In order to be used more widely, PrEP must be part of a comprehensive prevention strategy with associated milestones and success indicators that have been defined with policy-makers. The Kenyan Prevention Roadmap already includes the possibility of PrEP.
• Costs and cost-effectiveness models remain key, as are the selection of populations for which PrEP should be offered and the choice of an appropriate delivery model. The Sisters clinics, which provide a dedicated service for sex workers in Zimbabwe, are acceptable to many sex workers and fit within a government strategy.
• The early stopping of the PROUD PrEP study demonstrates that within the sexual health services of the United Kingdom of Great Britain and Northern Ireland there is a strong demand for PrEP and that it is feasible to identify people at greatest risk.
• Demand is now beginning to grow in African communities and needs to be stimulated among those who would most benefit and would be most likely to use PrEP.
• Policy-makers in health and other government departments need more information on PrEP presented in a way that they can use, as well as opportunities to discuss their specific concerns, for example on PrEP safety studies or measures to improve adherence.
• More needs to be understood about the costing of PrEP. This demands greater understanding of who would use PrEP, how they would use it and where they would access it.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.