Current Challenges and Disruptions

1. Decline in HIV Case Identification and Contact Tracing:
   • Limited availability of HIV testing (including self-testing, workplace testing, and community-based approaches).
   • As a result, of being unaware of their HIV status, pregnant women living with HIV may have compromised access to vital services to prevent vertical transmission of HIV.
   • Due to limited access to testing, there has been a significant decline in HIV case identification, contact tracing efforts, and peer-based linkage, particularly among high-risk populations such as men and youth.
2. Healthcare Worker Job Cuts:
   • HIV Programme Officers have had - and others may have – there jobs cut. For those who have retained jobs, there is a proposal to align their salaries with government pay scales.
   • This has affected the capacity of facilities/service points that provided antiretroviral therapy, leading to reduced availability of HIV testing and other services.
   • Data collection at all facilities/service points continues, but data quality control and data collation are affected.
3. Disruption in Distribution of Supplies:
   • Distribution of antiretroviral supplies, HIV, viral load, and other lab test kits, and condoms is disrupted.
   • Stockouts are foreseen in 3-6 months, although the country has sufficient condom stocks for the next 12 months.
4. Impact on HIV Prevention Services:
   • Primary HIV prevention services have been disrupted, including reduced availability of PrEP services, suspension or reduction of HIV prevention education and awareness campaigns, limited or suspended implementation of voluntary medical male circumcision services, and delays or disruptions in community-based HIV prevention outreach programmes.
   • HIV prevention programmes for adolescent girls and young women (AGYW) have been impacted, affecting between 120,000 -150,000 AGYW. These include a reduced capacity of service delivery points for HIV prevention, delays in linkages to HIV prevention services, discontinuation of AGYW-specific outreach programmes, reduced availability of HIV prevention education and awareness campaigns, and a reduction in the availability of counselling and social support services for AGYW. The DREAMS programmes targeting AGYWs are no longer operating, which is creating disruptions in PrEP access for AGYW and increasing their risk of HIV infection, while also negatively impacting their behaviour change in the long term.
5. Human rights, key and vulnerable populations Eswatini received U.S. funding for work on stigma, discrimination and enabling legal environments. Some programmes have stopped; other work is ongoing with reduced capacity. This funding has not been redirected to other programmes. 

Immediate Risks

1. Lack of US Funding:
   • US funding cuts could lead to dire setbacks in health initiatives, particularly in HIV and TB prevention, treatment, and care.
2. Stockouts and Reduced Service Capacity:
   • The disruption of the peer-led programme will result in limited access to HIV prevention services for key populations.
   • Reduced capacity of service delivery points and discontinuation of outreach programmes could increase the risk of HIV infection among vulnerable populations.

Politically Relevant Updates

Government convening/mitigation measures

Mitigation actions by government and country partners include integration of HIV services into other health services and mobilizing domestic resources to fill the financial gap. 

There is a country-level task team in place to discuss the impact on service delivery and identify mitigation measures. People living with HIV are part of the task team, while key populations are represented by the Ministry of Health's HIV programme focal point. 

Civil society impact, resilience and response 

Community-led organizations (CLOs) reported to be at risk of closure or severe reduction in services. The country reports suspension of services, loss of staff or funding cuts among CLOs involved in service delivery; reduced participation in policy discussions, limited ability to advocate for key issues and shift in focus due to funding constraints among CLOs involved in policy design, advocacy and work on societal enablers; and reduced ability to collect and report data, loss of funding for monitoring activities, and increased difficulty in accessing government or donor support among CLOs involved in community-led monitoring and data generation.