Thembi Dlamini and other women in her support group were able to advise each other, provide family advice
and run an artisanal company because her government actively sought counseling as a prevention for people living with HIV.
In other words, they were given
a life together by their government.
“We would have died,” she says, without
the availability of the medicines for free.
The pivotal decision and many other important support movements have made it possible for Eswatini to become the first country in Africa to meet the United Nations HIV target:
95% of people living with HIV are aware of their status, 95% of them are on life-saving antiretroviral therapy, and 95% of those on medication have a suppressed viral load.
The nation that once had the highest HIV prevalence in
the world did so 10 years before the 2030 deadline.
The country witnessed an outbreak in HIV cases
after discovering the first case of HIV in 1986.
In 1997, after several outbreaks of new HIV infections and deaths, the government declared HIV
a national emergency and committed to no longer posing a threat to public health by 2022.
of collective action
A multisector response, considered the fundamental success
factor, was galvanized by the government’s decision.
In 2001, the National Emergency Response Council on HIV/AIDS (NERCHA) was
set up to organize government-to-community programs, including the training of traditional leaders.
Housed within the Office of the Prime Minister and supported by
the government, NERCHA directed the policy and programs towards the objective.
“We were the first country to say we need to look closely at treatment,” says NERCHA
Director Khanya Mabuza. The government’s promise was to provide free antiretroviral (ART) drugs for HIV patients.
In 2016, as soon as anyone tested
positive, the commitment extended to include drug distribution.
The government procured 80 percent of antiretroviral drugs to ensure uninterrupted treatment programs,
while international donors filled the difference, says Dr Vusi Magagula, Health Services Chief.
For CD4 and viral load tracking,
the government also provided laboratory technologies.
Improving patient access to these monitoring and treatment facilities
has also been a vital part of the plan.
Through the introduction of the game-changing nurse-led ART policy, where nurses were trained to initiate care under the
mentorship of doctors from nearby hospitals, access was enhanced for HIV clients, with daily supervision provided by PEPFAR partners.
HIV programs have been related to HIV prevention initiatives in neighborhood primary health care
centers, as well as prevention of mother-to-child transmission of HIV, tuberculosis and non-communicable disease services.
At all health facilities, HIV testing services are regularly given, and the
age of consent for HIV testing has been lowered to 12 years.
Early in 2009, the government agreed to offer a three-month refill of its
drug to patients with a stable record of high adherence to their care.
The government recently accelerated the initiative to dispense refill
supplies for six months due to the COVID-19 pandemic.
In response to the effect of the COVID-19 pandemic on service continuity, the government has extended its provision of community service to include people with HIV testing,
prevention and treatment services (including the delivery of ART drugs) through outreach programs that depend on rural health motivators and initiatives to promote adherence to HIV treatment.
The influence of all these programs has helped to sustain
uninterrupted regimes and to engage with key populations that are insecure.
Peer-to-peer help for people living with HIV, mentor-mothers and group adherence counseling supporters
for teenagers and young people are other imaginative community interventions popular in Eswatini.
In her Mayiwane community in the northern Hhohho area, which she says
includes HIV-negative members, Thembi Dlamini helped launch one of the peer-support groups. “We do this so that those who have not tested yet can see we all live normal lives. There’s no need for discrimination,” she explains, after describing how she was shunned when she first started living with HIV. “Many people thought I had been bewitched.”
“The community mobilization and HIV communication programmes have influenced change in behaviours on stigma and discrimination and improved HIV service uptake in communities,” says Dr Nomthandazo Lukhele, the World Health Organization (WHO) HIV/TB Officer in Eswatini
Securing the effectiveness
in the pandemic
A crucial aspect of the monitoring of medication adherence
has been keeping a close eye on drug resistance.
Two HIV drug resistance surveys were performed by the Ministry of Health and PEPFAR in 2016,
leading to a move to a new drug in the ART regimen, in line with WHO guidelines.
Between 2010 and 2019, the cumulative gravity of all the measures contributed to a 66
per cent decrease in new HIV infections, with AIDS-related deaths decreasing by 49 per cent.
“Eswatini is a small country with a population of just over a million people. Hence, its achievement of the 95-95-95 should be an inspiration to many other countries, as we have shown that it can be done,” says Minister of Health Lizzie Nkosi in an interview.
The country is also illustrating how the challenge to
progress posed by the COVID-19 pandemic can be resolved.
The government went into catch-up mode when the lockdown led to declines in immunization, HIV and TB services and
continues to invest in the capability, availability and well-being of health workers at all levels of the health system.