In the Kingdom of Eswatini, government’s expected annual operations are guided by the Speech from the Throne, delivered by His Majesty King Mswati II at the State Opening of Parliament, before the start of each financial year. The national HIV and AIDS response led and coordinated by the National Emergency Response Council on HIV and AIDS (NERCHA) is under the Prime Minister’s Office, and therefore, the response also gets its policy direction and mandate from the King’s speech.
In opening the Second Session of the 11th Parliament on the 31st January 2020, His Majesty’s directive for the HIV response in 2020 was that the HIV response must be planned at Inkhundla (constituency) and chiefdom levels, which will put the communities at the centre of the epidemic and this approach would ensure that no one is left behind.
Addressing HIV and AIDS issues, His Majesty assured the nation that ending AIDS by 2022 is on track. The King said in 2019, the world united in France to mobilize resources for the fight against HIV/AIDS where Eswatini pledged US$6 million over a three-year period. He said from this pledge, the country was pleased that the Global Fund had in turn committed the highest amount ever received by the Kingdom. He said this would enhance the country’s performance on the global HIV indicators which had shown great improvement over the last three years.
“The number of new HIV infections are decreasing, AIDS-related deaths declining and people living with HIV on treatment are virally suppressed,” he said. The King further added that mothers were giving birth to children free from HIV, and that these were all positive signs that Eswatini was indeed on the right track to achieve its vision of ending AIDS as a public health threat.
His Majesty noted though, that in as much as there were great successes, there was still a lot to accomplish in the next 2 years and efforts must reach the most vulnerable populations at risk of contracting HIV. He further extended appreciation for the technical and financial support received from development partners.
“Bayethe Wena Waphakathi!” was the response from the NERCHA National Executive Director, Khanyakwezwe Mabuza when quizzed for comment on His Majesty’s directive as provided in the Speech from the Throne. Mabuza mentioned that the country has put in place the National Multisectoral HIV and AIDS Strategic Framework (NSF) 2018-2023, which lists programmes and time bound targets to drive the country to the envisaged Vision 2022. He said, “With his Majesty having provided policy direction for the year, it is all systems go on the delivery of the NSF programmes, with special focus on community involvement and engagement”.
Mabuza echoed His Majesty’s assertion that there remained a lot to achieve in the “Last Mile” but stated the national response remained motivated by the achievements in the recent years. He noted that to make meaningful headway, there is need to do more of what works as well as to learn from the short-falls and address existing programming gaps.
Recent achievements in the HIV response
Eswatini has done well to reduce new HIV infections as the 2019 HIV Estimates and Projections reflects that HIV incidence (15 years and above) remains at 1.4%, which was first recorded in the HIV Incidence Measurement Survey (2016/2017) which indicated that the massive scale-up of antiretroviral therapy (ART) along with targeted prevention efforts, had cut the rate of new infections by 44% from 2.5% in 2011. HIV prevalence (15-49 years) is now estimated at 27%.
New HIV infections (15 years and above) are estimated at 6 800; New HIV infections (0-14 years) are 850; HIV related deaths are estimated at 2 400; and the number of PLHIV are 205 000.
The HIV response in 2020
NERCHA Executive Director Khanyakweze Mabuza in response to His Majesty’s directive has said that the year 2020 provides a rare opportunity to galvanize and strengthen collaboration between all HIV response stakeholders to achieve the common vision of ending AIDS by 2022.
The NERCHA director stated that the HIV response will work to scale-up prevention at the community level, with focus on reaching young girls and men. “To ensure maximum impact, the HIV response will visit our deep-rooted approach on behavioral change at community level. Communication models will include the use of social media, interpersonal and mass media” Mabuza said. He elaborated that men will be reached through targeted men forums and parent groups, for which NERCHA will be working closely with the traditional structures, including bobabe tikhulu (chiefs).
Mabuza added that adolescent girls and young women (AYGW) are key to the success of the national HIV response and ending AIDS as a public health threat. He said a concerted effort to address AGYW in the various communities that they exit in is essential, noting that emphasis will be made to address their issues around the school community.
He said keeping AGYW in school is essential for the HIV response in Eswatini but doing so, requires a review of current school fees policies at secondary school level and also needs consideration of the bigger and wider perspective relating to the human capital challenge in the country. “There is need for AGYW to be given opportunities for a productive, happy, educated, connected and supported life. Whether they fall pregnant in high school or not, once out of formal schooling, there is very little other education or job opportunity for these young women - whether pregnant or not,” continued Mabuza.
Pregnancy may seem like a way out, or a security policy for the future but the Sitakhela Likusasa impact evaluation shows that education, health, pregnancy, effective years of learning, job creation, poverty, productivity and economic growth are all closely intertwined. Evidence shows that these also directly impact the HIV response so therefore, the human capital challenges need to be addressed in a concerted and integrated way, as shown in Eswatini’s low Human Capital Index score.
Mabuza concluded that key activities in the country’s HIV response in 2020 will include:
- Strengthening and increasing investment in HIV prevention interventions aligned to the newly launched National HIV Prevention Policy 2019 - The key target group is Adolescent Girls and Young Women and their partners due to their extraordinary vulnerability and susceptibility to contracting HIV. Evidence based programming will be delivered for improved prevention aligned with targets in the 2020 HIV prevention roadmap.
- Continuing Support for People Living with HIV (PLHIV) - The country’s HIV response recognizes that PLHIV are at the centre of the HIV response and all efforts of reducing stigma and discrimination rests significantly on how PLHIV are supported to deal with impact of HIV and therefore, a human rights-based approach to programming will be adopted to ensure that no one is left behind. All voices will be heard in ensuring that we all work towards ending AIDS.
- Strengthening and improving decentralized HIV services and community dialogues - These will be enhanced to ensure that the hard to reach population access HIV services particularly life-saving antiretroviral treatment, voluntary medical male circumcision, adherence to treatment and retention on treatment. Community leadership at all levels is vital in creating an enabling environment for the HIV response to proliferate. In response to regional dialogues outreach HIV services will be promoted.
- Strengthening and improving monitoring and evaluation systems – Particular effort will be made to strengthen and improve monitoring of community-based responses to HIV and AIDS to provide real-time data and make it available to users at all levels with emphasis on those working at regional and community levels. Granular and surveillance data will be required to inform the sustainable financing and response localisation strategies.
- Aligning grants management services with changing demands of funders – Will ensure that whilst the country remains consistent in practise, that it also learns and improves its grants management capacity.
- Recognizing the role played by women in HIV response - The HIV response recognizes and intends to strengthen women’s participation in the bid to end AIDS.
- Strengthening the involvement of the boy child – The HIV response realizes the gap that could potentially be created by the continued empowerment of the girl child and will therefore seek to increase programmes that are focusing on equipping the boy child with the skills to handle the empowered girl child.
- Expanding and increasing advocacy efforts –To instil the vision of ending AIDS by 2022 as a public health threat to all sectors, constituencies, organization and communities, there is need for a constant and consistent dialogue on what needs to be done to achieve Vision 2022.
Communities have played and continue to play an important role in the AIDS response at the international, national and local levels. In Eswatini, communities can ensure that the response remains relevant and grounded, while keeping people at the centre and leaving no one behind.
We all belong to a community so let’s get ready to ramble!