National Emergency Response Council on HIV/AIDS

DOCUMENTATION OF THE ESWATINI SUCCESS STORY It’s about time we tell the world about the strategies that worked

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7 September 2021

Following the multitude of accolades the country has received from UNAIDS and congratulated by many others for the 95-95-95 milestones, UNAIDS has taken the recognition a notch up, by engaging a consultant to document the Eswatini success story.  The UNAIDS 95-95-95 treatment cascade translates to 95% of people living with HIV in Eswatini know their status, that 95% of those who know their HIV positive status are accessing treatment and that 95% of people on treatment have suppressed viral load.

 The National Emergency Response Council on HIV/AIDS (NERCHA) is coordinating the implementation of the assignment, with the support of UNAIDS, and the collaboration of all sectors in the HIV response. The overall aim of the assignment is to generate information on strategic lessons from the AIDS response in the Kingdom of Eswatini in the past 20 years and above. The assignment will respond to the overall questions of what worked well in the HIV and AIDS response in Eswatini and whether it could be scaled-up and sustained. It will also critically analyze the game-changers or good practices in policy, system, and programs which shaped the HIV and AIDS response in the country. Lastly it will look at the gaps and challenges that still persist in the AIDS response in Eswatini.

The assignment will document achievements, good practices, gaps, and challenges to inform future sustainability and realization of the vision, goals, and targets in the national strategic documents on HIV and AIDS. It will apply the human rights approach, gender-sensitive, and inclusive participation of all stakeholders.  The assignment will be guided by the National multisectoral Strategic Framework (NSF), national HIV and AIDS coordination structure and organizational frameworks within individual entities. It will be anchored on inclusive participation of all stakeholders and communities.

Adoption of political declaration

In 2016, the political declaration on ending AIDS by 2030 was adopted by the United Nations General Assembly High-Level Meeting on Ending AIDS (UN General Assembly, 2016). The declaration commits the international community and countries to accelerate efforts towards ending the AIDS epidemic as a public health threat by 2030. UNAIDS elaborated these commitments by setting targets to be realized in 2020 – reducing global new HIV infections and AIDS-related deaths to fewer than 500,000 per year and eliminating HIV-related stigma and discrimination. Furthermore, UNAIDS set HIV treatment targets: by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression. These targets are referred to as 90-90-90 by 2020 or 95-95-95 by 2030.

In the Kingdom of Eswatini, His Majesty King Mswati III made a commitment to End the AIDS epidemic by 2022, eight years ahead of the global target. This commitment is embodied in the National HIV and AIDS Strategic Framework (NSF), 2018-2023. The NSF has four targets to be achieved by 2022: reduction of HIV incidence among persons aged 15-49 years by 85%; reduction of incidence among persons aged 15-24 by 85%; reduction of new HIV infections among infants aged 0-1 year to less than 0.05%; and reduction of AIDS deaths by 50%. The NSF is implemented through a multisectoral approach that involves all key sectors – government, civil society, private sector, traditional leadership, and development partners; and with implementation adopting a decentralized approach involving regional and community level structures.

In 2020, the Kingdom of Eswatini was celebrated as the only country globally to achieve and surpass the 2030 global HIV treatment targets. By 2019, 96% of all people living with HIV knew their HIV status; 98% of all people diagnosed with HIV infection were on antiretroviral therapy, and 97% of all people receiving antiretroviral therapy were virally suppressed. The country reduced new HIV infections by 66%, from 13,000 in 2010 to 4,500 in 2019. Eswatini also reduced AIDS-related deaths by 50%, from 4,600 in 2010 to 2,300 in 2019. PMTCT coverage was above 90% by 2019, meaning that all pregnant women exposed to HIV were receiving HIV treatment. Combined, these achievements show remarkable progress in the AIDS response. Based on this momentous achievement, UNAIDS has proposed that the Government considers documenting the process of achieving these impressive results and the lessons learned to allow for reflection and learning on its HIV and AIDS-response from policy, systems, and program implementation perspectives. 

Consultations and discussions with key informants

 The assignment will see interviews from various key stakeholders in the HIV and AIDS response and solicit information that will assist in unpacking the strategies that worked for the country’s success.  Further, workshops will be conducted to better understand the implementation processes and other related matters which will assist in validating the report.  These consultations with various stakeholders and key informants will focus on the governance, coordination, and implementation arrangements in the HIV and AIDS response. Key informants will include government ministries, NERCHA, civil society, non-governmental organizations, donors, PLHIV, key populations, UN agencies, and other development partners. It will focus on the multisectoral HIV and AIDS coordination framework, and the roles and responsibilities of various sectors. The consultations will provide evidence of how the system of the AIDS response and its various components contributed to or enabled the HIV and AIDS response in the country. It will highlight systematic gaps and challenges which need to be strengthened for future sustainability and acceleration of the HIV and AIDS response.

Partners, stakeholders and all key players in the HIV response will be contacted for interviews both physically and virtually, in line with COVID-19 regulations which discourage the gathering of people in large numbers. The storyline will be factual and appeal to broad audiences such as the international audience of countries and communities wo are hungry for lessons, institutions and organizations with shared interest in the HIV response as well as domestic audiences.

Following the multitude of accolades the country has received from UNAIDS and congratulated by many others for the 95-95-95 milestones, UNAIDS has taken the recognition a notch up, by engaging a consultant to document the Eswatini success story.  The UNAIDS 95-95-95 treatment cascade translates to 95% of people living with HIV in Eswatini know their status, that 95% of those who know their HIV positive status are accessing treatment and that 95% of people on treatment have suppressed viral load.

 The National Emergency Response Council on HIV/AIDS (NERCHA) is coordinating the implementation of the assignment, with the support of UNAIDS, and the collaboration of all sectors in the HIV response. The overall aim of the assignment is to generate information on strategic lessons from the AIDS response in the Kingdom of Eswatini in the past 20 years and above. The assignment will respond to the overall questions of what worked well in the HIV and AIDS response in Eswatini and whether it could be scaled-up and sustained. It will also critically analyze the game-changers or good practices in policy, system, and programs which shaped the HIV and AIDS response in the country. Lastly it will look at the gaps and challenges that still persist in the AIDS response in Eswatini.

The assignment will document achievements, good practices, gaps, and challenges to inform future sustainability and realization of the vision, goals, and targets in the national strategic documents on HIV and AIDS. It will apply the human rights approach, gender-sensitive, and inclusive participation of all stakeholders.  The assignment will be guided by the National multisectoral Strategic Framework (NSF), national HIV and AIDS coordination structure and organizational frameworks within individual entities. It will be anchored on inclusive participation of all stakeholders and communities.

Adoption of political declaration

In 2016, the political declaration on ending AIDS by 2030 was adopted by the United Nations General Assembly High-Level Meeting on Ending AIDS (UN General Assembly, 2016). The declaration commits the international community and countries to accelerate efforts towards ending the AIDS epidemic as a public health threat by 2030. UNAIDS elaborated these commitments by setting targets to be realized in 2020 – reducing global new HIV infections and AIDS-related deaths to fewer than 500,000 per year and eliminating HIV-related stigma and discrimination. Furthermore, UNAIDS set HIV treatment targets: by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression. These targets are referred to as 90-90-90 by 2020 or 95-95-95 by 2030.

In the Kingdom of Eswatini, His Majesty King Mswati III made a commitment to End the AIDS epidemic by 2022, eight years ahead of the global target. This commitment is embodied in the National HIV and AIDS Strategic Framework (NSF), 2018-2023. The NSF has four targets to be achieved by 2022: reduction of HIV incidence among persons aged 15-49 years by 85%; reduction of incidence among persons aged 15-24 by 85%; reduction of new HIV infections among infants aged 0-1 year to less than 0.05%; and reduction of AIDS deaths by 50%. The NSF is implemented through a multisectoral approach that involves all key sectors – government, civil society, private sector, traditional leadership, and development partners; and with implementation adopting a decentralized approach involving regional and community level structures.

In 2020, the Kingdom of Eswatini was celebrated as the only country globally to achieve and surpass the 2030 global HIV treatment targets. By 2019, 96% of all people living with HIV knew their HIV status; 98% of all people diagnosed with HIV infection were on antiretroviral therapy, and 97% of all people receiving antiretroviral therapy were virally suppressed. The country reduced new HIV infections by 66%, from 13,000 in 2010 to 4,500 in 2019. Eswatini also reduced AIDS-related deaths by 50%, from 4,600 in 2010 to 2,300 in 2019. PMTCT coverage was above 90% by 2019, meaning that all pregnant women exposed to HIV were receiving HIV treatment. Combined, these achievements show remarkable progress in the AIDS response. Based on this momentous achievement, UNAIDS has proposed that the Government considers documenting the process of achieving these impressive results and the lessons learned to allow for reflection and learning on its HIV and AIDS-response from policy, systems, and program implementation perspectives. 

Consultations and discussions with key informants

 The assignment will see interviews from various key stakeholders in the HIV and AIDS response and solicit information that will assist in unpacking the strategies that worked for the country’s success.  Further, workshops will be conducted to better understand the implementation processes and other related matters which will assist in validating the report.  These consultations with various stakeholders and key informants will focus on the governance, coordination, and implementation arrangements in the HIV and AIDS response. Key informants will include government ministries, NERCHA, civil society, non-governmental organizations, donors, PLHIV, key populations, UN agencies, and other development partners. It will focus on the multisectoral HIV and AIDS coordination framework, and the roles and responsibilities of various sectors. The consultations will provide evidence of how the system of the AIDS response and its various components contributed to or enabled the HIV and AIDS response in the country. It will highlight systematic gaps and challenges which need to be strengthened for future sustainability and acceleration of the HIV and AIDS response.

Partners, stakeholders and all key players in the HIV response will be contacted for interviews both physically and virtually, in line with COVID-19 regulations which discourage the gathering of people in large numbers. The storyline will be factual and appeal to broad audiences such as the international audience of countries and communities wo are hungry for lessons, institutions and organizations with shared interest in the HIV response as well as domestic audiences.

Following the multitude of accolades the country has received from UNAIDS and congratulated by many others for the 95-95-95 milestones, UNAIDS has taken the recognition a notch up, by engaging a consultant to document the Eswatini success story.  The UNAIDS 95-95-95 treatment cascade translates to 95% of people living with HIV in Eswatini know their status, that 95% of those who know their HIV positive status are accessing treatment and that 95% of people on treatment have suppressed viral load.

 The National Emergency Response Council on HIV/AIDS (NERCHA) is coordinating the implementation of the assignment, with the support of UNAIDS, and the collaboration of all sectors in the HIV response. The overall aim of the assignment is to generate information on strategic lessons from the AIDS response in the Kingdom of Eswatini in the past 20 years and above. The assignment will respond to the overall questions of what worked well in the HIV and AIDS response in Eswatini and whether it could be scaled-up and sustained. It will also critically analyze the game-changers or good practices in policy, system, and programs which shaped the HIV and AIDS response in the country. Lastly it will look at the gaps and challenges that still persist in the AIDS response in Eswatini.

The assignment will document achievements, good practices, gaps, and challenges to inform future sustainability and realization of the vision, goals, and targets in the national strategic documents on HIV and AIDS. It will apply the human rights approach, gender-sensitive, and inclusive participation of all stakeholders.  The assignment will be guided by the National multisectoral Strategic Framework (NSF), national HIV and AIDS coordination structure and organizational frameworks within individual entities. It will be anchored on inclusive participation of all stakeholders and communities.

Adoption of political declaration

In 2016, the political declaration on ending AIDS by 2030 was adopted by the United Nations General Assembly High-Level Meeting on Ending AIDS (UN General Assembly, 2016). The declaration commits the international community and countries to accelerate efforts towards ending the AIDS epidemic as a public health threat by 2030. UNAIDS elaborated these commitments by setting targets to be realized in 2020 – reducing global new HIV infections and AIDS-related deaths to fewer than 500,000 per year and eliminating HIV-related stigma and discrimination. Furthermore, UNAIDS set HIV treatment targets: by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression. These targets are referred to as 90-90-90 by 2020 or 95-95-95 by 2030.

In the Kingdom of Eswatini, His Majesty King Mswati III made a commitment to End the AIDS epidemic by 2022, eight years ahead of the global target. This commitment is embodied in the National HIV and AIDS Strategic Framework (NSF), 2018-2023. The NSF has four targets to be achieved by 2022: reduction of HIV incidence among persons aged 15-49 years by 85%; reduction of incidence among persons aged 15-24 by 85%; reduction of new HIV infections among infants aged 0-1 year to less than 0.05%; and reduction of AIDS deaths by 50%. The NSF is implemented through a multisectoral approach that involves all key sectors – government, civil society, private sector, traditional leadership, and development partners; and with implementation adopting a decentralized approach involving regional and community level structures.

In 2020, the Kingdom of Eswatini was celebrated as the only country globally to achieve and surpass the 2030 global HIV treatment targets. By 2019, 96% of all people living with HIV knew their HIV status; 98% of all people diagnosed with HIV infection were on antiretroviral therapy, and 97% of all people receiving antiretroviral therapy were virally suppressed. The country reduced new HIV infections by 66%, from 13,000 in 2010 to 4,500 in 2019. Eswatini also reduced AIDS-related deaths by 50%, from 4,600 in 2010 to 2,300 in 2019. PMTCT coverage was above 90% by 2019, meaning that all pregnant women exposed to HIV were receiving HIV treatment. Combined, these achievements show remarkable progress in the AIDS response. Based on this momentous achievement, UNAIDS has proposed that the Government considers documenting the process of achieving these impressive results and the lessons learned to allow for reflection and learning on its HIV and AIDS-response from policy, systems, and program implementation perspectives. 

Consultations and discussions with key informants

The assignment will see interviews from various key stakeholders in the HIV and AIDS response and solicit information that will assist in unpacking the strategies that worked for the country’s success.  Further, workshops will be conducted to better understand the implementation processes and other related matters which will assist in validating the report.  These consultations with various stakeholders and key informants will focus on the governance, coordination, and implementation arrangements in the HIV and AIDS response. Key informants will include government ministries, NERCHA, civil society, non-governmental organizations, donors, PLHIV, key populations, UN agencies, and other development partners. It will focus on the multisectoral HIV and AIDS coordination framework, and the roles and responsibilities of various sectors. The consultations will provide evidence of how the system of the AIDS response and its various components contributed to or enabled the HIV and AIDS response in the country. It will highlight systematic gaps and challenges which need to be strengthened for future sustainability and acceleration of the HIV and AIDS response.

Partners, stakeholders and all key players in the HIV response will be contacted for interviews both physically and virtually, in line with COVID-19 regulations which discourage the gathering of people in large numbers. The storyline will be factual and appeal to broad audiences such as the international audience of countries and communities wo are hungry for lessons, institutions and organizations with shared interest in the HIV response as well as domestic audiences.