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Eswatini steps up progress towards zero new HIV infection status by 2030

Eswatini steps up progress towards zero new HIV infection status by 2030

30 November 2023 | Eswatini
When 49-year-old Simangele Dlamini visited her local primary health care clinic for a routine check-up she saw a poster in the waiting room promoting pre-exposure prophylaxis (PrEP) for the prevention of HIV. The posters piqued her interest because she did not know the HIV status of her partner and suspected he had other sexual partners. After discussions with the health workers, Dlamini decided she would take PrEP, in the form of an oral pill, to protect herself from HIV. For four years she has faithfully taken her medication. “I take PrEP always to be safe,” she says. “It makes me confident whenever I come to test knowing that I am negative.”

Mbabane – Eswatini has made great strides in its response to HIV. New HIV infections have fallen steadily over the years, from 14 000 in 2010 to 4800 in 2020, and are projected to drop to 4300 by the end of 2023. 

The country’s core set of HIV prevention strategies include increasing the uptake of high-impact services such HIV testing and counselling, HIV treatment, prevention of mother-to-child transmission, post-exposure prophylaxis, condom use and voluntary medical male circumcision. In 2018, the country piloted the rollout of pre-exposure prophylaxis, the use of an antiretroviral medication by HIV-negative people to reduce their risk of acquiring HIV. 

With support from World Health Organization (WHO), Elizabeth Glaser Paediatric AIDS Foundation, the United States President’s Emergency Fund for AIDS Relief (PEPFAR), Georgetown University and other partners, the Government of Eswatini has bolstered the use of PrEP among people at higher risk of HIV infection it is now available from over 200 health facilities. 

In 2016, the year following WHO’s global recommendation to introduce oral PrEP among people at high risk of HIV infection, including adolescent girls and young women, sex workers, and men who have sex with men, the Organization began providing technical guidance to Eswatini to implement PrEP. After a series of in-country policy dialogues, WHO supported the country to develop a National PrEP framework, including operational plans, guidelines and monitoring and evaluation plans.

Initially, Eswatini introduced oral PrEP in 2018 in 22 facilities to assess acceptability and feasibility during an 18-month-period and to monitor side-effects and how many people still acquired HIV while using the method. “We found that PrEP was feasible and acceptable, and also that expanding access encouraged more people to know their HIV status,” says Sindy Matse, Acting Programme Manager at Eswatini’s National AIDS Programme. “This provided an opportunity for clients to discuss individual risks, and increased understanding and awareness of HIV risk.”

WHO supported the Ministry of Health to train around 30 national implementing partners from the United States President’s Fund for AIDS Relief. The trainers then trained health workers in 100 facilities, while WHO trained a further 100 health care workers from other sites, including private, mission and military facilities. Faith Mamba, a midwife at Siphocosini clinic in Hhohho District receives routine refresher trainings from these partners. The last training was on how to administer event-driven PrEP, which is effective in reducing the likelihood of men acquiring HIV during sex. A man takes oral PrEP for approximately three days before anticipated sex. “I feel valuable,” says Mamba. At least I help somewhere. I always encourage people to use protection despite using PrEP.”

According to Gezani Mamba, senior HIV adviser at the Elizabeth Glaser Paediatric AIDS Foundation, reducing new HIV infections in the country, given the high HIV incidence back in 2016, was of critical importance. “Since the introduction of PrEP, new HIV infections have reduced significantly,” he says. The number of PrEP users is on the rise, from 2200 in 2018 to 32 750 clients in 2022, surpassing the target of 20 000 clients for that year. And the number of health facilities providing PrEP rose from just 22 in 2017 to 204 in 2022.

Eswatini is currently piloting the introduction of the dapivirine vaginal ring in eight facilities. The flexible silicone ring is worn inside the vagina for a period of 28 days, after which it is replaced by a new ring. The ring works by releasing the antiretroviral drug dapivirine from the ring into the vagina slowly over 28 days. By mid-to-late 2024, the ring will be rolled out to all facilities. The country is also planning to roll out an injectable PrEP method. Dlamini is positive about these innovations in HIV prevention. “The vaginal ring would be nice since the clinic sometimes experiences drug stock outs,” she says. “Also, women want to be part of new innovations, like how men can use event-driven PrEP two hours before having sex.” For now, Dlamini is happy to continue to take her pill. She says her family knows that she uses PrEP and that she will continue to take the pill. “To remain negative for as long as I can,” she affirms.

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