In 2020, Eswatini became the first African country to achieve the 95-95-95 target, well ahead of 2025, and since then, seems on track to end Aids by 2030 in a country that once had the highest HIV prevalence in the world.
In 1991, in the former Swaziland, being diagnosed HIV-positive was a death sentence, as there had been no antiretroviral medicines for the 73 000 people living with the virus since the first case was recorded in 1987 – but the country has seen a remarkable turnaround of statistics in the past two decades.
By 1995, about 2 400 people had died of Aids, reports News24.
Hannie Dlamini was one of them – diagnosed in 1991 – but instead of giving up on life, he became one of the first people to openly declare his condition and became an HIV activist.
The public sector began providing antiretroviral therapy in 2001 at Mbabane Hospital, and in 2002, Dlamini was part of the history-making movement that fought for community-based ARV programmes.
“When we asked the government (in 2002) for ARVs in Eswatini, we did a pilot project with NECHA (National Emergency Response Council on HIV/Aids) to see if people would use the drugs,” he said.
“We initially planned to enrol 200 people in treatment, but the demand was 630.”
The overwhelming response could be one of the drivers of Eswatini achieving the “95-95-95” target in 2020, becoming the first African country to do so ahead of the 2025 set date.
The target means that 95% of people living with HIV should be diagnosed, 95% of those diagnosed with HIV should be receiving antiretroviral therapy, and 95% of all those receiving ART should achieve viral suppression.
The WHO reports that the number of new HIV infections has steadily declined over the years, falling from 14 000 in 2010 to 4 800 in 2020, and is anticipated to fall further to 4 300 by the end of this year.
HIV-related deaths have also decreased, from a peak of almost 10 000 in 2005 to 2 600 in 2021 and 2 370 in 2022.
Mother-to-child transmission of HIV has also dropped from 6.3% in 2017 to 1.2% in 2022.
End of Aids still possible by 2030: UN
Dlamini and other people with HIV, and non-governmental groups, continue working to eliminate Aids in Eswatini by ensuring everyone with the disease who needs treatment has access to it.
They also established the Swaziland Aids Support Organisation, a community-led organisation that offers HIV critical information on general healthy living.
Community-led initiative
Dr Michel Morisho, an HIV management specialist at Mbabane Government Hospital, acknowledged that “government could not have achieved 95-95-95 without communities”.
He said it was government policy that anyone who sought medical care at a public hospital was also offered HIV testing and counselling.
This is part of an ambitious 100-100-100 target, an upscale from the 95-95-95.
Community organisations such as Kwakha Indvodza are also key in encouraging men to take full responsibility for their well-being and reducing toxic masculinity and gender-based violence, which are some of the drivers of HIV.
Shortcomings
While Eswatini is on the path to ending Aids, the country is facing other health burdens associated with ageing, including non-communicable diseases like diabetes and cancer, which highlights the vital need to strengthen the healthcare system to provide easily accessible holistic disease management and treatment, along with HIV services, to improve quality of life.
See more from MedicalBrief archives:
Financial incentives for education help to improve HIV prevention
Preventive drug regimen in at-risk group increases PrEP uptake — Eswatini
HIV risk behaviour research challenges stereotypical ‘sugar daddy’ image
Swaziland halves rate of new infections in five years