An official website of the United States government

PEPFAR and CDC Closing of Old, and Launching of New Awards
September 24, 2021

A woman in a surgical mask speaks at a blue podium with the U.S. coat of arms on the front, and in the background are backdrops with the embassy seal and PEPFAR logo

Honorable Minister of Health Lizzie Nkosi
Principal Secretary Dr. Simon Zwane
Multilateral and civil society representatives
Chiefs of party for implementing partners
Ladies and gentlemen
All protocols observed

The United States President’s Emergency Plan for AIDS Relief (PEPFAR), represents the largest commitment ever, by any nation, to address a single disease. We’ve saved over 20 million lives, prevented millions of HIV infections, and accelerated progress toward controlling the global HIV/AIDS epidemic in more than 50 countries. It is an honor and privilege to be with you to reflect on the many accomplishments of our bilateral partnership to combat HIV/AIDS in Eswatini. Today, we specifically focus on PEPFAR partnerships through U.S. Centers for Disease Control (CDC)-funded mechanisms in the Kingdom of Eswatini and to officially launch our new partnerships to strengthen health systems and improve the lives of people living with HIV and TB.

This celebration is long overdue, as these partner transitions occurred in October 2020. Yet we were not in a position at that time to turn our attention away from battling a new pandemic – COVID-19. Now, as we emerge from a 3rd wave of COVID-19, we are thankful that we have the opportunity to recognize the contributions of our partners in battling both epidemics, and ensure that lessons learned are taken forward to inform the strategies and approaches proposed under the new partnerships.

Over the five-year period that we are celebrating today, 2015 to 2020, the U.S. Government invested more than $317 Million dollars or approximately E4.1 billion in PEPFAR resources in Eswatini. Roughly a third of that investment was directed through CDC-funded partners to support service delivery and system strengthening aimed at reaching the 95-95-95 HIV epidemic control goals. The most striking accomplishment of these five years is that Eswatini achieved the 95-95-95 goal. Eswatini is one of only two countries globally to have achieved this milestone.

To get here was no small feat. Some highlights during the five-year period being celebrated today follow:

  • The Swaziland HIV Incidence Measurement Survey 2 (SHIMS2) was completed. It demonstrated a 44% reduction in HIV incidence between 2011 and 2016, the first population-based assessment to demonstrate the impact of our collective investments.
  • Eswatini adopted game-changing test and treatment guidelines, opening the door for nearly 75,000 additional Emaswati living with HIV to be provided with life-saving antiretroviral therapy (ART), reaching 94% of all people living with HIV in the country.
  • Mother to child transmission dropped by over 40% — less than 500 infants now acquire HIV from their mothers annually.
  • And over 93,000 people living with HIV were given TB preventive therapy.

Each partner – those being celebrated today and those working side by side with them – played a vital role in this success. The impact is clear – Emaswati with HIV are now living long, healthy productive lives, children are being born HIV-free, and fewer young people are becoming infected.

I’d like to give you a snapshot of the diverse contributions by our CDC-funded partners being recognized today. Our partnership with the Ministry of Health serves as the foundation upon which all our partnerships are built. In rapidly adopting evidence-based guidelines, using data, insisting on quality, coordinating investments, and embracing innovation, the Ministry has positioned Eswatini as a trailblazer for others in the region to follow. This partnership has also been critical in facilitating the effective and impactful engagement of our other partners.

In addition to our Cooperative Agreement with the Ministry of Health, our investments through ICAP in strengthening laboratory and surveillance systems have not only contributed to HIV epidemic control, but have also been instrumental in our ability to respond quickly to COVID. The decentralized laboratory testing platforms, robust sample transport network, and internationally accredited reference labs established within the last five years allowed for continuity of essential HIV and TB diagnostic and monitoring services while simultaneously deploying a rapid COVID diagnosis strategy. ICAP’s collaboration with the Epidemiology and Disease Control Unit to track HIV and other disease trends had built capacity for EDCU to create timely and relevant COVID situation reports that are reviewed daily. They also continue to play an instrumental role in demonstrating the impact of our investments as a principal investigator on the SHIMS surveys in collaboration with the Ministry of Health and CDC.

Finally, our clinical service delivery partners covering the Manzini and Lomobo regions — ICAP, URC, PSI, JHPIEGO, and Georgetown University — facilitated the scale-up of prevention, targeted case identification, universal treatment, and viral load interventions through hands on mentorship, innovative programming, and quality improvement initiatives guided by rigorous and real time review of data.

An equally important ingredient in our recipe for success is the input received from the beneficiaries of these partnerships and investments. We engage program beneficiaries in the development of our annual Country Operational Plan as required by PEPFAR guidance, and this year we are introducing Community Led Monitoring through which civil society organizations will conduct independent reviews of service delivery and listen to feedback from beneficiaries who receive services from our partners and our PEPFAR team. This engagement and dialogue with the individuals and communities we serve is a hallmark of the U.S. Government. We listen and we expect our partners, including the Government of the Kingdom of Eswatini, to communicate with and listen to beneficiaries and incorporate their feedback as well.

We strongly believe that communication, including listening to different perspectives and incorporating feedback represents the way to address a wide variety of issues. It is in this spirit that we continue to urge all stakeholders, including the public, their elected representatives, and government officials, to pursue peaceful dialogue as an opportunity to broaden the discussion on critical national issues and seek solutions. Over the past several months we have continued to call for inclusive, comprehensive, peaceful, and honest dialogue—which is, at its heart, a listening exercise. We also continue to urge the government to conduct full and transparent investigations into alleged human rights abuses, uphold the rule of law in holding perpetrators accountable, and empower an independent judiciary which answers neither to the executive nor the legislative branch. To accomplish these things, we must start with communicating and listening.

PEPFAR has worked collaboratively with the Ministry of Health, U.N. partners, civil society organizations and non-governmental organizations through CDC, USAID, Peace Corps, and the Department of Defense to set the stage for the next five years to sustain Eswatini at HIV epidemic control. CDC through PEPFAR funding, has begun the next five-year cycle of partnerships to continue the impactful work of reducing the HIV/TB infection rate, improving the quality of care and treatment for people living with HIV, building capacity within the Government of Eswatini to sustain and increase the gains made over the last five years.

I salute the PEPFAR/CDC implementing partners being recognized today for their dedicated work and look forward to celebrating the accomplishments of the past five years and hearing the approach to the five years ahead.