Remarks by Ambassador Lisa Peterson: Launch of HIV Prevention Policy – NERCHA

Prime Minister
Members of the Media,
Ladies and Gentlemen,

Sanibonani.

Eswatini has achieved incredible successes in the fight against HIV and AIDS.  The U.S. Government has been honored to partner with the government and people of Eswatini, under the leadership of the Prime Minister’s Office and NERCHA, in a joint endeavor to stop this disease in its tracks.  Through this coordinated effort, we have had the opportunity know emaSwati who truly embody the concept of servant leadership, from community volunteers who provide emotional and logistical support to people who have recently discovered they are HIV positive, to the officials who have put a series of policies and practices in place to help the country achieve incredible strides in reducing the rate of new infections.

When PEPFAR was launched in Eswatini 15 years ago, entire families and communities were falling ill. Today, death and despair have been overwhelmingly replaced with life and hope, thanks in part to the more than 500 million dollars that taxpayers of the United States have invested in restoring the health and well-being of emaSwati. With ever-improving treatments for HIV, people are living long, fulfilling lives while reducing their likelihood of passing on the virus to others. Eswatini has turned a corner in the HIV epidemic. New HIV infections are down more than 40% since 2011.  The country looks to have achieved the benchmark of the 90-90-90 goals and is fast approaching the 95-95-95 goals.  Now, for the first time in modern history, there is the opportunity to make what once seemed impossible possible – controlling a pandemic without a vaccine or a cure.

Sadly, the rates of new infections in Eswatini are still among the highest in the world, placing a clear burden on emaSwati, particularly the youth. The 2019 UNAIDS HIV estimates for Eswatini indicate that over 7368 people were infected in 2019, and more than 2,363 people died from AIDS-related causes.  The numbers show us that young people are still becoming infected with HIV at alarmingly high rates.  The numbers also show that the decline in new infections is hitting a plateau. It is clear that what brought us success yesterday won’t bring us victory tomorrow.

Together we can—and must—do better than this.

We are seeing a generation come of age without having experienced the impact of AIDS across the population.  They are coming of age in an environment rife with intergenerational and transactional sex. Layer on top of these elements the risk from men who are living with HIV but not being on treatment.

Another thing stands in our way: stigma. HIV-related stigma hurts the people of Eswatini. It is on all of us to destigmatize HIV. This includes getting tested for HIV, disclosing a positive HIV status, and getting treated and living with HIV.  Stigma and fear continue to stand in the way of many people knowing their HIV status, seeking care and treatment, or returning to treatment.  Stigma makes us less effective at preventing new infections.  We need to be able to reach men who fear a positive result so do not test for HIV, or who have HIV but experience barriers to treatment initiation, at a risk to both their own life and that of their sexual partners.  We need to support men to test and treat to protect their families and communities from HIV infection.  This year PEPFAR is proudly launching an initiative to work with faith and traditional communities to deliver positive messages around HIV testing and treatment, reaching all who need the messages, but placing a focus on reaching men in particular – for whom we have not yet fully delivered.

Many in the HIV field believed test and treat would lead us to epidemic control.  As several countries have closed in on their last mile, study after study has shown it is unlikely that we can treat our way out of this epidemic.  The numbers simply do not add up.  Treatment is not enough on its own. Short of a highly effective vaccine or broadly available cure, we need to have robust prevention programming that complements high rates of treatment coverage in order to control the HIV epidemic.

There is another issue that threatens the sustainability of the HIV/AIDs health response.  Eswatini remains in a critical fiscal situation that could still undermine progress on many fronts, including in the health sector.  While there have been economic shocks over which the government had little control, including disease and drought, there continue to be choices that hold back development in the country.  By sticking to difficult but necessary courses of action, cabinet has started to stabilize the economy.  But their efforts are undermined by a range of actions that directly or indirectly undercut the public treasury.  I will address these concerns in separate channels going forward.

With that said, on behalf of my government I would like to deeply praise NERCHA and the full array of government offices for their unwavering commitment to the leadership necessary to bring about control of the HIV epidemic.  I extend my government’s thanks to the implementing partners for their tireless work to support the programs and people of Eswatini in preventing HIV and helping those with HIV to live long, productive lives. And I offer my government’s deep gratitude and respect to the everyday heroes, either affected or infected by HIV, who advocate for and inspire others, who offer a shoulder to lean on to a relative, friend or neighbor, and who help reduce stigma by talking about HIV. These are all the true servant leaders of this country.

Siyabonga.