His Excellency, the Right Honorable Prime Minister,
Their Royal Highnesses,
Members of Both Houses of Parliament,
United Nations Resident Coordinator and members of the UN Family,
Her Excellency, EU Ambassador to Eswatini,
His Excellency, UK High Commissioner to Eswatini
Chairperson and Council Members of NERCHA and Executive Director
Civil Society Representatives, Members of the media, Distinguished Guests, Ladies and Gentlemen,
I am honored to be here today in recognition of World AIDS Day and the tremendous progress that has been made toward fighting the HIV/AIDS epidemic. This progress was made due to the leadership and collective efforts of the government of the Kingdom of Eswatini, civil society, multilateral and bilateral partners and the private sector. As the global community continues efforts to control the COVID-19 pandemic, we must not forget the persistent challenge of the HIV epidemic, now entering its fifth decade and far from being over. HIV/AIDS remains a major public health crisis here in Eswatini. In this year alone it is estimated over 2000 people died of HIV-related causes and over 4000 were newly infected with HIV. These figures have declined markedly from their historic peaks, but HIV continues to take a devastating toll.
Globally, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) remains the largest commitment made by any nation ever to address a single disease.
It is an investment in saving lives – an historic symbol of our friendship as nations and the generosity of the American people. Seventeen years ago, when PEPFAR began work in Eswatini, fewer than 500 people were on life-saving anti-retroviral therapy. Now, PEPFAR is supporting more than 196,000 adults and children who are receiving antiretroviral therapy and nearly 9,000 emaSwati who began HIV treatment in the past year.
What is significant about this moment in history is that, despite the challenges, Eswatini currently has all the tools needed to control the HIV epidemic and ensure another generation never experiences the devastation of the past. We have medication available for all people living with HIV—medication that is safer and more effective than ever before. We have systems set up to allow most people to pick up their medication and have their viral load tested only twice a year. We have effective prevention options like PrEP, a once-a-day pill proven to prevent HIV infection.
Again, the tools are available to control the HIV epidemic.
Now it is imperative to reach the youth with prevention services and information on how to protect themselves. The 30 percent of emaSwati who are over the age of 35 well remember the horror and devastation HIV/AIDS inflicted on Eswatini. If you do the math, 70 percent of the population of Eswatini is under the age of 35. Of that 70 percent of youth,, over half had not even born yet in 2005, when HIV caused life expectancy to reach a tragic low of 40 years old. The stigma attached to HIV may mean that many youth don’t know why family members and friends died in such numbers.
The youthful population and the circumstances into which girls and young women begin engaging in sex continue to be a dangerous combination – 30 percent of new infections are in young women aged 15-24. In addition to protecting young women, we need to ensure that men are accessing testing and treatment services – both to protect their own health and prevent transmission to others. HIV is indeed a scourge, but one we have the tools to control.
As we reflect on the HIV pandemic in 2021, we have additional concerns that threaten the progress we have made together.
The ongoing challenges in delivering health services, as well as the social, economic, and health impacts of the COVID-19 pandemic and civil unrest are major threats to the progress made. This is a moment in time where we need to refocus our efforts on preventing new infections, address the social and gender inequality issues facing youth and the nation as swiftly as possible, and avert a backslide in HIV progress.
Investing in girls and young women is at the center of the PEPFAR program. Since 2015, PEPFAR’s flagship DREAMS program has invested more than $815 million across the world for adolescent girls and women to help them become Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe. Over the past year, we have expanded the geographic reach of the DREAMS program in Eswatini because it works.
It delivers services, mentorship, and training; empowers them with a network of peers and resources; provides them with small group and one-on-one counseling sessions; tackles issues of gender inequality which leave adolescent girls disproportionately vulnerable to HIV, teaches them about HIV prevention and testing; gives them family planning support; removes barriers impeding their access to facility-based services, and so much more. All of these services seek to meet the needs of these girls where they are, delivered through both facility and mobile outreach settings.
We also know that persons with disabilities are at higher risk of acquiring HIV due to multiple physical, mental, economic and/or social challenges they may experience. And we know that persons with disabilities may face numerous barriers in accessing services to either prevent or treat HIV. When a civil society representative for people with autism asked that we do more for people with disabilities, we were listening. In response, the United States awarded three grants specifically for supporting HIV service delivery, including education, prevention services, testing and linkage to treatment for people living with disabilities.
As the COVID-19 pandemic swept the globe, the investments made through PEPFAR became instrumental in combatting this new virus. PEPFAR-supported public health, clinical care, laboratory, supply chain, and data platforms have been – and remain – vital in the ongoing fight against COVID-19. PEPFAR responded immediately to adapt service delivery, accelerate program innovation, and drive policy change to better serve our clients. This included dramatically expanding decentralized distribution and multi-month dispensing of life-saving antiretroviral medications to keep clients in care and reduce their exposure to COVID-19.
Through these and other actions, PEPFAR has not only ensured continuity of life-saving HIV treatment for people living with HIV, but also expanded treatment access. Thanks to these efforts, our latest data for this year show that Eswatini has increased the number of people on HIV treatment while maintaining high rates of viral suppression —a huge accomplishment.
Health management information systems, created with PEPFAR assistance for HIV programs, have assisted in collecting and using data on COVID-19 cases, deaths, and vaccinations. Health care supply chains forged with U.S. financial and technical resources have delivered COVID-19 test kits, personal protective equipment, laboratory reagents, and other essential commodities. PEPFAR-supported health care workers are also supporting COVID-19 vaccine readiness and administration. The collective expertise of the health workforce already in place was ready to respond to this new medical crisis. Few of these capabilities would have been available at scale or with the needed sophistication without the HIV investments made both by donors and by the government.
The United States is proud to invest in the future of emaSwati through PEPFAR and all our health sector investments. By the same token, we must also work together to help Eswatini heal from the recent civil unrest. As the government and citizens of Eswatini approach national dialogue, we urge that preparations be in full collaboration with civil society. Inclusive, peaceful, and constructive dialogue on issues of concern to emaSwati will help Eswatini be a nation where all can reach their full potential.
The theme of this year’s World AIDS Day is End Inequalities, End AIDS, End Pandemics. We have the tools we need to do this, particularly as related to COVID-19. The U.S. has donated hundreds of thousands of doses of COVID-19 vaccine to prevent the spread of the virus. Many doses are currently unused, and we urge emaSwati to get vaccinated! It’s free, it’s safe, and it’s available right now. Please act now to vaccinate and help protect yourself, your loved ones, and your community from the worst effects of COVID-19.
Thank you to our implementing partners for their tireless work to support the people of Eswatini in preventing HIV and helping those with HIV to live long, productive lives. And I offer my deep gratitude and respect to the everyday heroes, either affected by or infected with HIV, who advocate for, support, share information with, and inspire the youth.
We are at a crossroads in the global AIDS response, and the choices we make now will have profound implications for years to come. After decades of progress, our work is not yet finished. If we falter, thousands more emaSwati risk infection with HIV, and thousands now living with HIV could die. But if, together, we confront the challenges before us with conviction and compassion, we can pave the path to end the HIV epidemic and to secure a better future for all emaSwati.