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,
Chairperson and Council Members of NERCHA,
Executive Director of NERCHA,
Civil Society Representatives,
Members of the media,
Ladies and Gentlemen,
I am honored to be here today in recognition of World AIDS Day and the tremendous progress the Kingdom of Eswatini has made toward fighting its HIV/AIDS epidemic. Although global attention is dominated by COVID-19, the HIV/AIDS pandemic is entering its fifth decade and is far from over. HIV/AIDS remains a major public health crisis and few countries will meet global treatment targets for 2020. In fact, only two countries have reached the UNAIDS goal of 95-95-95 – they are Switzerland and Eswatini. We congratulate you on this extraordinary accomplishment. And we are very proud to have been your partners along the way.
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 and the generosity of the American people. Sixteen years ago, when PEPFAR began work in Eswatini, fewer than 500 people were on anti-retroviral therapy. The existence of entire communities was threatened by the virus. Now, more than 206,457
adults and children are receiving antiretroviral therapy, with PEPFAR providing support to treatment for 187,429. We now have the opportunity to control and ultimately end the HIV/AIDS epidemic in this country.
But to do so we must overcome the impact of the COVID-19 pandemic, which has strained health systems and exposed gaps in public health almost everywhere. From the highest levels of national leadership to community-based health facilities, resources have been diverted from HIV efforts—potentially with harmful effects. Several studies suggest that severe disruptions to HIV treatment services could lead to negative effects in the long term, increasing HIV mortality and reversing achievements in the prevention of mother-to-child transmission of HIV. These are grave predictions, but there is more to the story.
As the COVID-19 pandemic swept the globe, the investments made through PEPFAR became instrumental in combatting this new virus. Years of implementing an effective HIV response helped Eswatini respond to COVID-19. Laboratory capacity, information systems, supply chain management and, most importantly, the collective
expertise of the health workforce already in place were ready to respond to this new medical crisis. Many of the same government officials, development partners, and frontline healthcare workers who partner to deliver HIV services sprang to action to provide COVID relief.
COVID-19 imperiled HIV services and forced the health system to adapt. But adaptations provided opportunities. Eswatini accelerated the scale-up of differentiated service delivery, expediting multi-month dispensing of HIV medicine, scaling up community drug distribution, and using virtual platforms to replace in-person services. HIV systems investments, planning, and preparedness were further integrated into the broader health sector. Together, we developed robust, flexible, people-centered health platforms that address the social and structural elements that determine health. Thanks to these efforts, our latest data for this year show that Eswatini is holding steady, maintaining the number of people on HIV treatment and virally suppressed—a huge accomplishment.
However, while the effects of COVID have thus far been less severe than anticipated and new HIV infections are declining, young people are still being infected at alarming rates. This past year, it is
estimated that 4,000 new HIV infections occurred among emaSwati—more than 30 percent of those in young women aged 15-24. We know that the adverse effects of HIV and COVID-19 are exacerbated by socioeconomic disparities, disproportionately affecting poor and marginalized people, particularly young women and girls. In addition, the impacts of the COVID-19 pandemic will be far reaching and long lasting, worsening the power imbalance that feeds gender-based violence.
The theme of this year’s World AIDS Day is “Ending the HIV/AIDS Epidemic: Resilience and Impact” which reflects the determination we must show to strengthen the capacity and resilience of communities to address inequalities and these dual health threats.
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 800 million dollars across the world for adolescent girls and women, to help them become Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe. We are now growing 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 counselling sessions; teaches them about HIV prevention and testing; gives them family planning support, and so much more. All of these services are brought to the girls, where they are, delivered primarily through mobile outreach vans.
While we work to prevent HIV infection and care for those who become positive, we also have to focus on key structural drivers of women’s and girls’ added vulnerabilities. A resilient response to disease can only be achieved in communities when women, as well as men, are fully empowered to play a role in their economic futures. By ensuring women have access to income and productive resources, including land, we lay the foundation for long-lasting change that will diminish women’s susceptibility to gender-based violence and set Eswatini on a path to sustainably reduce the spread of HIV. Under Eswatini’s Constitution, women have the right to own land. Educating them about this and other rights they already have and giving them tools to access those rights directly strengthens their economic situation, and that of the entire country.
The response to any crisis begins in the community, so we continually look for ways to augment our investment in communities by engaging traditional structures, empowering leaders and encouraging them to implement policies that invest in women and girls and lift up marginalized individuals. This year, for example, PEPFAR started a new initiative to harness the unique capabilities and compassion of faith and traditional communities. The initiative aims to reach more children, adolescents, and young people with HIV treatment and prevention services, while reducing sexual violence against children. We must remain steadfast in addressing this fundamental problem of violence against women and children.
In closing, I would like to take a moment to recognize the government of the Kingdom of Eswatini for its unwavering commitment to control its HIV epidemic, even in the face of COVID-19. This commitment has allowed the country to far exceed this year’s global 90-90-90 goals. 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 by HIV, who advocate for and inspire others, who offer a shoulder to lean on to a relative, friend or neighbour, and who help to ease concerns by talking about HIV. Emaswati have shown that this country cannot be defined solely by a prevalence rate. You are a shining example of the way in which strength, courage, and compassion can truly move this country forward.