Tuesday 2018-10-16

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ESWATINI’S ROAD MAP IN LAST MILE TO END AIDS

By Samkelo Mahlalela | 2018-07-12

It’s almost been a year since the Prime Minister Dr Sibusiso Dlamini presented exciting news of scientific data from a population-based HIV Impact Assessment, that put the country on the spotlight in the global HIV response.

As the prime minister announced the results of the second HIV Incidence Measurement Survey (SHIMS 2), the global community which had simultaneously gathered in Paris, France at the International AIDS Conference (IAS 2017) heard along with those present at the Cabinet Offices,that Eswatini had in the period 2011 – 2016, cut the rate of new HIV infections by almost half (44 per  cent).

Almost a year later, at the Sibane Hotel in Ezulwini, on Wednesday June 27, 2017, the prime minister (represented by the deputy prime minister) officiated in the launch of the latest national multisectoral HIV and AIDS strategic framework (NSF 2018-2023).The NSF articulates the country’s vision to end AIDS by 2022 (a call down from the 2030 international target) and provides the roadmap to get the country there.

The launch of the new NSF within the leadership of a government led by the Honourable Dr Dlamini,who with the guidance of His Majesty King Mswati III, has always provided the necessary political support for the HIV response is itself remarkable.

The prime minister has first-hand experience of  the HIV and AIDS journey of Eswatini, since the late 1980s. He was in office when the country faced the brunt of the severe impact of HIV and AIDS in the late 1990s - and spearheaded the country’s initial multisectoral response.

At that time, those who were diagnosed with HIV never lived for long and annual new infections peaked at slightly over 17 000 in 2012. The rapid increase in new infections and AIDS deaths gave rise to a common prediction of doom for the tiny kingdom with just over a million people.

A multisectoral response was thus preferred for the kingdom, giving birth to an elaboration of plans and strategies to prevent new HIV infections and AIDS deaths. The most recent of these being the extended National Strategic Framework (eNSF) and the Umgubudla Fast Track to End AIDS programme.Things turned around in the late 2000s, where the prevalence rate began to stabilise - owing to the ground-breaking introduction of ART and PMTCT. At that instance, an HIV positive status could no longer be viewed as a sure death sentence within 7-8 years.

The PM was there to launch many of the plans, including the new NSF 2018-2023 launched two weeks ago as the pedestal for Eswatini to end AIDS as a public health threat within the next five years. The multisectoral HIV response programme, has been one of the prime minister’s finest works in the political office of head of government.

Impact of recently ended

eNSF investments

Before we can appreciate the new strategy, we must look at the impact of the recently ended extended  National Strategic Framework (eNSF) 2014-2018. The eNSF expressed government’s commitment to provide comprehensive quality HIV and AIDS services to all – in line with the assertion that government considers HIV as a health, development and human rights issue.

In terms of orientation, the eNSF aimed to do better and more of the right things, at the right time and scale, while ensuring smart investment in priority programmes for greater impact and future resources. It adopted the ‘investing for results’ approach to improve efficiency and effectiveness in the national response. In this regard, the eNSF advocated for the integration of HIV services with other healthcare services and mainstreaming HIV into other socio-economic development frameworks.

Through its implementation, new infections have dropped by 44 per cent since 2014, to less than 8 000 annually; Almost 97 per cent of all children exposed to HIV during pregnancy and delivery are born free of HIV; Over 170 000 of the estimated 210 000 people living with HIV (PLHIV) are alive and on treatment; Young people and adolescents who are living with HIV are in schools with some attending college; and HIV positive parents are actively participating in productive employment to care for their families. We have come far!

Ending AIDS by 2022

The successes do not mean we have done it, so we must rest. But they should inspire us to reach the goal to End AIDS by 2022 through aiming for Zero New infections, Zero AIDS-related deaths and Zero HIV stigma and discrimination.

That is the trajectory that Eswatini is on. The NSF, which builds from the Umgubudla, is a translation of the next mile to 2022. To borrow from His Excellency’s speech two weeks ago, he said

“To achieve this, we must continuously remain aware that AIDS is preventable and manageable. We must intensify all measures at our disposal to prevent its spread and impact. We must make sure that those who are HIV negative remain negative.

Secondly and equally important, is to ensure that those who are living with HIV receive timely and quality HIV treatment to prevent their progression to AIDS. And thirdly, we must recognise that a multisectoral response is still useful to sustain the gains.” The NSF 2018-2023 as a guiding document for all stakeholders involved in the country’s HIV response, shows the priorities set by government to get Eswatini to End AIDS and provides deliberate intervention measures to lead to a reduction of HIV incidence, prevalence, and morbidity or mortality, to a point where HIV no longer represents a public health threat and is no longer among the leading causes of the country’s disease burden. Its overall objective is to prevent, treat, mitigate and sustain. Specifically, the NSF aims to super fast-track the HIV response to reduce new infections by 85 per cent; avert 50 per cent of deaths amongst people living with HIV (PLHIV); and eliminate HIV stigma and discrimination. Fortunately, the country has the necessary tools to end AIDS in the next 5 years.

Sadly however, speaking at the NSF launch, National Emergency Response Council on HIV/AIDS (NERCHA) Director, Khanyakwezwe Mabuza warned that while the country is making great strides in achieving set vision, the HIV response is faced with the reality of dwindling funds. The reality is that some of the donor nations and organisations transition from donor funding without the support to sustain the accomplishments realised. In the long-term, this results in the faltering of clinical care and community systems whither.

Commitment

The NSF will guide the country to build onto what has been done over the last 30 years. We have the experience, we have the energy, and most importantly we have the commitment. What is left now is to run the last mile to achieve epidemic control.

When we achieve this, we will be the flagship of the world and become one of the first countries in the world to reverse the epidemic. The HIV responseis determined to make this history and to make it eight years earlier than the 2030 Global target.

This will be made possible by the high political commitment we have enjoyed from our leader, His Majesty King Mswati III,  the government of the Kingdom Eswatini, coupled with robust support from the private sector and international organisations including bi-lateral and multilateral partners, people living with HIV and the many other players that continuously come together to ensure that the country has a vibrant and effective HIV response. 

NB; This is a repeat of last week’s article due to technical glitches.

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