By Samkelo Mahlalela | 2018-07-20

Eswatini’s vision for HIV is to end AIDS by 2022.

There is much that has happened in the recent past to give hope that the country will attain this vision.

 Hence the need to be more vigilant and ensure that we do not get complacent but keep HIV high on the national agenda. The reality is that some countries have witnessed a rebound of the epidemic as new infections began to crop up. Cognisant to this fact, the local HIV response strives to continue to find new ways to tame the epidemic and sustain the gains made thus far.

 That demonstration is organised in the series of rolling blueprints that set five-year targets, the latest being the National Multisectoral HIV and AIDS Strategic Framework (NSF) 2018-2023

The recently launched NSF 2018 -2023, is a tool for communicating Eswatini’s vision and priorities for the HIV response and confirms government’s commitment to the vision of ending AIDS by 2022.

Firstly, this strategy recognises that the country is on the trajectory towards reducing new infections and AIDS mortality but recognises that, if the Ending AIDS vision (getting to Zero) is to be fulfilled by year 2022, the current rate of new infections is not sufficient to achieve epidemic control as younger people bear higher new infections, and some (15 per cent) of PLHIV have not been tested nor enrolled in care, while more children and men living with HIV are not virally suppressed.  This because some sub-populations have not benefitted from the gains in prevention and treatment as more than 2 500 new infections occur among young people aged 15-24 each year and men and children under the age of 14 who are people living with HIV (PLHIV) have not enrolled in antiretroviral treatment. Also, other disease co-morbidities have emerged, posing a further threat to the lives of those living with HIV.

Unapologetically, the strategy sets an ambition to super-fast tracking the responseto reduce new infections by 85 per cent; avert 50 per cent of AIDS related deaths amongst people living with HIV (PLHIV); and eliminate all forms of HIV stigma and discrimination.It reflects that the ambitious targets will have to be achieved within the context of limited resources, constrained limited fiscal space and burdened health systems.

In the next five years, therefore, the country’s HIV response will be faced with an interesting but daunting challenge.

NSF 2018-2023 Design

The NSF is designed with a specific focus on the following strategic directions:

n HIV Response Financing: The strategy emphasises the need for sustained domestic financing, cost sharing, and programme efficiencies. Given the limited fiscal space and significant reliance on donors to fund critical areas of the response, the NSF proposes a two-pronged resource mobilisation strategy.

 The first approach is to mobilize resources from both traditional and non-traditional sources including private equity investment funds and other innovative options. The second approach is to maximise allocative and implementation efficiency through improved expenditure tracking, efficiency and cost-benefit analyses and improving effectiveness of implementation strategies.

n Localisation and micro-targeting of the response: Vulnerabilities to HIV and service coverage vary across sub-populations and geographical areas, meaning that to be effective, the HIV response should be decentralised and localised to address the needs of sub-populations in specific locations.

Targets have been set for sub-populations disaggregated by sex, age and regions to guide localised responses.

This approach ensures that “no one is left behind” by strengthening HIV preventions services through the delivery of innovative condom promotion and integration with sexually transmitted infections (STIs) and family planning (FP), economic empowerment, Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP)

n Strong monitoring and evaluation: The next phase of the response will be data driven. Granular and surveillance data will be required to inform the sustainable financing and response localisation strategies proposed above.

M&E systems will be strengthened to provide real-time data and make it available to users at all levels with emphasis on those working at regional and community levels.

n HIV Response Management: The focus of the HIV response coordination has so far been at the national level.

This strategic framework transforms coordination to focus at local levels to put communities at the centre of the response and to enable them to propel implementation of the localisation and micro targeting approaches. This harmonises coordination with the localisation and M&E strategic directions. 

n  Social Protection: Emphasis is on strengthening and creating stronger systems for sustainable social welfare as well as reducing HIV-related stigma and discrimination.

HIV prevention services will be integrated to ensure targeted populations are reached with a package of services. A new 95 per cent target has been set for testing, treatment and viral suppression. Also, there is a deliberate plan to work on reducing co-morbidities.

Attribution

It is proper that we attribute success to global systems that have support the new strategy. The development of the NSF was informed by and aligned to the following global, regional and national plans:

n Sustainable Development Goals (SDGs): This NSF will contribute to: SDG 3 - Ending the epidemics of AIDS, TB and Malaria by 2030, reducing by one third premature mortality from non-communicate diseases and increasing access to sexual and reproductive services; SDG 2 - Improving nutritional status of adolescent girls, pregnant women and lactating women; SDG 5: Gender equality and empowerment of women and girls; and SDG 16: reduction of sexual and gender-based violence.

n  2016 UN political declaration on HIV and AIDS: Eswatini has adopted the fast track targets agreed at the global declaration on HIV and AIDS and the NSF seeks to enable the country to achieve these targets.

n  HIV 2020 Prevention Roadmap:  The 10-point plan and the pillars for primary combination prevention laid out in the roadmap have been integrated into the design of the NSF. Additionally, the indicators and targets to measure progress in implementation of the roadmap are included in the NSF results framework.

n Regional Indicative Strategic Development Plan (RISDP) - Three key HIV strategies agreed to by countries in the SADC region under the RISDP framework have been integrated into the NSF. These are: Coordination and harmonisation of prevention, treatment and care policies and strategies; mitigating the socio-economic impact of HIV and AIDS; and monitoring of regional and global commitments including SDGs, the UN High Level Meeting (HLM) and Abuja declaration.

nUmgubudla Fast Track Programme:  The targets set out for the HIV response for 2022 have been harmonised with those set out in the umgubudla to ensure the country remains on course to ending AIDS. The development of the NSF was informed by the investment case articulated in the umgubudla.

n  The ‘three frees’:  The three frees framework seeks to ensure primary prevention of HIV is prioritised and sustained.

The NSF prioritises interventions to achieve the three frees targets and the results framework has included the targets of the ‘three fees’ framework.

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