WORLD AIDS DAY: HOW COMMUNITIES, GOVERNMENT, NGOS, AND THE WORLD UNITED TO MAKE ESWATINI AN HIV SUCCESS
Twenty-five years ago, this day was marked by genuine fears from multinational organizations, funding agencies, governments, and philanthropists who were worried sick that HIV would eviscerate this kingdom.
The statistics were alarming, and the curve kept getting sharper and sharper. Either the world would witness the worst human tragedy in contemporary history or its best success story. The stage was set: Eswatini would become a lesson in history, for better or worse. Several years later, the country can collectively pat itself on the back for choosing the path of redemption.
Once facing one of the world’s most severe HIV epidemics, Eswatini has emerged as a beacon of hope in the fight against the virus, achieving remarkable milestones in prevention, treatment, and care. At the peak of the epidemic in 2015, almost one out of three people were living with HIV. In 1995, when there was no antiretroviral treatment for people living with HIV, 73,000 people were infected, and 2,400 people died of AIDS that year.
Worried about the rising number of infections and deaths, communities of people living with HIV mobilized to press for antiretroviral treatment to be made available. According to the latest data from UNAIDS, the small southern African nation has surpassed the ambitious UNAIDS 95-95-95 targets, a global benchmark to end HIV as a public health threat by 2030.
This means that more than 95% of people living with HIV in Eswatini are aware of their status, over 95% of those diagnosed are on antiretroviral treatment, and more than 95% of those on treatment have achieved viral suppression, drastically reducing the risk of transmission. Experts attribute Eswatini’s success to strong political will, robust healthcare policies, and a collaborative approach involving the government, non-governmental organizations, and international partners.
Prime Minister Russel Dlamini recently reaffirmed the government’s commitment to sustaining these achievements, stating, “We have shown the world what is possible with determination and partnership. But the fight is not over—we will not rest until we have a generation free of HIV.” Eswatini has embraced innovative strategies to combat HIV. Community-centered health initiatives, such as mobile clinics and door-to-door testing, have ensured widespread access to HIV services, even in the most remote areas.
Pre-exposure prophylaxis (PrEP) has been rolled out for high-risk groups, while prevention of mother-to-child transmission programs have virtually eliminated new infections among newborns. Notably, Eswatini’s male circumcision program, part of a broader HIV prevention strategy, has also played a critical role in reducing new infections. For individuals like 35-year-old Nompilo Simelane, the country's achievements are life-changing. Diagnosed with HIV in 2015, Simelane credits the availability of free antiretroviral treatment and regular counseling for her health and optimism.
“I thought my life was over when I tested positive. But today, I am healthy, raising my children, and working. I am living proof that HIV is no longer a death sentence,” she shared. The success story of Eswatini cannot be told without mentioning one of the key campaigners against HIV: Hannie Dlamini. Now 50 years old, Dlamini has been living with HIV for 32 years after finding out about his positive status at the age of 18.
He was one of the first people in Eswatini to publicly declare his HIV status in 1995, a time when stigma and misinformation about HIV were rife. Dlamini rallied other people living with HIV and non-governmental organizations to form the Swaziland AIDS Support Organization (SASO), a community-led group providing support and health education.
SASO was instrumental in pushing for the introduction of antiretroviral treatment. “When we asked the government [in 2002] for ARVs in Eswatini, we conducted a pilot project with NECHA [National Emergency Response Council on HIV/AIDS] to see if people would use the drugs,” Dlamini explained. “The response was overwhelming. We initially planned to enroll 200 people on treatment, but the demand was 630.” Despite these advances, challenges remain. Stigma and discrimination still deter some individuals from seeking testing and treatment.
Youth and adolescent girls remain disproportionately affected by new infections, underscoring the need for targeted interventions. Eswatini’s success offers valuable lessons for neighboring countries grappling with their own HIV epidemics. Regional leaders have lauded Eswatini for its evidence-based approach and commitment to universal health coverage. Dr. Sipho Dlamini, an epidemiologist based in South Africa, noted, “Eswatini’s achievement is a reminder that even in the face of daunting odds, progress is possible. The key is a combination of science, community engagement, and political will.”
While Eswatini is on the path to ending AIDS, the country now faces other health burdens associated with aging, including non-communicable diseases such as diabetes and cancer.
Many people living with HIV have developed comorbidities, presenting a need to strengthen the healthcare system to provide holistic care. As Thembi Nkambule, who has been on HIV treatment for more than 20 years, stated: “Most of us are sick. We are presenting with kidney issues, hypertension, and diabetes. We need a stronger healthcare system to address these challenges.”
Eswatini’s achievement has moved the country closer to ending AIDS as a public health threat, thanks to the combined efforts of community-led organizations, the government, and global partners like UNAIDS, PEPFAR, and the Global Fund. This World AIDS Day, Eswatini stands as a symbol of what is possible in the fight against HIV.