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At a glance: HIV in Eswatini

The first African country to reach the 95-95-95 targets 

Key statistics

In 2020:

  • 200,000 people with HIV 

  • 26.8% adult HIV prevalence 

  • 4,800 new HIV infections 

  • 2,400 AIDS-related deaths 

  • >95% people on antiretroviral treatment 

Progress towards targets

The current targets for HIV testing and treatment are called the 95-95-95 targets and must be reached by 2025 in order to end AIDS by 2030.

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Did you know? 

Eswatini was the first African country to reach the 95-95-95 targets, and it achieved them years ahead of schedule. 

Prevention

Preventing HIV in Eswatini focuses on: 

  • condom dissemination especially for people at high risk of HIV 

  • HIV education, especially for young people who have low knowledge on preventing HIV 

  • preventing mother-to-child transmission 

  • voluntary medical male circumcision 

  • PrEP, which is available at all health facilities. 

Did you know?

A comprehensive lifeskills education programme is offered in all primary and secondary schools in Eswatini, and at community level to reach young people who are out of school. 

Testing

Testing for HIV is: 

  • lower among young people, and young men in particular 

  • higher among women than men due to a reluctance among men to access healthcare 

  • hampered by stigma – people don’t want to attend a clinic to test for HIV 

  • available to do at home via a self-test kit. 

Did you know?

Eswatini provides community-based HIV testing and self-testing, which has increased testing levels as it means people do not have to travel to clinics. 

Treatment

Treatment for HIV is: 

  • free, and has been since 2003 

  • higher among women than men 

  • lower among children than adults 

  • given to people straight away when they test positive 

  • well adhered to, with high levels of people reaching viral suppression. 

Did you know?

Services are integrated at health facilities, so people with HIV can receive HIV, tuberculosis, and sexual and reproductive health services in a single visit to a clinic or hospital. 

Local context

King Mswati III declared HIV a national emergency in 1999, saying that “HIV is our collective concern.” This sparked a national drive to bring the HIV epidemic under control. Despite huge progress, Eswatini still has the highest HIV prevalence in the world – around 27% of its population has HIV. 

HIV testing and treatment programmes have expanded considerably in the country in the last decade. Since 2010, HIV infections have fallen by almost two-thirds (64%) and AIDS-related deaths have halved. Of the 200,000 people with HIV in Eswatini in 2020, 62% are women and girls. Gender inequality means that women face greater economic and educational barriers than men, and women and girls with HIV experience high levels of stigma and discrimination.  

The country’s preventing mother-to-child transmission programme is effective, as 95% of pregnant women with HIV are on antiretroviral treatment.  

However, challenges remain. The country faces dual epidemics of tuberculosis and HIV: 73% of people with TB have HIV. Groups that are socially marginalised and criminalised are most affected by HIV. For example, Eswatini has the highest HIV prevalence among sex workers in the world (60.8%). 

The country’s legal environment stops many people from accessing services for HIV and sexual and reproductive health. Male homosexuality, sex work and drug use are all illegal. Abortion is legal but only in limited circumstances, such as in cases of rape, incest, foetal abnormalities and mental illness.  

Next: At a glance: HIV in Kenya

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