The Dream is Alive in Eswatini

In February, I had the opportunity to visit HIV facilities in Eswatini. Since 2003, EGPAF, with funding from PEPFAR through USAID, has been supporting the Kingdom of Eswatini to prevent mother-to-child transmission (MTCT) of HIV.??

One remarkable site in Mbabane, the Mahwalala Baphalali Red Cross Clinic, is a facility supported by EGPAF (under the USAID funded ASPIRE Project), the Eswatini Red Cross, and the Ministry of Health. The clinic achieved something we have hoped for and worked for over a decade - a near 100% elimination of MTCT - with just one documented case of HIV vertical transmission in the past three years.???

This hard-won progress did not happen coincidentally. It was the result of sustained political commitment and financial investment in the well-being of children. And it is but one example of success that can be replicated well beyond Eswatini.?

Recently, two of EGPAF’s global ambassadors, Tatu Msangi and her daughter Faith Mang’ehe, attended the 20th anniversary celebration of PEPFAR as special guests of former President Bush and Mrs. Bush. Together, they spoke about the early promises of Prevention of Mother to Child Transmission of HIV (PMTCT) and the transformative impact the program has had on their lives.?

Tatu, now a healthcare provider at the same clinic in Tanzania where she learned of her HIV status during her routine antenatal care, talked about the need to provide comprehensive healthcare for pregnant and breastfeeding women impacted by HIV. Her daughter Faith, a spirited 17-year-old young woman, highlighted the significance of being one of the 5.5 million babies born HIV free because of the scaled-up innovations brought about via PEPFAR-funded programs.? Together, they spoke about their hopes for an end to HIV with Tatu remarking, “We think one day the dream will come true and we will have an HIV-free generation through people’s efforts that are made to support these programs.”?

Tatu and Faith represent two sides of the proverbial coin that will help us achieve an AIDS-free generation. One being the need to reach pregnant and breastfeeding women with HIV with timely treatment to PMTCT. The other being the need to develop prevention programs for HIV negative young people to ensure they stay HIV negative as they take steps to start families of their own.??

Now in its twentieth year, PEPFAR and EGPAF have worked together to end AIDS in children, youth, and families in over 19 countries. And while we’ve seen the success in the reduction of MTCT rates globally, women are still falling through the cracks of the PMTCT care cascade. Treatment coverage for pregnant women has not meaningfully increased in nearly a decade, and almost 25 percent of new pediatric infections are due to mothers newly acquiring HIV during the pregnancy and breastfeeding period.?

EGPAF has long argued for the prioritization of children and adolescents in the global HIV response. But for too long, the gaps between children and adults have widened with children lagging behind in diagnosis, treatment, and viral suppression.? The 2022 UNAIDS “In Danger” report showed that only 54 percent of children living with HIV have access to the treatment that will save their lives, compared to 74 percent of adults– and only 40 percent of children on treatment have achieved viral suppression compared to 66 percent of adults – figures that are far from the 95-95-95 targets needed to end AIDS by 2030.? We cannot let children continue to be left behind in the global AIDS response and expect to end AIDS.???

While these figures alarm me, I am encouraged by PEPFAR’s new five-year strategy – especially given that one of its core pillars is dedicated to advancing health equity for priority populations – among them children and adolescents.? With a “laser-focused” strategy that emphasizes the need to scale up PMTCT services, improve child-friendly HIV testing and treatments, and hold governments, partners, and even themselves accountable for results, PEPFAR is taking the bold leadership and decisive action needed to end AIDS.??

The fight to end AIDS in children, youth, and families is not over. If anything, the successes we’re seeing in Eswatini, the testimonies of Tatu and Faith, and the shifting course of PEPFAR demonstrates that an AIDS-free generation is in our sights. It is now our collective responsibility to deliver on this dream.?