HIV/AIDS in Eswatini

HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).^[1][2]

The HIV/AIDS epidemic in Eswatini has contributed largely to high mortality rates among productive Swazi age groups. Over the long-term, the epidemic and its respondents induced major cultural changes surrounding local practices and ideas of death, dying, and illness, as well as an expansion of life insurance and mortuary service markets and health-related non-governmental organizations.^[3]

To help Eswatini and other countries across the world address HIV and AIDS, the Joint United Nations Programme on HIV/AIDS (UNAIDS) developed the 95-95-95 testing and treatment targets. Local and national efforts worked towards the following three goals by 2020: 90% of people living with HIV will be aware of their HIV-positive status; 90% of those who have been diagnosed with HIV will continuously and consistently receive antiretroviral therapy (ART); and 90% of all people who are receiving ART will have viral suppression.^[4] Although Eswatini has nearly achieved the testing and treatment targets of the 90–90–90 model,^[4] certain populations carry a disproportionate burden.^[5] The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has identified priority and key populations as the most vulnerable to HIV infection, due to epidemiological, socioeconomic, and environmental and contextual factors.^[5] In particular, PEPFAR identified three priority populations in Eswatini as the focus of HIV/AIDS prevention and treatment programs: adolescent girls and young women (aged nine to 29), men aged 15 to 39, and orphaned and vulnerable children (OVC). PEPFAR additionally identified three key populations: men who have sex with men (MSM), female sex workers (FSW), and transgender people.