Empowering Women in Eswatini: The Role of PrEPs in Combating the HIV Epidemic

2023-10-23 03:43:00

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Nowhere in the world is the HIV rate higher than in Eswatini. In the small kingdom in southern Africa, one in four adults is HIV-positive. But that might change soon.

On a meadow next to the village soccer field in a small settlement south of the capital Mbabane, 16 young women sit on the ground in a circle. They are there for an HIV prevention course, and they want to find out one thing above all: “We want to know how PrEPs work,” says one course participant.

Caption: HIV prevention course for women. SRF/Anna Lemmenmeier

PrEP is the so-called “pre-exposure prophylaxis”, the preventative taking of medication to protect once morest HIV. PrEPs are considered a game changer in HIV research in Eswatini. They enable women to protect themselves without having to rely on men’s cooperation.

Poverty and patriarchy

Unlike in other regions of the world, women in sub-Saharan Africa are infected with HIV much more often than men.

Women cannot negotiate condom use.

According to UNAIDS, six out of seven newly infected people aged 15 to 19 last year were women. There are many reasons for this, but ultimately it’s regarding poverty and patriarchy, says Sindy Matse, head of the national AIDS program in Eswatini: “The women cannot negotiate the use of condoms.”

Caption: Sindy Matse is head of the national AIDS program in Eswatini. SRF/Anna Lemmenmeier

Some of them are exposed to domestic violence or, out of poverty, engage in sex in return for food, clothes or money. “And usually the men are around ten years older, so there is a power imbalance.”

HIV on the decline

Today around 220,000 people in Eswatini are living with HIV. That’s around 26 percent of residents who are older than 15 years. Eswatini has made great progress in containing HIV, said Sindy Matse from the national AIDS program. While around 14,000 people in Eswatini were newly infected with HIV in 2010, today there are only around a third as many.

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Caption: HIV prevention is omnipresent in Eswatini. SRF/Anna Lemmenmeier

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Legend: The country in southern Africa is struggling with a high HIV infection rate. SRF/Anna Lemmenmeier

The number of AIDS deaths fell from around 10,000 in 2005 to 2,370 last year. Eswatini is the first country in Africa to achieve the global “95-95-95” target to end the HIV epidemic. Today, 94 percent of people infected with HIV in Eswatini know they are HIV positive, 97 percent of those are taking their HIV medication and 96 percent of those are no longer contagious.

Stigma and prejudice

Pre-exposure prophylaxis (PrEP) will also play an important role, says the HIV expert. The number of people taking PrEPs has increased fifteen-fold in Eswatini in the last five years.

However, one small detail still complicates the widespread use of prophylaxis: the pills look exactly the same as the medication you take if you are HIV-positive. An obstacle for the young women in the HIV prevention course.

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Legend: The HIV prevention courses are intended to inform women in particular regarding how they can protect themselves from HIV without having to rely on men’s cooperation. SRF/Anna Lemmenmeier

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Legend: The HIV prevention courses are intended to inform women in particular regarding how they can protect themselves from HIV without having to rely on men’s cooperation. SRF/Anna Lemmenmeier

Friends and family may think you are HIV positive. “You should make a powder or a smaller pill,” complains one course participant. HIV infections in Eswatini are declining. But patriarchal structures, poverty and stigma continue to be effective brakes until the end of the epidemic.

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