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Kitchen PJ, Bärnighausen K, Dube L, Mnisi Z, Dlamini-Nqeketo S, Johnson CC, Bärnighausen T, De Neve JW, McMahon SA. Expansion of HIV testing in Eswatini: stakeholder perspectives on reaching the first 90. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:186-197. [PMID: 32938320 DOI: 10.2989/16085906.2020.1790399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Achieving the United Nations' 90-90-90 goals has proven challenging in most settings and the ambitious 95-95-95 goals seem even more elusive. However, in Eswatini - a lower-middle-income country in sub-Saharan Africa with the highest HIV prevalence in the world - an estimated 92% of people living with HIV know their status. We conducted 26 in-depth interviews with stakeholders from policy, implementation, donor, local advocacy and academic sectors to elicit the facilitators and inhibitors to HIV testing uptake in Eswatini. Background data and related reports and policy documents (n = 57) were also reviewed. Essential facilitators included good governance via institutional and national budgetary commitments, which often led to swift adoption of globally recommended programs and standards. The integration of HIV testing into all points of care fostered a sense that testing was part of routine care, which reduced stigma. Challenges, however, centred on social norms that disadvantage certain groups with high ongoing HIV risk (such as key populations, adolescent girls and young women), a heavy reliance on external donor funding, and stigma that had subsided but nevertheless persisted. Amid concerns about whether the 90-90-90 targets could be achieved by 2020, the experience of Eswatini provides tangible insights into factors that have successfully influenced HIV testing uptake and may thus prove informative for other countries.
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Affiliation(s)
- Philip J Kitchen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | | | | | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Africa Health Research Institute, Mtubatuba, South Africa.,Center for Population and Development Studies, Harvard University, Cambridge, MA, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jan Walter De Neve
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
Epidemics, such as HIV in the early 1980s and Ebola in 2014, inspire decisive government investment and action, and individual and societal concern, sometimes bordering on panic. By contrast, endemic diseases, such as HIV in 2017 and tuberculosis, struggle to maintain the same attention. For many, the paradox is that endemic disease, in its totality, continues to impose a far higher public health burden than epidemic disease. Overall, the swift political response to epidemics has resulted in success. It has proven possible to eradicate epidemic diseases, often without the availability of vaccines and other biomedical technologies. In recent times, only HIV has made the transition from epidemic to endemic, but diseases that have existed for centuries continue to cause most of the infectious disease burden.
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Affiliation(s)
- Graham F Medley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK.
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
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