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Meeting Report The International AIDS Society Educational Fund meeting Outcome report 26-27 March 2019 Esulwini, Kingdom of Eswatini Science, Community and Youth in the HIV Response in Southern Africa 1 Table of Contents 1. LIST OF ABBREVIATIONS AND ACRONYMS ............................................................................................... 3 2. INTRODUCTION ........................................................................................................................................ 6 3. BACKGROUND AND CONTEXT .................................................................................................................. 7 4. MEETING REPORT .................................................................................................................................... 9 4.1 EXECUTIVE SUMMARY ......................................................................................................................................... 9 4.2 OFFICIAL OPENING AND WELCOME ADDRESSES ..................................................................................................... 10 5. KEY MESSAGES FROM AIDS 2018 ........................................................................................................... 13 5.1 HIV PREVENTION AND TREATMENT UPDATES - PROF KENNETH NGURE, IAS GOVERNING COUNCIL REPRESENTATIVE FOR AFRICA 13 5.2 UPDATES ON CURE - PROF CAROLINE TIEMESSEN, NATIONAL INSTITUTE FOR COMMUNICABLE DISEASES .......................... 13 6. REGIONAL OVERVIEW OF THE HIV EPIDEMIC – UNAIDS, LAWRENCE MASHIMBYE ................................. 14 6.1 RECOMMENDATIONS ........................................................................................................................................ 14 7. PANEL DISCUSSION: HIV PREVENTION FOR ADOLESCENT GIRLS AND YOUNG WOMEN - INNOVATIVE WAYS FORWARD ................................................................................................................................................. 15 8. PANEL DISCUSSION: HIV, NON-COMMUNICABLE DISEASES AND TUBERCULOSIS - THE PATH FORWARD FOR TREATMENT AND PREVENTION .................................................................................................................... 17 9. PANEL DISCUSSION: REGIONAL ACTION TO REDUCE HIV STIGMA AND DISCRIMINATION ...................... 19 10. CONCLUSION .......................................................................................................................................... 22 11. ACKNOWLEDGEMENTS .......................................................................................................................... 23 12. APPENDICES ........................................................................................................................................... 24 12.1 PROGRAMME .................................................................................................................................................. 24 This report was developed in collaboration with the National Emergency Response Council on HIV and AIDS (NERCHA). The views expressed in the report do not necessarily reflect the views of the International AIDS Society. 2 1. List of abbreviations and acronyms AIDS Acquired Immune Deficiency Syndrome AGYM Adolescent Girls and Young Women AMICAAL Alliance of Mayors Initiative to Combat AIDS at Local Level ART Antiretroviral Therapy AP COUNTRIES Countries in the Asia-Pacific Region CANGO Coordinating Assembly for Non-Governmental Organizations CBO’s Community Based Organization CDC Centre for Disease Control DTG Dolutegravir DSD Decentralized Service Deliveries EBIS Eswatini Broadcasting and Information Services FAO Food and Agriculture Organization FLAS Family Life Association FSW Female Sex Workers GNP+ Global Network of People Living with HIV GAM Global AIDS Monitoring HIV Human Immuno-deficiency Virus IAS International AIDS Society ICAP International Centre for AIDS Care and Treatment Programs IDU’s Injecting Drug User INCMNSZ National Institute of Medical Sciences and Nutrition KP’s Key Populations LMIC Low and Middle-Income Countries MoH Ministry of Health MSM Men who have Sex with Men MSF Médecins Sans Frontières 3 NCD Non-Communicable Disease NGO Non-Governmental Organizations NHSP National Health Support Project NERCHA National Emergency Response Council on HIV and AIDS NICD National Institute for Communicable Diseases NSF National Strategic Framework NPTG National Prevention and Treatment Guidelines OVC Orphaned and Vulnerable Children PEPFAR President’s Emergency Fund for AIDS Relief PEP Post-Exposure Prophylaxis PLHIV People Living with HIV PrEP Pre-Exposure Prophylaxis PSI Population Services International PWID People who Inject Drugs PSHAC Public Sector HIV and AIDS Committee RFM Raleigh Fitkin Memorial Hospital SODV Sexual Offences and Domestic Violence SNAP Swaziland National AIDS Program SNNC Swaziland National Nutrition Council SRHR Sexual Reproductive Health Related SWAGAA Swaziland Action Group Against Abuse SWABCHA Swaziland Business Coalition on HIV and AIDS SWANNEPHA Swaziland Network of People Living with HIV/AIDS TDF Tenofovir Disoproxil Fumarate TB Tuberculosis TGM Transgender Men TGW Transgender Women UHC Universal Health Coverage 4 UEDF Umbutfo Eswatini Defence Force UNAIDS Joint United Nations Programme on HIV and AIDS UNFPA United Nations Population Fund UNICEF The United Nations Chidren’s Fund UNESWA University of Eswatini USSD Unstructured Supplementary Service Data WFP World Food Program WHO World Health Organization 5 2. Introduction The Kingdom of Eswatini successfully hosted the IAS Educational Fund Regional Meeting on Science, Community and Youth in the HIV Response in Southern Africa on 26 to 27 March 2019 in Ezulwini. The meeting was a post-conference workshop to the 22nd International AIDS Conference held in 2018 in Amsterdam, the Netherlands (AIDS 2018). This meeting was part of regional meetings organized around the world through the IAS Educational Fund programme to provide key scientific and policy content from the International AIDS Conference and the IAS Conference on HIV Science. During these meetings, targeted topics relevant for the local settings are discussed and recommendations are drawn up to drive a local call to action on the translation of the latest science on the discussed topics. The insightful two-day meeting was held in Ezulwini at the Royal Swazi Sun Convention Centre. During the workshop, key scientific and policy content from AIDS 2018 was shared, as well as implementation science priorities on prevention, treatment and stigma in Southern Africa. Specific topics included HIV prevention for adolescent girls and young women, non- communicable diseases and co-infections (TB) and strategies to reduce stigma. Scientific research results on these specific topics were also discussed for policy and programme improvements in the region. The meeting was attended by more than 150 participants including researchers, clinicians, healthcare workers, policymakers, international organizations’ staff, civil society representatives and representatives of key and vulnerable populations. Participants from Kenya, Malawi, South Africa, Zambia and Lesotho were present. Officials from the Kingdom of Eswatini also attended the meeting. Eswatini Prime Minister, Ambrose Dlamini and the Minister of Health, Lizzy Nkosi, and other cabinet ministers were present for the official opening. Participants were encouraged to self-reflect on their national, regional, local, and organizational situation and share knowledge and experiences with co-participants. Panel discussions led by sector experts also focused on targeted populations at risk including youth, men who have sex with men, transgender groups and sex workers. On the first day, the meeting was co-chaired by Dr Vusi Magagula, Director of Health in Eswatini’s Ministry of Health and Keratile Thabana from the National AIDS Commission- Lesotho. On the second, the meeting was co-chaired by Nokwazi Mathabela, NERCHA, from the Kingdom of Eswatini and Professor Kenneth Ngure, IAS Governing Council representative from the School of Public Health, Jomo Kenyatta University of Agriculture and Technology of Kenya. 6 3. Background and Context The rapid pace of scientific discovery in care for people living with HIV and AIDS requires clinicians and HIV service providers to remain continually up to date on research developments and best practices. While UNAIDS Estimates 2018 show that since 2010 there has been significant progress in controlling new HIV infections among adults in several countries in East and Southern Africa (ESA), other countries still lag behind. The percentage change of new HIV infections among adults in Eastern and Southern Africa between 2010 and 2017 showed increases in Botswana (+7%), Burundi (+25%), Ethiopia (+48%), Eritrea (+49%), Madagascar (+162%) (UNAIDS, Global AIDS Update, 2018). Sex workers, people who inject drugs and men who have sex with men and their partners contribute to 17% of new infections in ESA (UNAIDS special analysis, 2018). There is high HIV prevalence among sex workers and men who have sex with men (MSM) in most countries, yet condom use and knowledge of HIV status are below the recommended value in the majority of ESA countries according to data based on the 2018 Global AIDS Monitoring report. Broadly, insufficient attention is given to key populations despite extremely high prevalence (UNAIDS, Global AIDS Update, 2018). 7 Antiretroviral treatment coverage of children (0-14) has more than doubled (25%
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