Noncedo Khumalo grew up in a country with one of the highest HIV prevalence rates in the world, Eswatini—a country landlocked between South Africa and Mozambique.  The 24-year-old has overcome her fair share of difficult times to make ends meet. The recent US funding cuts have now put her future in question.     

“Young girls go for older men because when you finish high school and you want to pursue university, it becomes so hard for us, (economically) so many take a short cut,” she said. 

This was how many of her friends acquired HIV. They had little awareness of HIV or how to protect themselves, she explained. She said that condom use was low and there were many myths about HIV including that it is a curse, only affecting some families. 

Gender-based violence and sexual assault increase the risk of HIV infection. “In some cases, the abuser is a family member who is a bread winner, so women don’t report it,” said Ms Khumalo. 

Dr Nondumiso Ncube, Executive Director of Eswatini’s National Emergency Response Council on HIV/AIDS, says that while the country has managed to consistently reduce new HIV infections, new HIV infections remain stubbornly high amongst the younger population, particularly adolescent girls and young women who are three to five times more likely to be infected than their male counterparts. As a result, Dr Ncube says young women and girls are at the centre of the country’s new HIV strategy.

Ms Khumalo was determined not to be one of these statistics. Every day she walked almost six kilometres to attend school. She got a diploma in social work and became involved with Young Heroes, a local community organization, supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) three years ago.  

Through this initiative, Ms Khumalo provided peer counselling to adolescents and young women about how to prevent HIV and about broader sexual and reproductive health. She visited schools and communities, offering information and support to help young people protect themselves against HIV. 

Around 60% of Eswatini’s HIV response was funded by PEPFAR, however, in January the US cut all funding for HIV and issued a stop-work order for Young Heroes, forcing them to scale back their services. Ms. Khumalo lost her job. 

Now unemployed and unable to reach the vulnerable young people she once served, Ms Khumalo fears for the safety of young women and girls in her community, where transactional sex between older men and young women, often motivated by poverty, and sexual and gender-based violence remain widespread. “I’m scared for the future of young people,” she said. “Without these HIV programmes, who will protect them?” 

Nosipho Sacolo, a young woman living near the capital city of Mbabane expressed her fears.  “After managing to stay free from HIV for so many years, we no longer have the services to protect us.”  

UNAIDS Country Director for Eswatini, Nuha Ceesay says HIV prevention services—many of which are now closed—have been a game changer in Eswatini. 

“Eswatini has made huge progress in preventing new HIV infections, with new infections falling by 73% since 2010,” he said.

The country still has some challenges, according to him. More than 1300 young women and adolescent girls are infected every year. And nearly twice the number of women are living with HIV compared to men.

UNAIDS and partners are concerned that the abrupt halt to PEPFAR supported HIV prevention programmes could reverse the gains that have been made. 

A local network of non-governmental organizations (NGOs) working to ensure access to primary health care for people in Eswatini—including populations at high risk of HIV infection—CANGO, says the PEPFAR pause could have dire consequences for the country's HIV response, including a rise in new infections among young women and girls. "85 000 people were benefiting from the support, (now) all the people who were working in the sector, who were supporting our people living with HIV, are now sitting at home," said CANGO Executive Director, Thembinkosi Dlamini.

With PEPFAR’s support Eswatini had managed to ensure 93% of people living with HIV were on lifesaving antiretroviral treatment. This is one of Principal Secretary of the Ministry of Health, Khanyakwezwe Mabuza’s main concerns. “Treatment is not something you can skip,” he said. “We have to make sure that people continue to get their life-saving treatment.”

Meanwhile, Ms Khumalo is still hoping that the government and partners will not abandon the peer outreach workshops. Her livelihood and countless others depends on it as do the people they are helping to stay free from HIV.