On World AIDS Day, we commemorate the remarkable achievements of IPPF Member Associations in their unwavering commitment to combating the HIV epidemic. Their tireless efforts have significantly expanded access to prevention, sexual and reproductive health services, and rights, transforming the lives of countless individuals worldwide. One of the key achievements of IPPF Member Associations has been their ability to expand access to essential sexual and reproductive health services through innovative approaches to HIV prevention, testing, and treatment. By establishing comprehensive service delivery networks and building the capacity of healthcare providers, they have ensured that individuals can access the care they need, regardless of their geographic location or socioeconomic status.   Eswatini has made significant strides in advancing sexual and reproductive health and rights (SRHR). The recent introduction of the dapivirine vaginal ring (DVR) and the potential availability of CAB-LA mark a pivotal moment in the country's HIV prevention efforts. The Dapivirine Vaginal Ring (DVR): A Discreet and Effective Solution The DVR, a discreet and user-friendly monthly ring, has revolutionized HIV prevention. By eliminating the need for daily pill-taking, it has significantly improved adherence rates and reduced the stigma associated with HIV prevention. This groundbreaking innovation has empowered individuals to take control of their sexual health and make informed decisions. The adoption of the dapivirine vaginal ring in Eswatini marked a pivotal step in HIV prevention efforts as the ring offered a discreet and effective alternative to traditional methods. It has offered individuals more options to safeguard their health, expanding accessibility and flexibility in HIV prevention strategies. One of the key contributions that came with the Dapivirine vaginal ring is its monthly application, which has eliminated the need for daily adherence associated with oral PrEP. This simple innovative prevention method has brought in a huge contribution to the Kingdom’s HIV prevention efforts as it has reduced the strict time adherence, enhancing the overall effectiveness of the intervention. In rural areas, the discreet nature of the dapivirine vaginal ring plays a significant role in mitigating the stigma surrounding HIV prevention. Unlike oral medication that may be visible to partners and family members. This discrete form of prevention will encourage more individuals to consider and utilize PrEP without fear of judgement or discrimination.

Eswatini (27 August 2024) - IPPF’s Member Association in Eswatini, the Family Life Association of Eswatini (FLAS), is soon to roll out the first women-controlled HIV prevention product, the dapivirine vaginal ring (DVR). FLAS will be among the first organisations to offer the DVR outside implementation or pilot studies anywhere in the world. Made of flexible silicone, the ring is inserted into the vagina by a woman and slowly releases the antiretroviral drug dapivirine in the vagina over a one-month period, helping to reduce a woman’s risk of acquiring HIV. In 2023, in sub-Saharan Africa, women and girls accounted for 62% of all new HIV infections and every week, 3,100 adolescent girls and young women aged 15–24 years became infected with HIV. Therefore, there continues to be an urgent need for HIV prevention methods that females can use to protect themselves. The DVR is a product women can control themselves and use without the knowledge or consent of their partners, unlike condoms, which men often refuse to use. The DVR is inserted into the vagina and left for a one-month period, where it can then be replaced each month for continued protection. Unlike daily oral PrEP, the DVR does not rely on remembering to take a pill each day and is also discreet as it stays inside the vagina throughout the month. The DVR does not prevent pregnancy or other sexually transmitted infections (STIs), so women choosing to use the ring may want to consider combining it with condoms and methods of contraception. The availability of the DVR is an exciting step in supporting women’s autonomy and choice in HIV prevention. This need for women-controlled HIV prevention products has long been advocated for, with the African Women Prevention Community Accountability Board launching the HIV Prevention Choice Manifesto in early 2023. The Choice Manifesto prioritises the principle of choice to ensure that women and girls have the right to choose which HIV prevention methods work for them. Currently the ring is available at selected facilities through implementation studies across six countries in East and Southern Africa; South Africa, Kenya, Zimbabwe, Lesotho, Eswatini, and Uganda.  Diantha Pillay, Associate Director for Product Access for IPM South Africa NPC (an affiliate of the Population Council), said:  “It is encouraging to see the efforts made by FLAS and IPPF to support the choice agenda for HIV prevention for women and make effective HIV prevention methods, like the DVR, more widely accessible in a real-world setting. We hope this can pave the way for introduction of future pipeline products that speak to the needs of women.” The Population Council is currently developing a longer duration DVR that women would use for three months versus one month to significantly lower annual product costs and offer women a more convenient option to protect themselves. Thabo Lizwe Masuku, Programs Manager for FLAS, said: “Women have been telling us for a long time that  there is a need for a variety of methods for HIV prevention, since they are highly exposed. For women and girls to truly have choice about what works for them as they navigate different stages and circumstances of their lives, policy makers, donors, governments and implementers must ensure the mix of HIV prevention methods are available, accessible, and affordable. Access to the ring through our clinics in Eswatini now gives women choice and options to protect themselves against HIV.” IPPF is committed to ensuring that choice in HIV prevention is a reality for women and girls and aims to roll out the dapivirine vaginal rings at as many Member Associations as possible, as well as offer other HIV-prevention choices, as we work alongside our partners towards a future free of HIV in Africa and beyond. For more information and to speak to staff in Eswatini, please email [email protected]   Notes: The dapivirine vaginal ring has been recommended by the WHO since January 2021. (25) In clinical trials, the  ring was shown to reduce HIV infection by 35% in The Ring Study (26,27) and 27% in the ASPIRE Study. (28,29) Recent open-label studies show greater adherence to the ring, and modelling data suggest that HIV risk could be reduced by about 50%. (30) The dapivirine ring has received regulatory approval from the European Medicines Agency (EMA), as well as from local medicines regulators in Namibia, South Africa, Kenya, Zimbabwe, Uganda, Zambia, Malawi, Rwanda, Eswatini, Lesotho, Botswana and is currently under regulatory review in a number of other countries Our Member Associations (MAs) that provide clinical services are required to provide comprehensive SRH services through our Integrated Package of Essential Services (IPES) which include services for sexual health and well-being, contraception, abortion care, sexually transmitted infections (STIs)/reproductive tract infections (RTIs), HIV, obstetrics and gynaecology, fertility support, and sexual and gender-based violence. IPPF’s new five-year strategy, Come Together, focuses on expanding choice. In support of this, we recently launched a special programme to expand our HIV prevention options, which aims to integrate the newest HIV prevention methods – the vaginal ring and injectable PrEP - into our comprehensive sexual and reproductive health services.  IPPF’s IMAP Statement on Biomedical HIV Prevention can be found here. About the Family Life Association of Eswatini (FLAS)  For over 30 years, the Family Life Association of Eswatini (FLAS) has provided sexual and reproductive health (SRH) services to the people of Eswatini (formally Swaziland). While family planning, antenatal, post-natal and post-abortion care form a key part of FLAS services, there’s a significant focus on HIV and AIDS programmes. Eswatini has some of the highest HIV and AIDS prevalence rates in the world. As a result, the prevention and management of HIV and AIDS, the provision of voluntary counselling and testing (VCT), and the prevention of mother to child transmission (PMTCT) are central to FLAS’s work. FLAS has 15 service points, including three permanent clinics and three mobile facilities, staffed by a permanent team of 40 staff backed by 230 volunteers, 180 Youth Action Movement members and 29 peer educators. About the International Planned Parenthood Federation (IPPF) IPPF is a global healthcare provider and a leading advocate of sexual and reproductive health and rights (SRHR) for all. Led by a courageous and determined group of women, IPPF was founded in 1952 at the Third International Planned Parenthood Conference. Today, we are a movement of 150 Member Associations and Collaborative Partners with a presence in over 146 countries.Our work is wide-ranging, including comprehensive sex education, provision of contraceptives, safe abortion, and maternal care and responding to humanitarian crises.  We pride ourselves on being local through our members and global through our network. At the heart of our mission is the provision of – and advocacy in support of – integrated healthcare to anyone who needs it regardless of race, gender, sex, income, and crucially no matter how remote. Our services are available to all, and reach the most marginalised groups in societies, including key and priority populations, youth, and people with disabilities. Most of our MAs have special programs to engage youth (10-24) inside and outside of school settings. Because our clinics offer comprehensive services, attending our clinics is non-stigmatizing and does not label people as having a particular disease or membership to a particular group. This model of services that are integrated and open to all, embedded in indigenous, locally owned organisations, is ideal for ensuring that the most vulnerable and marginalised groups can access the HIV prevention services they need. About the Population Council The Population Council is a leading research organization dedicated to building an equitable and sustainable world that enhances the health and well-being of current and future generations. The Council transforms global thinking on critical health and development issues through social science, public health, and biomedical research. We generate ideas, produce evidence, and design solutions to improve the lives of underserved populations around the world.  

IPPF provides comprehensive sexual and reproductive health care to clients around the world. HIV testing, prevention, and treatment services are essential parts of our integrated sexual and reproductive health care package. To expand the choices individuals have to protect themselves from HIV, IPPF is excited to announce a special program to provide the newest methods of HIV prevention - injectable PrEP (a 2-monthly injection of cabotegravir-LA) and the vaginal ring (a monthly vaginal ring of dapivirine), as well as expanding where oral PrEP is offered. This program is being launched through a consortium of IPPF Member Associations called the Consortium to Advance Access to new HIV Prevention Products (CAAPP) - led by Family Planning Association of India, and including the Family Life Association of Eswatini, Lesotho Planned Parenthood Association, Family Planning Association of Malawi, Federation of Reproductive Health Associations, Malaysia, Family Planning Association of Nepal, and Planned Parenthood Association of Thailand. We hope this program will increase access to the number of ways people can protect themselves from HIV, supporting individual's choice to find an HIV prevention method that works for them.

Mankayane, Swaziland - On 1 December, IPPF Director General, Tewodros Melesse, made an address on the occasion of World AIDS Day in the Kingdom of Swaziland along with His Excellency the Right Honourable Deputy Prime Minister, Mr Paul Dlamini, Honourable Minister of Health Ms Sibongile Ndlela Simelane, United Nations Resident Coordinator, Mr Israel Dessalegne, and the United States of America Ambassador to Swaziland, Ms Lisa Peterson. "It is an honour and a privilege to be commemorating World AIDS Day with you, the Swazi people. Every year, World AIDS Day provides us with the opportunity to take stock of how far we have come since the early days of the epidemic. I’d like to begin by taking us 30 years back in time, which was 1986. That year, IBM unveiled the first laptop. Mobile phones were the size and weight of large bricks. In apartheid-era of South Africa, Nelson Mandela was behind bars; and here in Swaziland, the country recorded its first case of HIV/AIDS. Many of you here today will agree with me when I say that, while Swaziland has not been immune to the many ways in which the world has changed over the past thirty years, it is the HIV epidemic more than anything else that has shaped this country during that time. For those of you who have lived through the epidemic, you will remember all too well the fear and the stigma that ran through this country and many African countries. You will remember how little we knew about HIV, and about how to prevent it. People living with HIV at this time deserve to be honoured. You showed us the strength and determination to fight for change. You were brave and angry, and gave hope to others. As I stand in front of you, I am keenly aware that there is not a single person here whose life, one way or another, has not been affected by HIV, and that all young people here today have never seen a world without HIV. The young people are the future but we have to remind ourselves that there is no future if we don’t invest in prevention. Many of you have loved ones who were taken from this world before their time. You grieved and continue to grieve the loss of brothers, sisters, mothers, fathers, children, grandchildren, friends, colleagues, and many others. These vibrant souls, remain with us always, in our hearts and in our minds, and give us energy to continue in the future. We can now take some comfort from the fact that the picture has changed dramatically in these past thirty years. Most significantly, people living with HIV are now living longer, healthier, and productive lives well into their old age, thanks to the availability of antiretroviral treatment that has transformed HIV infection into a chronic, manageable condition. I would like to take this moment to commend the Government of the Kingdom of Swaziland for its commitment to providing antiretrovirals free to all who need treatment. The impact of this cannot be underestimated. AIDS-related mortality has reduced by drastically and accordingly, life expectancy has now rebounded. The transmission of HIV from mother to child is close to being eliminated along with syphilis. And overall, Swaziland has also begun to see a downward trend of new HIV infections, especially among young people. ‘Now is not the time to be complacent’ These are remarkable successes, and Swaziland has established a strong foundation. Critically, this is a foundation upon which to build - not to rest. We cannot risk becoming complacent, as HIV remains the greatest public health and socio-economic challenge facing this country. Importantly, our response must be integrated with other key challenges. We know that there is a high unmet need for family planning, leading to high levels of unwanted pregnancy; we know that maternal and infant mortality is unacceptably high; and we know that the overall knowledge of sexual and reproductive health is exceptionally low among young people. ‘There is a serious prevention gap’ This situation is not unique to Swaziland. UNAIDS is raising the alarm about the global picture and what it calls the ‘prevention gap’. Efforts to meet the global target of ending AIDS by 2030 are off track and progress is at risk of stalling. The global community warns that if there is a resurgence of HIV, the epidemic will be impossible to control. This cannot be allowed to happen. Primary prevention has been and will continue to be an essential component of the HIV response. To attain an AIDS-free generation, we need new solutions, new innovations and, importantly, we need to reinvigorate our prevention efforts. Prevention saves lives, saves budget, and increases productivity. ‘Hands Up for HIV Prevention’ Today, people across the global are raising their hands to HIV prevention this World AIDS Day. There is no ‘one size that fits all’ and we must pay special attention to those that continue to be left behind. Young women and girls are at a particularly high risk of HIV infection. They need information and the freedom to make free and informed decisions about their sexual and reproductive health; they need access to effective HIV and sexual and reproductive health services; they need services that are youth-friendly; and they need gender-based violence to be eliminated and gender inequalities to be eradicated. We are also leaving key populations behind – including sex workers, people who inject drugs, transgender people, and men who have sex with men. Many countries in the world push these populations to the margins of society. It is essential that our prevention efforts bring these populations forward. To end HIV, no one can be left behind. I must commend the efforts to ensure the meaningful engagement of these populations; and by taking steps to remove barriers to access services. At the root of all of our prevention efforts is a recognition that the HIV epidemic is being fuelled by inequalities and prejudices entrenched within the legal, social and economic structures of society. Poverty, sexism, homophobia, and other forms of discrimination – are well known barriers to ending HIV. To ensure that everyone can live a life of hope, with dignity, respect and meaning – people must be free to make choices about their sexuality and well-being, in a world without discrimination. ‘We need to work together to give hope’ I truly believe that we will not see an end to HIV unless we work together, be it at the local level, the regional level or at the global level. The remarkable successes that we have witnessed have been the result, not of a single actor, but of a chorus of voices that have called out in unison for better access; and that demanded respect, care and compassion. Civil society in particular has an incredible track record of mobilizing the required response. It has been instrumental in changing public attitudes and perceptions, and has also be mobilised to address barriers that prevent people from realising their right to health. In conclusion, the power to end HIV and AIDS does not lie with a single individual, with a single organisation, or government structure. When we leverage the unique skills that we all bring to the table, we will reach our goal of ending AIDS both in Swaziland and the world. This power is ours and the time to act is now. If we work together as Obama says, ‘Yes, we can!’, then we can do it. I leave you with a story. Like FLAS, I visited the IPPF association in Iran who are working with underserved communities, such as sex workers, and integrating in society. I asked one young woman, ‘if you were God for fifteen minutes, what would you do?’ She said, ‘I would give hope, if you have hope, you can overcome your challenges’. We need to keep that hope and give that hope to the people. We can give that hope by doing it together."

This year to mark World AIDS Day I travelled to Swaziland in southern Africa. I saw and heard first hand stories from a country that has made huge inroads in its efforts to curtail the HIV epidemic but it also led me take stock. The @ippf Director General with the Minister of Health and Dudu Simelane former Executive Director at FLAS, now with @IPPFAR #WorldAIDSDay pic.twitter.com/1xkvEkp3tT— FLAS | Temndeni (@FLAS79) December 1, 2016 It made me think about the 78 million people who have become infected with HIV and remember the 35 million who have died from AIDS-related illnesses. Great progress has been made in dealing with the HIV epidemic, especially with the increasing number of people living with HIV on treatment but we cannot become complacent as the decline in new HIV infections among adults has stalled. Globally, critical attention needs to be paid to reinvigorate HIV prevention efforts, with young people at the front and centre of the response. World AIDS Day is a good day for us to reflect and re-state our commitments to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals. At the International Planned Parenthood Federation (IPPF) we remain committed to an integrated HIV and sexual and reproductive health (SRH) response. Of particular importance are young women and adolescent girls. According to UNAIDS nearly 7500 young women aged 15-24 years acquired HIV every week in 2015, the vast majority in southern Africa. In Swaziland, the HIV prevalence among young women aged 15-19 years is 10 per cent compared with 2 per cent among young men of the same age. The transition to adulthood is a particularly challenging time for girls in sub-Saharan Africa, who face a high risk of HIV infection and other sexually transmitted infections, unwanted pregnancies, and violence. This heightened vulnerability is intricately linked to deeply entrenched gender inequalities, harmful gender norms, and structures that limit women and girls from reaching their full potential. Young people within key populations also face particular HIV risks, including young men who have sex with men, young people who sell sex, young transgender people, and young people who inject drugs. This is often due to lower knowledge of risks or lower ability to mitigate those risks compared with their older, more experienced counterparts. These young people are often more vulnerable to discrimination, bullying, harassment, family disapproval, social isolation and violence. Also, young key populations often represent overlapping vulnerabilities and cannot be seen in discrete boxes, requiring a response that recognizes young people in all their diversity. This time last year, IPPF signed a memorandum of understanding with UNAIDS to ‘Fast-Track’ access to HIV prevention, testing and treatment options and SRH services by 2020. Under this partnership, IPPF is committed to deliver concrete actions to reach the most underserved people and ensure young people have the knowledge and means to protect themselves from HIV. Within IPPF’s Strategic Framework 2016-2022, we have committed to deliver 1.5 billion rights-based SRH services, including HIV, and reach 500 million young people with quality comprehensive sexuality education (CSE) programmes. The power to end HIV does not lie with a single individual, with a single organization, or government actor. When we leverage the unique skills that we all bring to the table, we will reach our goal of ending AIDS both in Swaziland and the world. This power is ours and the time to act is now. Director General of the @ippf joining the #handsupforhivprevention campaign in #Swaziland during the #WorldAIDSDay commemoration. pic.twitter.com/aYTTK1WK8G— FLAS | Temndeni (@FLAS79) December 1, 2016

This programme addresses critical challenges faced by young women around sexual health and sexuality. It has produced a range of advocacy, education and informational materials to support research, awareness-raising, advocacy and service delivery.    Girls Decide is about the sexual and reproductive health and rights of girls and young women. Around the world, girls aged 10 to 19 account for 23% of all disease associated with pregnancy and childbirth. An estimated 2.5 million have unsafe abortions every year. Worldwide, young women account for 60% of the 5.5 million young people living with HIV and/or AIDS. Girls Decide has produced a range of advocacy, education and informational materials to support work to improve sexual health and rights for girls and young women. These include a series of films on sexual and reproductive health decisions faced by 6 young women in 6 different countries. The films won the prestigious International Video and Communications Award (IVCA). When girls and young women have access to critical lifesaving services and information, and when they are able to make meaningful choices about their life path, they are empowered. Their quality of life improves, as does the well-being of their families and the communities in which they live. Their collective ability to achieve internationally agreed development goals is strengthened. Almost all IPPF Member Associations provide services to young people and 1 in every 3 clients is a young person below the age of 25. All young women and girls are rights-holders and are entitled to sexual and reproductive rights. As a matter of principle, the IPPF Secretariat and Member Associations stand by girls by respecting and fulfilling their right to high quality services; they stand up for girls by supporting them in making their own decisions related to sexuality and pregnancy; they stand for sexual and reproductive rights by addressing the challenges faced by young women and girls at local, national and international levels.

Integra is a 5-year research initiative in Kenya, Malawi and Swaziland. It aims to reduce HIV infection, HIV-related stigma and unintended pregnancy. IPPF implements the Integra Initiative with support from the Bill and Melinda Gates Foundation and in collaboration with the London School of Hygiene and Tropical Medicine and the Population Council.  

This publication shares the experiences of people living with HIV. Men and women from Ethiopia, Mozambique and Swaziland talk about HIV-related stigma and describe their courage, inspirations, suffering, resilience and determination to trigger change. Their stories demonstrate how stigma and discrimination can hinder access to vital support and care and the prevention, testing and treatment of HIV. National and international organizations working on HIV-related issues have an immense responsibility towards people living with HIV, to change the unjust reality revealed by these personal stories into a better one. We must increase our efforts towards ensuring everyone enjoys a dignified, stigma-free life – one where every human being is valued and free of discrimination.