Eswatini: A small kingdom setting a giant example of HIV prevention – opinion

November 28, 2025
by Peter Sands, Executive Director of The Global Fund

When I walked into Central Medical Stores in Eswatini this morning, the very first thing I saw were boxes.

They were neatly arranged in tall, orderly columns on pallet racks in the middle of the warehouse – a plain cardboard box, fastidiously labeled, indistinguishable from other medical shipments. Warehouse employees moved through them in quiet cells, entering data, conducting routine checks, and performing work that kept the health care system running. There was nothing to suggest that there was anything historic inside these chests or that they were the primary of their kind in Africa.

But inside those unassuming boxes was something extraordinary: the primary shipment of lenacapavir to reach on the continent, a twice-yearly HIV prevention shot developed by Gilead Sciences that might redefine how people protect themselves from infection. I arrived just a number of days after the team received the package.

The excitement amongst warehouse employees was moderate but palpable. Teams from the Ministry of Health, the National Emergency Response Council for HIV and AIDS (NERCHA), AIDS Healthcare Foundation Eswatini (AHF Eswatini), the Global Fund and the Children’s Investment Fund Foundation (CIFF), in addition to Gilead, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and other partners have spent years preparing for this moment – strengthening systems, developing implementation plans, harmonizing protocols and ensuring the readiness of supply chains. Eswatini, a rustic with one among the best HIV prevalence rates on the planet, has long taken a number one role within the HIV response, and this atmosphere was palpable within the magazine.

These boxes were greater than only a delivery. They represent a turning point in a rustic that saw the worst of the epidemic and fought tirelessly to reverse it.

Later that day in Manzini, I saw up close what this milestone meant.

The LaMvelase Clinic, run by AHF Eswatini, is the country’s largest treatment center and one among the busiest HIV testing, treatment and prevention centers. By noon, the courtyard was packed: adolescent girls at school uniforms, young men in work boots, moms holding young children, members of key populations who often face stigma elsewhere. The clinic has turn into a spot of trust – a rare space where people can seek care without judgment.

In one among the offices, a nurse described her typical day. He sees dozens of clients with very different needs: HIV testing, screening for venereal diseases, family planning, counseling. Many people come because they’ve heard that the clinic offers compassionate and confidential care and that it provides real prevention options.

What struck me most was how deeply the staff understood the realities that shape people’s decisions. In Eswatini, as in lots of places, every day oral preventive pills will be difficult to cover. For people experiencing gender-based violence or power imbalances in relationships, asking their partner to make use of a condom could also be dangerous or just unimaginable. The stigma will be enough to forestall someone from carrying medications in any respect.

In this context, a long-acting injection taken twice a yr just isn’t only convenient – it’s liberating. It gives people, especially young women, a discreet and personal strategy to protect themselves.

Upstairs, Dr. Nkululeko Dube reflected on how far this country has come. He remembers a time when antiretroviral drugs were briefly supply, when hospital wards were stuffed with people dying from treatable infections, when families sold livestock and furniture in exchange for drugs that arrived too late. Today, Eswatini has exceeded UNAIDS 95-95-95 targets and built one among the world’s strongest HIV treatment programs.

But it also jogged my memory how fragile progress will be. A small number of individuals still have no idea they’re HIV positive or usually are not yet receiving treatment. Without decisive preventive motion, this persistent gap could cause recent infections and threaten the gains of the last decade.

That’s why the boxes I saw within the warehouse are so necessary to me.

As I left the AHF clinic, I assumed in regards to the journey these vials would take: from Central Medical Stores to facilities across the country; from trained hands to people making decisions about their future; from scientific innovation to the truth we live in.

Warehouse employees inspect the delivery of lenacapavir to Central Medical Stores in Eswatini, the primary such delivery to the African continent. Photo: The Global Fund/Daniel Toro

Eswatini just isn’t alone in the intervening time. Across sub-Saharan Africa, momentum is gaining momentum. Zambia has also just received its first shipments, and 7 other countries are preparing to receive their first shipments of lenacapavir between now and early next yr – a robust demonstration of regional leadership and a dramatic shift from the historical pattern where the world’s hardest-hit countries received innovation last, not first.

For the primary time, a cutting-edge HIV prevention tool is being introduced in low- and middle-income countries almost concurrently with high-income countries. This in itself is a breakthrough, as previous HIV prevention drugs took a mean of 5 years to turn into available in these facilities after evidence of their effectiveness first emerged.

As the primary doses arrive, a brand new possibility is taking shape: a future during which scientific advances reach people in all places — not years later, but now.

But this moment can also be a test. Together with PEPFAR, we’ve got set a daring goal: to succeed in as much as two million individuals with long-acting pre-exposure prophylaxis (PrEP) over the subsequent three years. Achieving this could significantly reduce the number of recent infections in countries with the best burden. But without sustained investment – ​​from donors, governments and partners – this momentum risks stalling as we approach what could possibly be a decisive step towards ending AIDS.

Preventing infections is now much more cost effective than treating them throughout your life. It strengthens health systems, accelerates the trail to sustainable national financing and protects the extraordinary progress that countries like Eswatini have achieved. But success doesn’t just rely upon funding – it is determined by trust. Trust clinics that provide stigma-free care. Trust healthcare professionals to make sure medication availability. Trust global partners to remain the course.

What I bring back from Eswatini is the memory of those easy boxes within the warehouse – unusual on the surface, stuffed with possibilities on the within. I carry with me the commitment of the Manzini nurse, the determination of Dr. Dube, the professionalism of the warehouse team and the leadership of the Ministry of Health and NERCHA.

If we act now – boldly, together and with communities at the middle – the moment I witnessed in Eswatini may in the future be remembered because the moment the world began to complete its work: the moment ending AIDS went from an aspiration to an achievable reality.

This article was originally published on Forbes.