Please allow me to begin today by first paying my respects to
His Majesty King Letsie III
Her Majesty Queen Masenate
The Right Honorable the Prime Minister
The Honorable Speaker of the National Assembly
The Honorable President of the Senate
Her Ladyship the Chief Justice
The Acting President of the Court of Appeal
The Honorable Deputy Prime Minister
Honorable Members of his Majesty’s Cabinet
Their Excellencies Heads of Diplomatic Missions and UN Agencies
Ladies and Gentlemen
I feel honored to be part of this year’s World AIDS Day commemoration, my third in Maseru. As I stand here today, I feel increasingly optimistic that we – all of us, working together, because this is a shared endeavor – are making real, substantial progress in the fight against this terrible epidemic. Over the past year, I have witnessed engaged and visionary leadership and innovative policy changes that are having a positive, lasting impact on the lives of many Basotho. I will talk about that progress in a moment, but let me first say a few words about what we at the U.S. Embassy did to celebrate this year’s World AIDS Day.
I must say I thought it was a great idea when the government encouraged all of its partners to celebrate this day in a very different way than in the past, by volunteering our time to help those affected by the AIDS epidemic. And, judging by the inspiring photo exhibition we saw earlier, a number of organizations and individuals embraced that call to service. I am very proud of our team at the U.S. Embassy, which also rose to that challenge. Many of my Embassy colleagues and I spent a morning volunteering at St. Cecilia’s home for orphans and vulnerable children on the outskirts of Maseru. The orphanage is run by an amazing Catholic priest, Father Mahlaku, who ensures the 68 children under his care are well fed and well-clothed, and get the love and emotional support they need to thrive. Our team painted several rooms, donated food and supplies and spent time with the children living there, who have faced challenges I suspect are unimaginable to many of us here today.
Two of the children had an especially powerful impact on me. The first was Matokelo, a 6-year-old girl who looked no older than three, with a round face and a wonderful twinkle in her eyes. She followed me around all morning with a huge smile, giggling at everything I said. I was stunned to learn that Matokelo had been found abandoned six months earlier, walking on all fours because her spine had been ravaged by tuberculosis, and she was starving. What a difference six months of love and care have made in her life. And then there was 16-year-old Retŝelisitsoe (“Retsa-disEETS-way”), who told me matter-of-factly that he had no mother or father, but that his grandmother visited him from time to time. There was no other family he could think of. He was smart and curious, but there was an unmistakable sadness in his eyes. The children at St. Cecilia’s were remarkable for their spirit and their resilience. They also were a compelling reminder of the human toll that HIV/AIDS has taken in Lesotho, and why our work against this epidemic matters.
And, on that front, there is reason to be optimistic, given some notable achievements Lesotho has made this year in the fight against HIV/AIDS. Let me mention several of them.
First, the government of Lesotho took the bold step earlier this year to launch Test and Treat, the first country in sub-Saharan Africa to do so. That was not an easy policy decision, given the potential financial implications, but it is already making a dramatic difference. With this change, every Mosotho who tests positive is now eligible to begin treatment right away, instead of having to wait for months or years until their CD4 count drops to a certain level. As a result, we have seen a substantial increase in the numbers of HIV-positive Basotho on treatment in the five target districts supported by the U.S. President’s Emergency Plan for AIDS Relief (or PEPFAR). In 2014, when I gave my first World’s AIDS Day speech, only 35% of HIV-positive Basotho were on anti-retroviral treatment (or ART). That number increased to 42% in 2015. And now, in 2016, 57% of HIV-positive individuals are on ART in the five PEPFAR supported districts. And let me give you two other important numbers: 600,000 and 33,000. 600,000 Basotho have been tested this year, more than in any previous year, and 33,000 more HIV-positive Basotho are on treatment now than was the case last year. That is impressive progress, and a testament both to the impact of Test and Treat and intensive efforts to get as many people tested and on treatment as possible. And it suggests that our ambitious goal of achieving 80% coverage of ART in those five districts over the next year is within reach.
The launch of Test and Treat has been accompanied by other meaningful policy changes and innovations. For instance, Lesotho has moved from a focus on a patient’s CD4 count to testing the level of virus in their blood. Viral load testing indicates whether treatment is working and, if it is, the patient is unlikely to transmit the HIV virus to others. PEPFAR has helped Lesotho expand the national capacity for viral load testing by funding viral load machines in Maseru and Mafeteng, and one planned soon for Leribe. These three machines will make it possible to test all HIV-positive patients on ART. Already, we are seeing the results of this important effort. The number of viral load tests over the last year increased dramatically from 5500 in the first quarter to 56,000 in the last quarter.
Another important innovation has taken place in the way antiretroviral medication is distributed and monitored. Stable patients are now able to collect a several-month supply of ARVs, join groups which coordinate prescription pickups and help ensure members’ adherence to medication regimes, and increasingly access services outside regular clinic hours. All of these changes help unclog busy health facilities and reduce the financial and other burdens on ART patients.
I am mindful that, on this World AIDS Day, it is important to honor those heroes, those champions who have made the ultimate sacrifice in the fight against the HIV/AIDS epidemic. In 2016, we lost one of those champions in Lesotho: Ntate Chele Bakuena. Ntate Chele, as many of you know, was Director of the Lesotho Network of People Living with HIV and AIDS and a member of the National AIDS Commission Board. I was always struck by Ntate Chele’s forthrightness in discussing his own HIV positive status and his determination to ensure that the voices of all people living with HIV and AIDS were heard. My condolences go out to his family, who I know are struggling with their loss. I hope they are able to take some comfort in knowing that Ntate Chele was a man of great courage who had a real impact.
One thing that has surprised me during my time in Lesotho is how much stigma is still associated with being HIV-positive. Unfortunately, stigma prevents people from being tested and often from seeking life-saving treatment and other medical services. That’s where champions can play such an important role. When someone stands up and shares his or her story it personalizes the message and breaks down the barriers created by stigma. And it was with that objective in mind that the U.S. Embassy arranged a one-week program in Lesotho for a young American AIDS activist named Hydeia Broadbent earlier this year. Only 32 years old, Hydeia has been HIV-positive since birth, and I was amazed at the impact she had here, particularly with young people. First, she was a compelling example of how knowing your status and staying on medication makes it possible to lead a long and healthy life. Second, Hydeia shared that her being open about her status allowed her to get the emotional support she needed from family and friends and, sometimes, even strangers. One teenage Mosotho girl was so inspired by Hydeia that she approached her after a presentation and shared for the first time with anyone that she was HIV+. Another young woman commented to me that she wanted to be Lesotho’s Hydeia.
Indeed, Lesotho could benefit from many Hydeias, people willing to speak out about their status and serve as role models. I hope there are people out there, young and old, prominent figures and ordinary citizens, willing to take that courageous step.
In conclusion, it is clear that Lesotho is making real, measurable progress against the epidemic, although there is much more hard work to be done. We cannot let up now. Over the next year, the U.S. Embassy, through PEPFAR, will focus on a couple of key areas. Our primary programmatic thrust will continue to be ensuring as many Basotho as possible know their status and that those who are HIV positive begin treatment immediately. We will devote particular attention to urban areas, where prevalence rates are higher than in rural areas, and to adolescent girls and young women, whose infection rates are the highest of any age cohort in Lesotho.
It is clear that winning the fight against the HIV/AIDS epidemic requires close collaboration among all key partners. The United States will continue to be a committed and reliable partner to Lesotho in this critical struggle. Together, it is increasingly possible, I believe, to build a future without any new infections and where all Basotho living with HIV/AIDS are on treatment, free from discrimination and living healthy, productive lives. We owe it to future generations, to children like Matokelo and Retŝelisitsoe (Retsa-DiSEETS-Way) from St. Cecilia’s orphanage, to do all we possibly can, all of us together, to win this fight.
Khotso, Pula, Nala