Khotsong, bo ‘me le bo ‘ntate
Please allow me to pay my respects to:
His Majesty King Letsie III
And Her Majesty Queen Masenate
The Right Honorable, The Prime Minister
Honorable Speaker of the National Assembly
Honorable President of the Senate
His Lordship the President of the Court of Appeal
Her Ladyship the Chief Justice
Honorable Deputy Prime Minister
Honorable Ministers of the Cabinet
Honorable Members of Parliament
Your Excellencies, Members of the Diplomatic Corps
Ladies and Gentlemen
All Protocol Observed
I want first to acknowledge and thank our hosts for today’s event: The Baylor College of Medicine, which today is celebrating its10th anniversary in Lesotho. The United States is proud to partner with Baylor in treating children with HIV and AIDS in Lesotho. Today, 7600 HIV-positive Basotho children are on life-saving anti-retroviral treatment (or ART). We aim to increase that number significantly by this time next year. So, congratulations once again to Baylor on its anniversary and for hosting this event. We are honored to be a part of it.
Success always starts with a vision. It’s impossible to decide what route to take until we know where we are going. Earlier this year, leaders from around the world, including Prime Minister Mosisili and my President, Barack Obama, agreed to achieve in the next 15 years a set of Sustainable Development Goals (SDGs), 17 goals intended to end poverty, protect the planet, and ensure prosperity for all. Included in one of the SDGs is an almost breathtakingly ambitious vision: the HIV/AIDS epidemic by 2030.
Let me repeat that: Ending the AIDS epidemic by 2030. That, of course, does not mean there won’t be anyone living with HIV or AIDS in 2030. What it does mean is that HIV/AIDS will no longer pose the global public health threat that it does today and will no longer have such a devastating impact on so many individuals, families, and societies. This is an ambitious goal, but it is within our reach.
UNAIDS has laid out a clear path to follow in order to end the AIDS epidemic. That path is widely known in the public health world as the 90/90/90 path. In other words, the only way for countries to achieve control of the epidemic is to ensure that 1) 90% of all People Living with HIV know they are HIV positive; 2) that 90% of those who are HIV positive are receiving Anti-Retroviral Treatment (ART); and 3) that 90% of those on treatment are virally supressed, meaning the treatment is effective in keeping clients healthy and reducing the virus to very low levels.
Let us take a look at the progress Lesotho is making toward achievement of the 90/90/90 targets. Based on significant increases in HIV testing rates, we expect Lesotho will be able to report meaningful progress toward the first 90 target once the final results of the 2014 Demographic Health Survey become available. The preliminary report from that survey indicates that 85% of Basotho have been tested at least once, up from 68.8% in 2009. Further, 58% of Basotho were tested in the past year, up from 42% in 2009. As more Basotho test more often, more HIV-positive Basotho will know their status.
The rise in HIV testing, however, has not been followed by sufficient progress on the second 90 target — initiating people on life saving treatment. Approximately 40% of HIV positive adults and children are on ART in Lesotho. We need to increase that number, supporting more HIV positive Basotho to enroll in treatment. And, together, we must make better progress in both measuring and achieving the third target – suppressing the viral load of 90% of those on treatment. The way we know that treatment is successful is by measuring the viral load. The chance that those on treatment can pass the virus to others is very low.
The United States is proud to be a close and dedicated partner in the fight against the HIV epidemic in Lesotho. We have been by your side for nearly a decade and will continue to commit substantial resources and to work hand in hand with government, other external partners, and civil society in this critical effort.
The United States government, with the generous support of the American people. has been a major contributor to the HIV/AIDS response in Lesotho, through both multilateral and bilateral channels. Multilaterally, the U.S. government has committed more than $11 billion to the Global Fund, including $1.35 billion this year alone. Bilaterally, our support comes through the President’s Emergency Plan for AIDS Relief (PEPFAR). Since the outbreak of the epidemic, through PEPFAR, the United States has committed $65 billion globally, including $250 million to Lesotho.
A year ago, when I spoke at World AIDS Day, the narrative about Lesotho’s struggle against HIV/AIDS had for far too long been a negative one. Shortly before I arrived in October 2014, several prominent U.S. officials asked me why a country of Lesotho’s size wasn’t making more progress against the epidemic. That was the image that popped into their heads when they thought of Lesotho: the country with the second highest HIV prevalence rate in the world, at 23 percent, where it had remained for ten years straight.
Although that prevalence rate has not yet begun to decline, I am increasingly optimistic that we – all of us working together – are beginning gradually to change that narrative into a more positive one. Lesotho is now on a better trajectory that I believe will result in many more lives saved.
Let me explain the reasons for my growing optimism.
First, we have made significant changes to our own strategy, in partnership with the Ministry of Health and other stakeholders, to increase our impact. The predominant focus of our PEPFAR program now, over these next five years, will be on the cascade of care – ensuring that as many people as possible are tested, enrol in treatment, and stay on treatment.
To achieve the 90/90/90 goals by 2020, it is critical to achieve epidemic control – that is why we are now focused like a laser on getting as many people on treatment as possible.
In addition, we have modified our geographic approach to focus on the five districts with the highest burden of disease: Maseru, Berea, Leribe, Mohale’s Hoek, and Mafeteng. 75% of Basotho and 80% of HIV-positive Basotho live in those five districts, and we believe that concentrating efforts there will have the greatest impact on controlling the epidemic in Lesotho. As an important step toward achieving the 90/90/90 targets, by 2017, we aim to ensure that 80% of people living with HIV in Maseru, Berea and Leribe are receiving ART. And by 2018, we plan to reach 80% ART coverage in Mohale’s Hoek and Mafeteng. This does not mean that other districts will not have an HIV program. The government of Lesotho’s commitment to provide health care nationally remains strong and the U.S. Government’s support to central Ministry of Health operations and quality assurance monitoring across the country will help supplement the Ministry’s important work.
In addition to the annual baseline PEPFAR budget of $39 million, we have also committed substantial additional funding for three new initiatives. The DREAMS initiative aims to lower the rate of new HIV infections in adolescent girls and young women, 15 to 24 years of age, in Maseru and Leribe, by 2017. Currently that age group accounts for 35% of new HIV infections but only 10% of the population in those districts.
The United States Government is also increasing our focus on initiating HIV-positive children on ART. Our Accelerating Children’s HIV/AIDS Treatment (ACT) initiative has boosted the number of children on ART from 5,700 in 2014 to 7,600 in September 2015. That’s a significant increase – from 30% of HIV-positive children to 40%, in only one year. We are not satisfied yet and expect to see 10,500 HIV-positive children on ART by World AIDS Day next year. Key to achieving this goal is our investment in a public-private partnership with Vodafone. The U.S. funding will support the use of innovative mobile technology, MPESA, to provide cash transfers and mobile clinics so that previously unreached children living with HIV can access and remain on ART.
Partnerships like these demonstrate that while funding for HIV is important, a lack of resources is not the main obstacle to making better progress against HIV/AIDS in Lesotho.
Successfully turning the corner on this epidemic will take visionary and engaged leadership, accountability and courage.
Over the course of the past year, I have seen how many Basotho display that courage and leadership every day. And that is the second major reason I am more optimistic than I was a year ago about the way forward.
First, government leadership is obviously critical in generating momentum in the fight against HIV/AIDS and in reducing the stigma that prevents too many Basotho from getting tested and initiating treatment. In that vein, I want to recognize His Majesty for dedicating a significant portion of his Speech from the Throne earlier this year to this particular challenge. The Prime Minister, who has spoken forcefully and frequently about the need to confront this epidemic head-on and the First Lady, who speaks eloquently about the need to support children and adolescent girls infected and affected by this scourge. And the Deputy Prime Minister for his leadership in working with all stakeholders to structure a new National AIDS Commission that is vigorous and effective. We look forward to the NAC’s establishment in the very near future. And, finally, I want to acknowledge the Honorable Minister of Health Dr. Monyamane for the energy, strategic vision, and partnership he has demonstrated since taking office.
I’ve also had the privilege of meeting incredible people – I consider them heroes — fighting in communities across this country to end the devastation caused by this epidemic. Every day, these heroes demonstrate leadership, vision, and courage in all sorts of awe-inspiring ways. I remember the nurses I met when visiting a clinic in Thaba-Tseka built with support from the United States under the first Millennium Challenge Corporation (MCC) Compact. These amazing public servants, these heroes, were determined to provide care to those who needed it, under the most difficult circumstances, including regular stock outs of key commodities and staffing shortages. I was incredibly moved during a visit to Nts’ekhe Hospital in Mohale’s Hoek where, with the help of several implementing partners supported by the United States, the hospital staff, those heroes, are providing care and treatment to more than 3,000 people living with HIV. And I was inspired by the courage and vision I witnessed here in Maseru when I marched with Matrix and hundreds of their supporters. Matrix is an organization that advocates for the rights of the LGBTI community, including equal access to healthcare.
I am delighted to be able to acknowledge all of your contributions, those in high-profile positions as well as those who work so hard in relative obscurity, to make a difference. It is your collective efforts that inspire us and that are essential to ending the epidemic.
And there is a third major reason I am optimistic about Lesotho’s ability to get this epidemic under control. On September 30, the World Health Organization (WHO) released new guidance recommending ART for all persons who are HIV positive, independent of the progression of their disease. Simply put, that means WHO is advising that those who test positive should immediately go on treatment. Embracing and implementing this recommendation would have a significant positive impact in Lesotho. The evidence is clear that initiating treatment earlier — the TEST AND TREAT model — results in better health outcomes. Economically, it also makes sense as significantly fewer Basotho becoming infected with HIV reduces future health care costs. The contributions of healthier and more productive Basotho to the economy would far outweigh what it costs to keep them on ART. I know this recommendation has given pause to some governments because it has resource implications. That said, initiating people on treatment as soon as they test positive should not be such a big leap in Lesotho, where several demographic groups currently already begin ART as soon as they are infected: pregnant women, Basotho who are co-infected with both HIV and TB, children under five, and couples in which only one person is infected.
In conclusion, I would like to offer a few words of guidance to those who are not here today but may read about today’s ceremony or may watch it on television tonight. I want to emphasize that all of you – whether you live in Maseru, a small town, or a remote village – all of you have a pivotal role to play in bringing the HIV epidemic to an end. The fight against this scourge requires, as we like to say in the United States, an all hands on deck effort. Everyone has a crucial role to play. There are four things you can do that will make a difference for you, for your families, and for the communities in which you live:
- Avoid Risky Behaviors that make you vulnerable to infection and encourage your loved ones to do the same.
- Know Your HIV Status. Get tested for HIV and encourage others to do the same. There is no shame in getting tested; it’s the only way to take charge of your own health.
- Begin Treatment Early. If you are HIV positive, start treatment right away. That will keep you healthy and protect your family; and
- Stay on Treatment. Stay healthy by taking your ART as prescribed and continuing to go to the clinic for care; and encourage others to do the same.
I’d like to end today with a quote from a proclamation issued by President Barack Obama in honor of last year’s World AIDS Day.
President Obama said “As a Nation, we have made an unwavering commitment to bend the curve of the HIV epidemic, and the progress we have seen is the result of countless people who have shared their stories, lent their strength, and led the fight to spare others the anguish of this disease. Today, we remember all those who lost their battle with HIV/AIDS, and we recognize those who agitated and organized in their memory. On this day, let us rededicate ourselves to continuing our work until we reach the day we know is possible — when no child has to know the pain of HIV/AIDS and no life is limited by this virus.”
Thank you for your attention today and for what you do every day to bring an end to the HIV/AIDS epidemic in Lesotho.
You can count on the continued partnership of the United States in this critical struggle.
Khotso, Pula, Nala