Remarks at World AIDS Day National Commemoration Event: Thaba Bosiu

His Majesty King Letsie III

The Right Honorable, The Prime Minister

Honorable Ministers of the Cabinet

Honorable Members of Parliament

Your Excellencies, Members of the Diplomatic Corps

Distinguished Guests

Ladies and Gentlemen

I am honored to address you all today at Lesotho’s national commemoration of World AIDS Day.

On World AIDS Day, it is important to reflect on how far we have come over the past thirty years.  In 1984, the HIV epidemic had begun to consume public health efforts in the United States and Europe.  Dr. Robert Gallo, who was working at the U.S. National Institutes of Health, had just determined that HIV was the cause of AIDS and the U.S. Centers for Disease Control (CDC) reported that more than 4,000 predominately young men in the United States had died of AIDS.

Fast forward to 1991, when prominent figures across society — politicians, musicians and athletes — were beginning to break the stigma barrier by publicly declaring their HIV status.  I still remember exactly where I was and what I was doing on that day in October 1991 when I learned that Magic Johnson, the famous basketball player, announced that he was HIV positive.

In 1996, the advent of Highly Active Anti-Retroviral Therapy (HAART) for the first time offered hope to the tens of thousands of people suffering from this terrible disease. No longer did a diagnosis of HIV mean an automatic death sentence.  Instead, we began to see the transition of HIV from a fatal disease to one that was chronic but could be managed over one’s lifetime.

In 2001, global leaders gathered at the first-ever special UN session on HIV/AIDS.  They committed to mobilize between $7 billion and $10 billion annually by 2005.  With the launch of The Global Fund, the World Health Organization’s 3 by 5 Initiative and the U.S. Government’s President’s Emergency Plan For AIDS Relief (PEPFAR), the global response to the HIV pandemic was born.

Since then, due to our strong partnerships and collective efforts across the globe, new HIV infections have dropped by half since the peak of the epidemic, and life expectancy has rebounded.  In sub-Saharan Africa, new HIV infections are down by one-third since 2005; AIDS-related deaths have declined by nearly 40 percent; and access to lifesaving HIV treatment has increased more than forty-fold.

We have made so much progress. Why then, 30 years after Dr. Gallo showed that HIV causes AIDS and 18 years after life-saving treatment first became available, why then, have an estimated 26,000 Basotho died from HIV/AIDS this year alone?

The Government of Lesotho launched its National AIDS Control Program in 1987.  In 2004, Lesotho made a significant step forward with the launch of the national Know Your Status Campaign and the opening of the first site offering anti-retroviral therapy (ART).  In 2005, the National AIDS Commission was established and a Sexually Transmitted Infection and HIV/AIDS Directorate in the Ministry of Health was set up to launch ART throughout the country.

Since the first ART clients were served in 2004, the number of Basotho on ART has steadily climbed each year, and HIV testing and counseling campaigns have identified many more HIV positive Basotho. And, with support from the international community, Lesotho has set up innovative programs to address the drivers of the epidemic and to mitigate the impact on families and communities.

The government has revised its national strategic plan for HIV to improve targeting and prioritization, and it has secured major funding from The Global Fund, multilateral and bilateral donors, and even the private sector.

Lesotho is doing so much right.  At the same time, too many Basotho continue to die; too many children continue to be born HIV positive, and too many families continue to be devastated by this terrible but manageable disease.

An AIDS-free generation is within Lesotho’s reach, but to get there the country must deliver the right thing, in the right place, at the right time.

  • The right thing means focusing on the highest impact interventions, those that make the biggest difference, and scaling them up.
  • The right place means focusing resources on the key geographic areas and on the most vulnerable populations.
  • The right time means getting ahead of and ultimately controlling the HIV/AIDS epidemic.  Continually fighting an expanding epidemic is not sustainable, programmatically or financially.  It is critical to reach what we call the tipping point, when the number of people on treatment exceeds the number of new infections.   That is when Lesotho will know that it is finally beginning to get this emergency, this national threat, under control.

The American people and the United States Government are long-standing partners in Lesotho’s fight against HIV/AIDS.  Since 2007, we have provided more than $193 million to support Lesotho’s response to the epidemic.  This year, we will provide an additional $35 million through our bilateral program.

Our investments complement those made by the government, other development partners and the private sector.  The government can maximize the impact of those investments by facilitating coordination among all the players involved in the response to the epidemic.  One important step in that direction would be the immediate reestablishment of the National AIDS Commission.

In addition to our standing bilateral program, the United States is increasing our investments to help Lesotho expand pediatric care, an essential area of focus, given the potential impact of the epidemic on the next generation.    There are 1,200,000 children in Lesotho, more than half of the population.  300,000 of those, or 25 percent, are orphans or deemed vulnerable – predominately due to HIV.  36,000 children are HIV positive, yet only 14% are on ART.  Why is that?   And why are an estimated 3,500 children in Lesotho diagnosed with HIV every year?  That is a tragedy, because of the devastating impact on future generations, and because we know how to prevent the transmission of HIV from pregnant women to their children.

No child should be born HIV positive; we know how to prevent that.   So to help Lesotho address this critical challenge, the United States Government has committed $3 million to a partnership with Vodafone.   By facilitating access to medical care for pregnant women who are HIV positive, this public-private partnership aims to reduce maternal mortality, prevent the transmission of HIV to infants, and expand pediatric ART coverage.

We are also working with the Children’s Investment Fund Foundation to support a project designed to double the number of Basotho children on ART in the next two years.

I will hold my team accountable to ensure that both these initiatives work transparently, in partnership with the government and people of Lesotho, and demonstrate a measurable impact on the challenges associated with pediatric HIV infection.

Additional resources are always welcome, but money is not the main obstacle to making better progress in Lesotho.

Successfully turning the corner on HIV/AIDS in Lesotho will take visionary and engaged leadership, accountability and courage.

  • Courage from pregnant women to make the long trip to get tested and, if positive, to commit to treatment so that their babies can be born disease free;
  • courage from family members, co-workers and communities, to fight stigma and ensure that people living with HIV are not treated as second-class citizens;
  • and courage from doctors and medical workers to respond vigorously to any obstacles they encounter, so that the programs they run are effective and have maximum impact.

There are leaders across this region who embody that courage.   In the early days of the epidemic, Basotho like Bimbo Mashologu  — one of the first recipients of ART — spent many years telling people that treatment works.  And none of us can forget Nkosi Johnson, the courageous  South African child, whose stirring calls to end stigma rang out across the world.

And these heroes are not alone.  Today,  Bakoena Chele, Chairman of the Lesotho Network of People Living with HIV and AIDS (LENEPWA)  and other HIV positive Basotho — including the Ambassadors of the ‘Pusha Love’ campaign —  continue to fight against the stigma that stops Basotho from accessing the treatment  they desperately need.  We need more Basotho on treatment celebrating life, we need to empower them, and we need all Basotho to know, treatment works.

Treatment Works!

  1. Treatment works to prevent new HIV infections and to put Lesotho firmly on the path to the end of this epidemic.
  2. Treatment works to prevent the transmission of HIV from mothers to their children  and to help achieve an AIDS free generation
  3. Treatment works to prevent the deaths of those with HIV/AIDS, which tear families apart and leave thousands of Basotho children orphaned
  4. Treatment works to give every man, woman, and child living with HIV the opportunity to live a healthy life and achieve their dreams.

Today, we must agree to redouble our efforts to get this epidemic under control.  Our success in targeting our assistance and ensuring it has an impact —  in protecting children, in fighting stigma, and in scaling up treatment –will be measured in the number of lives saved.

I will end today with a quote from the remarks President Obama delivered on World AIDS Day one year ago:  “We can’t change the past or undo its wrenching pain.  But what we can do — and what we have to do — is to chart a different future, guided by our love for those we couldn’t save. That allows us to do everything we can, everything in our power to save those that we can.  The United States will stand with you every step of this journey until we reach the day that we know is possible, when all men and women can protect themselves from infection; a day when all people with HIV have access to the treatments that extend their lives; the day when there are no babies being born with HIV or AIDS, and when we achieve, at long last, what was once hard to imagine — and that’s an AIDS-free generation.”

Khotso, Pula, Nala