World AIDS Day 2015: The Time to Act Is Now

By: Matthew T. Harrington, United States Ambassador to the Kingdom of Lesotho

Every year on the first of December we mark World AIDS Day. This year we are focused on success and success starts with vision. Earlier this year, leaders from around the world, including leaders from Lesotho and the United States, agreed as part of the United Nations Sustainable Development Goals to support an ambitious and inspiring vision — that of ending the HIV and tuberculosis epidemics by 2030.

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 life-saving 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. The United States Government’s theme for World AIDS Day is, “Time to Act Now.”  And that is what is left for us to do.  Act to make our shared vision a reality.

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.

The United States also supports three major initiatives.  Through the DREAMS Initiative, Lesotho has been awarded an additional fourteen million dollars to cut new HIV infections in adolescent girls and young women, 15 to 24 years of age, by 40% in Maseru and Leribe districts by 2017.  This project will work with girls, their families, communities, and schools to empower young women to stay free from infection.  Without such attention, they will remain disproportionally at risk of contracting HIV. They currently account for 35% of new HIV infections though only make up 10% of the population in those districts.  The U.S. is also contributing 14 million dollars to support the Accelerating Children’s HIV/AIDS Treatment (ACT) Initiative and three million dollars to the Vodafone and Ministry of Health Mobilizing HIV Care and Treatment partnership. Both of these programs are intended to substantially increase the numbers of HIV-positive children on ART.

To stand a chance of achieving the 90/90/90 targets and ending HIV as a global public health threat by 2030, it is critical that we focus our efforts on getting as many people tested and on treatment as possible.  Lesotho is making progress, with significant increases in the number of men and women testing for HIV but progress has been insufficient in initiating people on treatment. With only 37% of HIV positive adults and 40% of HIV positive children on ART, we must do more now.

In order to increase our impact, the PEPFAR program in Lesotho is focusing intensively on the cascade of care – from testing, to treatment, to viral load suppression.  First, we have modified our geographic focus to match the burden of disease.  By 2017, we aim to ensure that 80% of HIV-positive residents in Maseru, Berea and Leribe initiate and remain on ART.  And by 2018, we plan to reach 80% ART coverage in Mohale’s Hoek and Mafeteng.

Secondly, on September 30, the World Health Organization (WHO) released new guidance recommending ART for all people living with HIV, independent of the progression of their disease.  Simply put, that means the WHO is advising that those who test positive should immediately go on treatment.   The evidence is clear that initiating treatment earlier — the TEST AND TREAT model – helps keep people living with HIV healthy and, by reducing the level of the HIV virus in their blood, makes it less likely they will transmit HIV to others. It also makes sense economically, as healthier Basotho contribute far more to the economy than it costs to keep them on ART.

As President Barack Obama said last year on World AIDS Day, “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.”

Successfully turning the corner on HIV/AIDS in Lesotho will take visionary and engaged leadership, accountability, strong partnerships, and courage from government, from health workers, from communities, and from individuals and their families. Ending the AIDS epidemic by 2030 will require a collective determined effort from all of us. The vision and the goals are there. The time to act is now.