Remarks by U.S. Deputy Chief of Mission William D. Bent
2022 PRE-WORLD AIDS DAY COMMUNITY ENGAGEMENT
Ntungamo, Uganda | November 30, 2022
(as prepared for delivery)
Good afternoon everyone. It is an honor to be here in Ntungamo as we celebrate World AIDS Day 2022, when the world unites in support of people living with HIV and remembers those who have died of AIDS-related illnesses. Uganda has long been considered one of the world’s most compelling success stories in combating the spread of HIV. The country’s early adoption of a multi-sectoral approach to HIV and AIDS, and its recognition that the epidemic was not only a public health problem but also a complex development challenge, helped reduce HIV infection rates. Building on this early success, Uganda continues to make significant progress towards eliminating HIV/AIDS as a public health threat by 2030.
This year’s World AIDS Day theme is “Ending Inequalities.” Looking back to the themes over the years, they have mirrored the policy goals of public health authorities, moving from awareness and education to the larger objectives of community and global cooperation. From the late-1990s, as awareness grew about the life-extending promise of HIV treatment through antiretroviral therapy, the focus gradually shifted from family and community to key structural barriers stifling the global prevention effort, including stigma, discrimination, and the disempowerment of women and children. With the founding of the Global Fund in 2002 and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, the focus further shifted to ensuring sustained focus on this pandemic via international investment and support.
Uganda can be proud of the progress made over the past 19 years of PEPFAR implementation and we appreciate the ongoing and deep coordination with the Global Fund and UNAIDS. Uganda is one of a few countries to reach the UNAIDS 95-95-95 goals and effective control of the HIV pandemic. We now must work to sustain the impact and begin the long-term, gradual transformation of the program, including the merging, management, and oversight of HIV services in more intentional alignment and integration with domestic systems. The PEPFAR Country Operational Plan 2022 represents the next step in this journey. The United States government recognizes that a healthy population is the foundation of a country’s social and economic development.
However, here, as in many countries in East and Southern Africa, the gap between achievements to date and the goal of ending the HIV pandemic remains formidable. HIV disproportionately affects the most marginalized and under-served people, specifically children– both girls and boys, adolescent girls and young women, and key populations including sex workers, men who have sex with men, people who inject drugs, and people in confined settings such as prisons. A part of promoting an inclusive and supportive environment is acknowledging these inequities. In sub-Saharan Africa, six out of seven new HIV infections among adolescents aged 15-19 years occur among girls. And, around 4,200 adolescent girls and young women aged 15-24 years became infected with HIV every week in 2020 in Sub-Saharan Africa.
In order to sustain the gains made toward epidemic control, the region and district partners must invest in approaches that strengthen equity in service delivery, remove legal barriers, shift harmful social and gender norms, and reduce inequalities. Laws and policies based on the protection of individual rights are the foundation of an enabling legal environment. These laws and policies have the potential to transform the impact of a country’s HIV response.
The U.S. government, through PEPFAR, is committed to delivering high quality, inclusive, person-centered HIV prevention and treatment services that meet people where they are with what they need. Working with the Ministry of Health, we have successfully rolled out community-based care models such as community drug distribution, multi-month dispensing, and community-led monitoring of services, which have simplified access to HIV services for those who need them. Working with the Government of Uganda and other donors, PEPFAR is committed to ensuring that all ages, genders, and vulnerable populations in communities know their HIV status, and if infected, receive life-saving HIV treatment services to achieve viral suppression.
To promote high-quality, equitable and person-centered services using a quality improvement approach, we will lean on Community-Led Monitoring, also known as CLM, as one of the community initiatives PEPFAR is funding. CLM is used to advance equity and to support improvement in PEPFAR programs, especially for vulnerable groups. The community-led monitoring program has strengthened continuous quality improvement activities, elevating the voices of communities to identify their own priorities, develop local solutions to local problems, and enhance person-centered care in real time by using qualitative data and inclusive engagement of key stakeholders and decision makers. To inform our programming, we also routinely connect with the broader civil society at the national and sub-national levels. This year’s CLM has a specific focus on services for key populations and pediatric care and treatment programs to track and ensure accountability for child, adolescent, and family-centered care.
PEPFAR recognizes that policies, laws, and regulations to achieve coverage of high-impact interventions to ensure social and legal protection and equity for those accessing HIV/AIDS services are largely in place. However, Key Populations are not protected and are therefore more at risk of experiencing stigma and discrimination.
Another priority is to continue to work closely with our civil society partners to identify and address stigma, discrimination, and violence that disproportionately impacts key populations. Since 2020, PEPFAR has provided funding for community-led drop-in-centers to become accredited and provide health services close to the community. The number of people living with HIV among key populations can be up to five times higher than in the general population. Therefore, it is critical for Uganda to provide tailored support to those who need it most to prevent HIV and attain epidemic control. The community health department is an essential leader of all community health actors to use the findings and recommendations of the legal environment assessments released earlier this year to ensure focused programming that facilitates equitable access to health services and enables meaningful participation for all populations.
I commend the district leadership, all partners and stakeholders in this region for meaningfully engaging the community to address the inequalities holding back progress to end AIDS and their strong collaboration with the office of the President to hold this World AIDS Day precursor event.
Thank you all.