Remarks by Amb. William W. Popp for the 2023 National HIV/AIDS Symposium
Tuesday, November 14, 2023, Kololo Independence Grounds,
- Honorable Minister of the Presidency, Honorable Ministers present, Honorable Members of Parliament
- Ambassadors/Heads of Missions and Development Partners
- Director General, Uganda AIDS Commission
- Religious, Cultural, and Civil Society Leaders
- Distinguished guests,
- All protocols observed
Good afternoon. I am honored to attend my first National HIV Symposium in Uganda and have the opportunity to highlight the tremendous and lasting impact of the PEPFAR program, celebrating 20 years since its creation. Among all U.S. government programs, PEPFAR is one of the clearest demonstrations of the power of drawing scholars, researchers, scientists, engineers, and others together to find bold, innovative, and audacious solutions to big challenges.
World-renowned musical artist and activist Bono, who has been an important voice in the global fight against HIV/AIDS, noted that PEPFAR is “the most eloquent expression of American values anyone can think of in recent times, … the most brilliant outpouring of American ingenuity.”
Of course, we all have more work to do, but many of you remember the early days when HIV/AIDS was a death sentence for many people. Fortunately, over the last 20 years, together with partners around the world, PEPFAR has saved more than 25 million lives and dramatically improved health outcomes in more than 55 participating countries.
The theme of this year’s symposium mobilizes everyone to take collective responsibility while ensuring social accountability if we are to end HIV/AIDS as a public health threat by 2030.
In this spirit, focusing on equity and accountability is vital to reach epidemic control by 2030. We have made great strides, but over the years we have also identified a number of gaps. This includes that it is essential to add “Equity” to Accountability, Transparency, and Impact as guiding pillars for HIV prevention and treatment programs. In particular, laws or practices that discriminate against any people seeking health services…work against our efforts. We must prioritize equity if we want to eliminate the persistent inequalities experienced by children, adolescent girls and young women, and key population groups that are at increased risk of contracting HIV.
As many of you know, the first national AIDS control program in Africa began here in 1986, and Uganda was the first African country to begin to reverse its HIV epidemic. Over the past decade, the number of people contracting HIV has fallen significantly, but Uganda’s HIV infection rate is still one of the highest in the world. Sadly, HIV infections are not declining as rapidly among adolescents and key populations as among other age and population groups. Girls and young women remain disproportionately impacted by HIV, with two-thirds of adolescents diagnosed with HIV being girls. HIV prevalence among sex workers is estimated to be as high as 35%, 14% among men who have sex with men, and as much as 35% among fishing communities.
Meanwhile, national data indicate that at the end of September 2022, over 1.36 million people living with HIV were on treatment and 1.16 million people had a confirmed suppressed viral load. That is the power of PEPFAR programs and collaboration at work. At the same time, we continue partnering with multi-sectoral agencies, organizations, and all Ugandans to focus attention on areas where gaps still exist. As the theme of the event indicates, equitably addressing every person who requires health services is key if we are to sustain the progress already made.
Evidence shows that laws and policies, such as the criminalization of HIV transmission and same-sex relationships, hamper HIV response and people’s access to stigma-free sexual and reproductive health services. Instead, information-based efforts – including age-appropriate sex education and targeted HIV prevention campaigns – can reduce HIV infections, as can addressing domestic partner violence, which remains a significant social driver of HIV.
Issues discussed over the next two days should not only demonstrate solidarity and commitment to end HIV/AIDS related deaths by 2030, but also a commitment to act, make changes, and advocate for what we need. We can do many things – we can reach the global 95-95-95 treatment targets for all ages, genders, and population groups; we can close equity gaps for priority populations, including adolescent girls and young women, key populations, and children; and we can reduce new HIV infections dramatically through effective prevention and treatment, in support of UNAIDS targets.
As we think about the people living with HIV and the young people here today, I would like to reinforce that what matters most is not the numbers, but the names – not the statistics, but the stories: the lives forever altered for the better, the chapters rewritten, and the futures restored because of HIV treatment.
The tools provided by PEPFAR and our partners have helped to prevent, treat, and control this disease. We should be proud of the tremendous progress we have achieved, but again, our work is not finished. New data from UNAIDS on the global HIV response reveals that years of the COVID-19 pandemic and other global crises slowed progress in fighting HIV. Millions of lives are at risk as a result. In addition, because of stigma, discrimination, and other structural factors, certain populations and geographic areas continue to bear most of the burden of this disease. Thus, we remain deeply committed to ending HIV everywhere by engaging and empowering communities and ensuring that our programs, research, and policies are informed by the voices of the people most impacted by HIV.
Our work on HIV/AIDS also extends to supporting organizations and institutions in the broader health space. Why? Because the HIV epidemic does not exist in a vacuum. Ugandans, including people living with HIV and AIDS, have health needs beyond HIV prevention and treatment. For example, we have seen that in the battle against the most recent pandemic, the platforms built for PEPFAR were critical in the fight against COVID and Ebola. This is why PEPFAR has worked to build health systems equipped to adapt to the threat of HIV/AIDS while also preparing for public health concerns yet to come.
I am sure you are all aware that after the implementation of the Anti-Homosexuality Act in May, the U.S. government paused the PEPFAR Country Operational Plan, or COP2023, approval process so that we could review the implications. The United States remains profoundly concerned about the AHA and any instance of its implementation. As stated by President Biden in May, we will continue to call for the immediate repeal of this legislation.
Ultimately, COP 23 was approved to move forward to ensure life-saving assistance continues to benefit the people of Uganda. However, the assistance will have restrictions on certain direct funding to the Government of Uganda as well as other limitations due to concerns about the harm of the AHA on human rights and the HIV response. The new restrictions are not intended to impact service delivery. The US remains committed to serving all people of Uganda without discrimination.
In alignment with U.S. law and efforts by the U.S. government to prevent discrimination based on race, religion, gender identity or sexual orientation, we will continue to ensure that principles of non-discrimination are upheld in all PEPFAR programs. In accordance with these requirements, we seek to provide services to all populations and maintain equitable access for all in the fight against HIV.
Finally, to better expand access to HIV prevention, treatment, and care interventions, PEPFAR has reimagined its Strategic Direction based on extensive partner and stakeholder input to focus on the following:
- First, to broaden the HIV/AIDS conversation beyond the health sector and engage directly with national HIV/AIDS planning and coordination structures.
- Second, to strengthen national health systems for HIV and related health security capabilities to promote public health security and responsiveness. To achieve this, Uganda will need robust national surveillance of HIV/AIDS and other public health threats, and strong laboratory networks that support timely diagnostic testing and public health responses.
- Third, to continue to commit to evidence-based and data-driven programming. The history of disease control has taught us that the “last mile” is always the most difficult. Closing the gap will require embracing and elevating the best new scientific innovations and ensuring that programming is data driven.
In sum, we are at a pivotal moment in the global HIV response. We are closer than ever to reaching the United Nations Sustainable Development Goal of ending the global HIV pandemic as a public health threat by 2030. And the United States is committed to working with the Ugandan people and other stakeholders, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS.
To sustain the gains made toward epidemic control, we 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 that are based on public health evidence and protection of individual rights are not only the foundation of an enabling legal environment but can also magnify the impact of a country’s HIV response.
Epidemic control also requires a multi-sectoral approach in supporting and implementing inclusive laws and policies that respect human rights, increase accountability and transparency, and ensure that populations in need can be reached equitably.
Until we reach our goal of epidemic control, PEPFAR will serve as a light of compassion, care, and collaboration – with the wherewithal to fulfill our most basic human commitment: to preserve health and to save lives. The legacy of this bold initiative, now 20 years on, will continue to show what it means to “do big things” to address big challenges, and here in Uganda, the United States’ commitment to work with the Ugandan people to deliver a more prosperous, healthy, and peaceful Uganda. Thank you.