Remarks by U.S. Ambassador Natalie E. Brown at 2022 Candlelight Memorial Commemoration
May 15, 2022 | Teso, Uganda | (As prepared for delivery)
Good afternoon to all. I am honored to be here to commemorate the 2022 annual Candlelight Memorial event here in Teso. For decades, people have gathered each year on this day to remember the more than 2 million Ugandans and the more than 35 million people globally who have lost their lives to HIV since the early 1980s.
Last year, Uganda’s National theme was “Freeing workplaces of stigma and discrimination,” and this year, the theme focuses on stigma yet again. It is crucial that we keep this as part of the conversation, but it must be more than a conversation. After almost four decades of death in the shadow of stigma and discrimination, because we have extended antiretroviral therapy (ART) to so many Ugandans, HIV-related deaths have decreased. Still, the stigma and discrimination remain, playing a significant role in new HIV infections and preventable deaths.
It is time for all of us to match our words with actions. But to do so, we must turn the conversation to what we are not talking about and what we are not doing, to acknowledge the things that need to change, and to make a deliberate choice to take action. Our conversation needs to become about conscious decisions, who gets to make them, and who doesn’t get to make them due to stigma and discrimination driven by a lack of knowledge and understanding. Preventing HIV, knowing your status, and choosing lifesaving ART should be a deliberate choice for everyone, but for many, it is not.
Without proper information, people – no matter their age – cannot make deliberate choices. This is particularly true for young people. Young people worldwide struggle with the physical and emotional changes that adolescence brings, which can be confusing even when the adolescents involved are aware of and understand what is happening. However, in many cultures, including Uganda and areas of the United States, sexuality is a subject that is not openly discussed across generational lines. Although this is slowly shifting, this lack of information remains an issue in the households of many young people, leaving myths and misinformation about sex and sexuality to persist.
While adolescent physical and emotional changes offer opportunities for new and important life decisions, confusing changes and uninformed decisions can quickly go from scary to life-threatening. Uganda has the youngest population in the world, with a median age of just over 16 1/2 years. Many of you may know that adolescent girls and young women in Uganda continue to have some of the highest rates of new HIV infections. The gender disparity is especially pronounced among girls and women aged 15-24, whose HIV prevalence is 3 times greater than their male peers.
The youth in Uganda and many other countries worldwide, including the United States, are deprived of high-quality and timely sexual reproductive health information. Parents and guardians at home are uncomfortable with the topic or do not have the knowledge to give to their children. Politically, few can agree on what and how much is appropriate to teach and at what age the information should be delivered. This is not a new moral dilemma, but the longer we take to make the issue about conveying scientific facts and allowing potential HIV victims to make informed choices rather than re-hashing political disagreements, the longer the deaths will continue in a shadow of ignorance and stigma. No one makes a conscious choice to get HIV, give HIV to their unborn child, or die from a disease when there is the option of successful lifesaving treatment.
Without timely and compulsory sexual reproductive health education in schools and available adolescent-friendly sexual and reproductive health services, uninformed decisions are being made and will continue to be made, resulting in continued teenage pregnancies and new HIV infections.
Abstinence is often the curriculum of choice in culturally conservative communities, including here in Uganda, in many others around the globe, and in my own country because many many believe giving kids too much information and too many options can be interpreted as encouraging kids to partake in unhealthy behavior; activities they are not mentally, emotionally, or physically prepared for; or activities that go against cultural norms. In reality, the lack of information perpetuates teenage pregnancies and sexually transmitted infections – some with life-long or life-threatening repercussions if undiagnosed or untreated. Additionally, with high rates of child marriage, rape, and child abuse, abstinence often is not a choice. Research and statistics show that giving children age-appropriate sexual reproductive health information in the classroom increases knowledge and improves attitudes and behaviors. Having information also equips children to protect themselves and make deliberate and healthy decisions when they can, and empowers them to seek help when they can’t. And such information should not only target young women, but also young men, who also deserve access to information to help them make safe choices for themselves and their partners.
As I have spent more and more time over the past 18 months with young people living with HIV; with young women and adolescent girls participating in the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) supported Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program, which is an evidence-based age-appropriate comprehensive package of medical, behavioral and structural interventions across multiple sectors shown to mitigate the risk factors that may lead to HIV infection; and with secondary students benefiting from the U.S. Mission’s Nile Explorer Bus health, leadership, and STEM-based extracurricular activities as it visits schools throughout Uganda, there is a common thread that I am seeing: Uganda’s youth are hungry for information, particularly information that will allow them to make informed decisions about their sexual and reproductive health. I have regularly heard about the lack of understanding and challenges around menstruation; about young girls partaking in transactional sex to get basic needs met without understanding the potential consequences; about the lack of understanding around personal rights and consent resulting in rapes and sexual assaults among young people; and about the number of young people who are afraid to seek advice and prophylaxis from health centers for fear of being morally shamed.
My experiences, however, are not just anecdotal. Recently, the preliminary results of the 2022 Uganda Legal Environment Assessment (LEA) for HIV/AIDS were prepared by an independent non-governmental organization to assess the extent to which existing laws, regulations, and policies enable or constrain key protections for those affected by HIV in Uganda. The assessment shows that while Uganda is finding success in many areas of its HIV response, Uganda is hindering its response in some key areas. Uganda has laws and policies in place that provide for non-discrimination and equality in access to services. However, the assessment highlights some of the punitive and restrictive clauses in various laws that result in discriminatory behavior against some at-risk and vulnerable populations. In the ”Key Findings” section in the Executive Summary of the assessment, it states, “While Ugandan laws do not explicitly legislate against or on the basis of gender identity or sexual orientation, laws which criminalize sex work, sexual relations between people of the same sex, and drug possession and use, serve to reinforce social stigma and fuel cruel treatment and harassment of the affected persons – some of whom are living with HIV and others at risk of HIV infection.”
Many of these critical populations are also those where we see the highest rates of new infections, and the assessment provides many recommendations to address the key areas; some examples are:
- Expand services tailored for adolescents and young people, persons with disabilities, and other vulnerable groups across the country;
- Increase interventions to reduce stigma in communities, health facilities, workplaces, and schools;
- Expand provision of comprehensive care packages that address the medical and psycho-social needs of people living with HIV and other vulnerable groups, including young mothers who became pregnant or were married at an early age during the lockdowns;
- As schools reopen and guidelines on reentry of teenage mothers are rolled out, engage strongly with all the school stakeholders to improve the environment for the young mothers to be accepted and to learn;
- Work to resolve issues around the Sexuality Education Framework and the School Health Policy to enable ownership and rollout of these policies;
- Decriminalize sex work; and
- Amend sections of the penal code.
In sum, we need to do better. The adults in young people’s lives, from their households to their communities to their local, regional, and national governments, need to do better. Stigma, discrimination, and uninformed decisions leading to HIV infections and other social issues stem from a lack of information, misinformation, and disinformation. Adults worldwide are harming their young people by failing to teach them about their bodies, failing to teach them about protective measures each individual has the right to make concerning their bodies, and failing to teach them what it means to make informed and deliberate decisions with full awareness of the potential consequences.
Additionally, those at the highest risk of infection, including sex workers, people who inject drugs, prisoners, and members of the LGBTQI+ community, have the fewest opportunities to seek treatment or are afraid to seek treatment or prevention services due to other drivers of stigma and discrimination. Policy actions that establish or increase criminal sanctions against these high-risk groups will only further decrease prevention, decrease testing, and decrease treatment opportunities.
As I said last year, on this day, if we are to address the problem of stigma and discrimination truly, we must set aside our judgments of others and re-affirm the inherent dignity and fundamental rights of all humankind. Rather than casting those who are born different in a shadow of judgment and stigma, preventing them from accessing the HIV prevention and treatment they deserve, we must extend our hand further to address the social and structural barriers that prevent them from accessing the support and treatment they need to live healthy productive lives.
On a strategic note, as we inch closer to achieving epidemic control in Uganda, we need to consider even more the long-term sustainability of the response. Domestic funding of the response continues to fall short of the desired sustainability levels. The COVID-19 pandemic tested the resilience of the national health system as a whole and has impacted the HIV response in particular. I acknowledge the fact that Uganda has a comprehensive health financing strategy that covers HIV/AIDS services. Now that the Rt. Hon. Speaker and members of parliament are commemorating this day with us in person, I want to mention that Domestic Resource Mobilization initiatives like the AIDS Trust Fund, and the One Dollar initiative among others have been on paper for too long. Please, make these initiatives operational.
As we honor the memory of those who have lost their lives to AIDS, the United States commits to using part of our more than 400 million USD of annual HIV response assistance in Uganda through PEPFAR to address the stigma and discrimination around HIV by taking action on the Legal Environment Assessment recommendations. In fact, I was honored to join Minister Aceng and partners around Uganda just 10 days ago for the approval of the 2022 Country Operational Plan – COP 22 – which will guide our HIV/AIDS response. Through these plans in Uganda and elsewhere, the United States recommits globally to keep the future bright, assuring that our support will remain steadfast for all those who need it free of judgment, stigma, and discrimination.
Finally, as I look around and see everyone who traveled from near and far for this event today, I am appreciative that vaccines helped make this possible. COVID-19 rates are coming down, but it remains a threat, especially for those with HIV or other underlying conditions. So please get vaccinated, get boosted, and encourage those you love to do the same. Thank you.