Remarks by U.S. Ambassador Natalie E. Brown at Y+ Beauty Pageant Grand Finale
Serena Hotel Kampala | November 23, 2022 (As prepared for delivery)
Good evening, I am thrilled to be with you once again for the eighth Y+ Beauty Pageant. I am happy to note that this is my third pageant, having attended my first one just after arriving in Uganda in 2020. The events just keep getting better and better, and the contestants never fail to impress. I want to thank the organizers for this incredible partnership as we work together to create space and platforms for young people to advocate for their own needs.
I would like to begin by acknowledging the Uganda Network of Young People Living with HIV/AIDS (UNYPA) and thank you for the powerful theme of this year’s Beauty Pageant “We Have Got the Voice; Pass Us the Mic.” I have personally seen UNYPA’s advocacy and ability to create a safe space for young people living with HIV to express themselves, share stories of change, and build coalitions to fight stigma within their own communities over the years. The 2020 theme was “Changing the Narrative,” and last year’s (2021) theme was “Opening Opportunities” – which are important building blocks for this year. My interactions with UNYPA and the Y+ ambassadors have shown me first-hand how your organization continues to change the narrative and provide a platform for opportunities for young people living with HIV across Uganda.
Since 2003, the United States government through the President’s Emergency Plan for AIDS Relief (PEPFAR) has partnered with the Government of Uganda and Civil Society Organizations to invest in expanding access to HIV prevention, care, and treatment intervention in Uganda. According to the latest UNAIDS estimates, 1.4 million people are living with HIV in Uganda, and people are living longer and healthier lives largely due to improved access and utilization of HIV services. PEPFAR invests in direct healthcare service delivery in every district in Uganda, supporting over 1.3 million people with HIV treatment. The latest PEPFAR annual results show that over 165,000 people began taking pre-exposure prophylaxis (PrEP) for HIV prevention, and over 91,000 people returned for PrEP refills in the last year (during COP21), protecting their health while their HIV risk remained high. Additionally, nearly 610,000 orphans and vulnerable children and their families were served through family-centered comprehensive services and HIV and violence prevention interventions, all facilitated by the United States. These figures make clear that the community has put in the hard work, and it is having an impact. As proof: the Uganda Population-Based HIV Impact Assessment (UPHIA) that was released earlier this year found a decline in new HIV infections by 39% and AIDS related deaths by 67% from 2010 to 2021.
The health systems built over years of collaboration among the government, NGOs, and PEPFAR are also being leveraged to respond to other public health threats as well, such as COVID-19 and now the Ebola outbreak. In both instances, PEPFAR partners and peer educators responded. Last year, I shared with you how Michael Ssenyonga, a previous Mr. Y+, founded the Kasese Network of Young People Living with HIV and during the peak of the pandemic ensured that food and life-saving medication reached more than 700 young HIV-positive people. I think his excellent example inspired others because now healthcare and community workers are following up with individuals who may be contacts of those afflicted with Ebola and unable to get to the clinic to pick up their medicines. These workers are tailoring services to meet individual needs, and providing psychosocial support through this difficult time. In addition, despite the stress on the laboratory system from the Ebola outbreak, the framework put in place is managing the additional load to ensure people living with or tested for HIV continue to receive timely test results.
I commend all the health care workers who responded to COVID-19 – get your jab; cases are on the rise – and who are now supporting the Ebola response. Their interventions ensure that there are survivors and they help to mitigate further spread of this disease. We should all be aware, however, and share with our communities, that there is still a risk of Ebola Virus (EVD), especially as the festive seasons nears and people think about travel. Anyone who has contact with a person who has symptoms of EVD should follow Ministry of Health guidance for early screening to care for themselves and protect others. The earlier you receive treatment, the better the outcome. We often discuss stigma as it relates to HIV/AIDS. Let’s not ignore the impact of health-related stigma and discrimination. We need to welcome survivors of this serious illness – 79 so far – back into our communities and ensure they have the support they need.
Despite the declining trends in new infections and AIDS related deaths I just mentioned, it is not yet time to celebrate. The epidemic is still severe and affects individuals of all ages and genders, but with differing impact among different populations. Young people ages 10-24 remain more vulnerable to HIV infection, with 43% of the new HIV infections occurring in this age group. Out of the 1.4 million people currently living with HIV, 50,000 are young men and 120,000 are young women ages 15-24. In 2021, there were 20,000 new HIV infections within this same age group, of which 15,000 were among adolescent girls and young women and 5,000 among boys and young men. There were 6,000 new infections among children between 0-14 years. All of these data reinforce the very real need for UNYPA’s initiative, especially as we navigate an environment that continues to see adolescent girls and young women at high risk for early pregnancy, vulnerable to gender-based violence, HIV infection, and HIV treatment failure.
We also recognize that all of these numbers represent people, our family members and friends, and I have valued the opportunity hear directly from young people about their experiences with HIV. In February, I received a Valentine’s Day visit from UNYPA ambassadors, and listened to the incredible life experiences of several young people here today. On a visit to Oyam District, I learned about the daily trials and small wins from a group of young peer leaders who were dedicated to reducing stigma and fear of initiating HIV treatment in their community. And most recently, I attended the National HIV and AIDS Symposium, where I was duly impressed by Ruth Awori’s {Awar-Lee} MC skills and had the opportunity to hear from strong civil society advocates who emphasized the importance of providing accessible services for all, including persons with disabilities. The current variations in HIV testing, infections, care and treatment highlight the need to focus efforts on ending inequalities between young people and adults.
It is still possible to end AIDS by 2030. Four decades of Uganda’s game-changing scientific breakthroughs and program experience have given all of us the knowledge we need to accomplish this goal. Applying a person-centered service delivery framework, together with committed stewardship by government, focused and efficient investment, and the enthusiasm of young people to advocate for needs-based service delivery, can galvanize policy makers, development partners, civil society, and communities towards the solutions that will reduce the number of new HIV infections and AIDS-related deaths. PEPFAR is reimagining its strategic direction to end the HIV pandemic and sustainably strengthen public health systems. Our strategic direction will be closely coordinated and aligned with the new “Global AIDS Strategy 2021-2026: Ending inequalities, Ending AIDS,” which was released by UNAIDS and adopted by all PEPFAR countries.
As the discussion today is mainly focused on amplifying the voices of young people to advocate for their needs, I want to emphasize that PEPFAR remains deeply committed to ensuring all ages, genders, and population groups at risk for HIV infection receive data-driven and evidence-based, equitable, people-centered, and gender-affirmative HIV prevention and treatment services. We are aware that pandemics do not affect all people uniformly, as underscored by the major equity gaps that persist for adolescent girls and young women (AGYW) and children. We will double our existing efforts to intentionally prioritize these groups by accelerating our efforts to effectively and efficiently achieve durable viral load suppression and reduce incidence.
Noting that youth are the most technologically connected age group, with 71% of the worldwide population online compared with 48% of the total population, treatment adherence activities and differentiated service delivery models targeted to youth should include new opportunities to leverage technological resources and innovations. Such digital approaches provide an excellent way to engage adolescent and young people living with HIV, both during and following the COVID-19 pandemic, such as UNYPA’s app for peer support groups, improving youth and medical provider communications, and identifying local youth-friendly services. I applaud youth led organizations, like UNYPA, which have led on digital and community interventions to reduce stigma and discrimination.
Moreover, in order to advance equity in HIV prevention, PEPFAR Uganda has maintained investment in the DREAMS program, which stands for Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe, expanding to more districts and increasing service coverage within current districts over the years. DREAMS is focused on comprehensive HIV prevention among adolescent girls and young women in 24 high-incidence districts and reached over 240,000 adolescent girls and young women this last year through gender sensitive, evidence-informed prevention programs including curriculum-based behavioral change interventions, HIV testing services, pre-exposure prophylaxis (PrEP) expansion, education subsidies, socio-economic strengthening, gender-based violence prevention, and post violence care. These interventions are grounded in communities supported by strong partnerships with government and AGYW-focused partners, including youth-led organizations. I visited a DREAMS program in Wakiso in August, and what impressed me most was a young woman, a former DREAMS beneficiary, who used the lessons she learned in the program to prepare and save for university which she started this year. She remains active in DREAMS, but now as a mentor, helping other girls plan for their futures and find their voices.
PEPFAR will continue to collaborate with and complement the efforts of the Government of Uganda, and Ugandan civil society to keep girls in school, and prevent teenage pregnancies and HIV infection. There are high rates of teenage pregnancies, and 25% of adolescent girls aged 15-19 years have had a child or are pregnant. The school environment should serve as a safe space, and a place where children and adolescents can receive messages about HIV prevention. PEPFAR’s DREAMS and Orphans and Vulnerable Children (OVC) programs assist in keeping children and adolescents in schools through providing education subsidies to adolescents on the verge of dropping out of school. Last year, PEPFAR provided over 30,000 education subsidies to counteract the effects of the COVID-19 lock down.
The recently concluded National HIV and AIDS Symposium, under the theme “Ending Inequalities among Adolescent Girls and Young Women and Boys,” was another step towards addressing prevention and persistent treatment gaps impacting our progress. At the event I saw the passion of the community advocating to address the needs of the most vulnerable populations. I had the chance to speak with strong civil society leaders about the importance of recognizing the unique needs of persons with disabilities, and the importance of offering equitable and stigma-free health services for all populations.
All interventions to build back better for children and adolescents living with or at risk of HIV require the global community, including program participants, to be united by a collective desire for equitable access to treatment and necessary resources. Without equal partnership and a willingness to listen to the experiences of all stakeholders, like the young people disproportionately affected, the HIV epidemic will continue to deepen in the midst of inequity. Building back requires us to commit to partnerships with organizations and individuals that are ready to innovate and coordinate more resilient HIV programming, to sustain and catalyze actions. PEPFAR will collaborate with all partners including young people, government, and communities to dismantle the social and structural barriers that hold back progress in the global HIV response by addressing equity for women and girls, sex workers, men who have sex with men, people who inject drugs, people in confined settings such as prisons, and LGBTQI+ persons around the world.
As I conclude, I want to turn attention back to all of you here, most especially the soon-to-be-crowned Miss and Mister Y+, and the dedicated leaders and staff of UNYPA. You embody the creativity and innovation it takes to move us forward in this fight against HIV. All of us are invested in seeing Uganda reach epidemic control. We greatly appreciate your contribution to that goal. Tonight, on the eve of the American holiday of Thanksgiving when Americans wherever they are pause to express gratitude for family, friends, and life’s blessings, I want to thank you for carrying the torch for young Ugandans, for changing the narrative for those living with HIV/AIDS, and for opening new opportunities. We look forward to seeing what else you will do with your light as we pass you the mic.
