Remarks by U.S. Deputy Chief of Mission William D. Bent
Rukungiri District, Uganda | December 1, 2022
(as prepared for delivery)
Good afternoon! I am delighted to join Ugandans to commemorate this significant day in the history of HIV/AIDS. Each year on December 1st, the world commemorates World AIDS Day. Founded in 1988, World AIDS Day was the first international day for global health. On this day, people around the world are united in support of people living with HIV and take time to remember those who have died from AIDS-related illnesses. This year’s global theme “Equalize,” along with the Uganda national theme, “Ending Inequalities Among Adolescent Girls, Young Women and Boys,” point us in the right direction towards a strong multi-sectoral commitment to ending the HIV/AIDS pandemic. Likewise, UNAIDS is urging each of us to address the inequalities that hamper progress in ending the HIV pandemic. This year’s theme highlights the dual importance of delivering quality, people-centered HIV prevention and treatment services and of strengthening the capacity and resilience of communities and health systems to address HIV and other health challenges. I am delighted to attend this World AIDS Day and recognize the importance of ensuring equitable health service and accurate information about HIV is available across Uganda.
The U.S. government’s theme for today is— Putting Ourselves to the Test: Achieving Equity to End HIV— and like Uganda’s National theme, it emphasizes accountability and action, affirming the Biden-Harris Administration’s dedication to ending HIV, both in the United States and around the globe, through an approach that centers on communities disproportionately affected by the pandemic. This year, we also observe World AIDS Day in the context of other infectious disease threats—such as COVID-19, Ebola, and mpox—which have heavily impacted many of those same communities. These threats have further exacerbated the fact that our public health response to HIV will require us to address health disparities holistically.
This theme also highlights the importance of HIV testing. Those at risk must get tested for HIV and everyone should know their status. We are advancing a status-neutral approach to HIV testing that puts equity at the forefront. Under this approach, no matter what the result, people should be connected with the necessary HIV prevention and treatment services, including strategies to address the structural and social barriers to health. I want to call upon the country’s leadership to add “equity” to accountability, transparency, and impact as a guiding pillar for HIV programs, as well as to prioritize work to eliminate the persistent inequalities experienced by children, adolescent girls and young women, and key populations including as sex workers, men who have sex with men, people who inject drugs, and people in confined settings such as prisons.
We have made remarkable strides since the first World AIDS Day commemoration 34 years ago. These advances are largely based on the advocacy of people living with HIV, community-based organizations working in areas most affected by HIV, and through collaboration and partnership between governments, public-sector partners, multilateral institutions, non-governmental, academic, and philanthropic organizations. The U.S. government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), is proud to have been on the forefront of advancing HIV epidemic control for nearly 20 years. Scientific research has yielded innovations in HIV care, treatment, and prevention so that individuals living with HIV can enjoy longer, healthier lives. Robust scientific studies have also shown that people who are on HIV medication and achieve and maintain viral suppression, cannot spread HIV to others – this is a vital message for today – an undetectable viral load means the virus is untransmissible or “U=U”. This means that successful treatment further drives down new infection rates and protects our loved ones from HIV transmission.
As the largest commitment by any nation to address a single disease in history, led by the U.S. Department of State in collaboration with seven other U.S. government partner agencies, PEPFAR’s programs have saved more than 21 million lives, prevented millions of HIV infections, and helped countries build a strong foundation to prevent, detect, and respond to other health threats globally, including COVID-19 and Ebola.
Yet despite our tremendous progress, our work is not finished. New data from UNAIDS on the global HIV response reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and 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. We remain deeply committed to ending HIV everywhere by engaging and empowering communities, and by ensuring that our programs, research, and policies are informed by the voices of the people most impacted by HIV.
This World AIDS Day, we acknowledge that providing equitable access to HIV testing, prevention, care, treatment, and research is key to ending the HIV pandemic. This year represents a pivotal year in PEPFAR, as several countries are reaching or approaching the UNAIDS 95/95/95 benchmarks for attaining epidemic control. Uganda must, as a country, ensure HIV programs address population equity and outstanding barriers that threaten to derail progress to reduce new HIV infections and associated mortality. Uganda must tailor its programs to serve all populations because a focus on equity also means a focus on population groups where our efforts to date have not closed these gaps.
As U.S. Ambassador Natalie E. Brown mentioned during the National HIV Symposium, 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 HIV treatment should be an easy choice for everyone, but for many, it is not.
Uganda’s investment in the HIV response is critical to long-term sustainability. Approximately 85% of the Uganda’s HIV/AIDS response is externally funded, posing a major sustainability challenge. Domestic resource mobilization is vital going forward and together as partners, we need to focus on finding more sustainable strategies– this means mobilizing additional domestic and external funding but also seeking efficiencies in the use of our current funding. One immediate strategy could be to support the One Dollar Initiative and for the government to lead the incremental transition of functional health systems responsibilities to ministries, ensuring a whole of government and multi-sectoral approach to building and sustaining resilient health systems.
Sustaining epidemic control will require more robust and efficient systems to allocate and manage limited resources. This fiscal year, PEPFAR is working across all levels of the health system. At the national level, we will continue prioritizing development of key policies to ensure that programmatic barriers hindering equalities among adolescent girls, young women and boys are addressed. At regional level, we will continue to support the Ministry of Health to roll out the Regional Referral Hospital strategy while ensuring the capacity of these Regional Referral Hospitals is built to fully take on core mandates like Continuous Quality Improvement and supportive supervision, in addition to providing quality HIV prevention and treatment services. PEPFAR Uganda believes that strengthening Regional Referral Hospitals technical and organizational capacity is fundamental for supporting oversight at the decentralized level, especially as we reach epidemic control and start transitioning more responsibility to the Government of Uganda.
To better align PEPFAR programs with the Government of Uganda’s development models, we will support the Ministry of Health – the Community Health Department, Ministry of Finance, Ministry of Gender, Labor and Social Development and Uganda AIDS Commission to better coordinate stakeholders implementing community health services and align all these into the Government of Uganda-led Parish development model for sustainability. Uganda will focus on the Community Health Extension Workers pilot, the national community health strategy and standardization of community data reporting systems.
Finally, together, with the Government of Uganda and civil society leadership, we have made tremendous progress on the HIV response. However, the magnitude of sustaining the HIV Impact remains high. Uganda still has about 1,000 new infections and 500 deaths every week. This reminds us that in addition to the Presidential Fast Track Initiative, we must recommit and re-energize all sectors of society to center equity within the country HIV response by ensuring that everyone with HIV and those at-risk for infection have access to appropriate HIV testing, treatment, and prevention services. We encourage anyone who doesn’t know their status, to get an HIV test today and to help us combat HIV-related stigma. As we work to implement the National HIV AIDS Strategy, this year’s theme reminds us that the time has come to act, and for all of us to put ourselves to the test of ending HIV by supporting health equity, sustainability, public health systems and security, respectful partnerships, and science, in the context of community leadership, innovation, and leading with data, and more importantly by amplifying the voices and strategic priorities of people living with HIV.