U.S. Embassy Kampala
December 1, 2020
Remarks by U.S. Ambassador Natalie E. Brown
World AIDS Day Commemoration
Office of the President – Conference Hall,
(Remarks AS PREPARED FOR DELIVERY)
His Excellency the President of the Republic of Uganda
Honorable Minister of the Presidency
Honorable Minister of Health
Honorable Members of Parliament
Ambassadors/Heads of Missions
Director General, Uganda AIDS Commission
Heads of UN Agencies
Religious and Cultural Leaders
CSOs and other key stakeholders
Ladies and Gentlemen,
All protocol observed
Your Excellency, I am deeply honored to join Ugandans today to recognize progress achieved in the three decade-long fight against HIV/AIDS in Uganda. The theme for Global World AIDS Day 2020, “Global solidarity, shared responsibility,” and the Uganda national theme “National solidarity and a shared responsibility towards ending AIDS” point us in the right direction – they point us toward a strong, multi-sectoral commitment to ending the HIV epidemic.
The two themes also highlight the 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. And this event is an excellent platform to disseminate HIV messages, to increase knowledge, especially among men and young people, about prevention and control of HIV, and for Uganda to demonstrate national and global solidarity toward ending AIDS as a public health threat by 2030.
Among the many advocacy events focused on keeping attention on the fight against this pandemic, World AIDS Day is key, and I commend the Uganda AIDS Commission for making this important event happen safely, despite the many challenges posed by the current COVID-19 pandemic.
It wasn’t that long ago that HIV was a death sentence in many parts of the world. Now, today, together we have made remarkable progress. At the end of September 2020, of the estimated 1.4 million People Living with HIV in Uganda, 86% had been diagnosed, 99% of those diagnosed were on treatment and 74% of those on treatment were virally suppressed. This demonstrates that many people living with HIV can access services, achieve viral suppression, and lead healthy lives.
We still have a long way to go, however, to achieve the updated UNAIDS targets of 95-95-95. Eliminating the remaining gap will be more challenging and will require highly innovative approaches to provide access to services to children, adolescents, and young adult men, the groups that constitute the majority of those yet to be reached. The COVID-19 pandemic only complicated this. While progress continued in some areas, there were setbacks in others, and many community-based programs were paused or had to be redesigned. We’re steadily regaining ground and together we can make what once seemed impossible possible.
COVID-19 heightened the challenges but is not the only obstacle. More than 30 years into the HIV fight, stigma, discrimination, and non-disclosure remain key challenges, limiting access to services, particularly for those groups I just mentioned. This is why the United States, through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, and working in close collaboration with Uganda’s Ministry of Health, international partners, and civil society organizations, has responded to these challenges by expanding client-centered interventions through village health teams, expert clients, peer networks, mentor mothers, and others. By scaling up social network strategies among adolescents and young adults, the identification of HIV positive cases and their subsequent treatment initiation has increased.
Moreover, the United States recognizes that a healthy population is the foundation for a country’s social and economic development. Therefore, every year we invest nearly $500 million in Uganda’s health sector—the bulk of which goes to supporting HIV programs through PEPFAR. Through the collective work of U.S. government agencies –the Departments of State and Defense; the U.S. Agency for International Development; the U.S. Centers for Disease Control and Prevention; Peace Corps, and others, which represents a whole of government approach — we support Uganda’s HIV response programs with a focus on prevention through elimination of Mother to Child Transmission, Voluntary Medical Male Circumcision, provision of pre-exposure prophylaxis to special populations, implementation of care and treatment services, including managing TB co-infection, and the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe program for adolescent girls and young women (which you may know as DREAMS). In fact, just last week I had the pleasure to help to launch DREAMS activities for two previously unserved districts, Masaka and Kalangala.
Women and key populations continue to be disproportionately impacted by HIV in Uganda, which continues to threaten the gains we have made towards achieving epidemic control and setting this nation on a trajectory to achieve its development goals. The personal testimonies of young women who have benefited from DREAMS were truly inspiring, and equally important, was hearing district leaders commit to supporting these new DREAMS efforts, as local collaboration and support are vital to the program’s success.
With these young people in mind, who have so much potential and so much to live for, let me remind you of why we are gathered on this important day and the outstanding tasks:
Stigma, discrimination, and non-disclosure, along with insufficient psychosocial and nutritional support, remain significant challenges. Therefore, establishing more inclusive health promotion mechanisms, and increasing efforts to work with “people living with HIV” must be a focus. All concerned actors – governments, civil society organizations, organizations supporting key populations – must work collectively to foster a more favorable environment for ready access to HIV prevention for these critical groups.
We urge the Government of Uganda to rapidly adopt relevant, global HIV normative guidance and policies, and to fully implement them at scale, in order to address key impediments to health care access by the most vulnerable and poor. PEPFAR is ready to continue working with the Government of Uganda to urgently address key policy barriers that data show are impeding inclusive access to health services.
The demands for investment in the HIV response remain daunting. Approximately 85% of Uganda’s HIV/AIDS response is externally funded, by donors and others outside Uganda, which poses a major sustainability challenge for this nation. Uganda’s domestic resource mobilization will be critical going forward. I want to take this opportunity to commend Uganda on having significantly increased the allocation of domestic funds by providing an additional 50 billion Ugandan shillings (approximately $13M) for HIV commodities in the financial year 2020/2021. However, to be clear, together, we need to identify and implement more sustainable strategies to invest in the HIV/AIDS response here. This means mobilizing additional domestic and external funding, but also seeking efficiencies in the use of current funding. One immediate strategy is to support the One Dollar Initiative and make the AIDS TRUST FUND operational.
There are many drivers of the HIV epidemic, which require us to have a comprehensive, multi-dimensional response, to include factors that lie outside the health sector. For example, we must work together to ensure young children and adolescents, especially girls, remain in school. We also need to ensure better integration of services between HIV and sexual and reproductive health rights and health systems more broadly. This is necessary not only from an economic point of view but also from a practical one: health systems are the foundation of all service delivery – prevention, health promotion, and treatment – and the HIV response cannot be delivered without strong health and community systems. So we must improve referrals from community to facilities and ensure follow up care for mothers to ensure elimination of mother to child transmission of HIV.
Finally, Your Excellency, Uganda has made significant progress in fighting HIV and AIDS during the period 2010-2020. Yet, the magnitude of the epidemic remains unacceptably high. Uganda still suffers about 1,000 new infections and 500 deaths every single week. This reminds us that in addition to the Presidential Fast Track Initiative, we need to sustain our commitment to “National solidarity and a shared responsibility towards ending AIDS” in Uganda and globally by leveraging the power of partnerships, working closely with government agencies, the private sector, philanthropic organizations, multilateral institutions, international organizations, civil society and faith-based organizations, and most important, people living with HIV.
Only through a concerted, all hands on deck approach will we be able to achieve this last and most difficult step in achieving the goal we set for ourselves so long ago: to ensure future generations can live free of HIV and AIDS. The United States is proud to be a partner in this effort, which is underscored by our own theme for World AIDS Day 2020: “Ending the HIV/AIDS Epidemic: Resilience and Impact.”
Thank you for your kind attention.