Africa: Digital Press Briefing – The Future Role of The United States PEPFAR in Africa

Ambassador John N. Nkengasong discusses the  President’s Emergency Plan for AIDS Relief  in Africa, the importance of establishing strong  public -private partnerships  for sustainability of the response, government ownership and leadership in the HIV/AIDS response.

MODERATOR:   Good afternoon to everyone joining us from across the continent. We are hosting today the U.S. Department of State’s Global AIDS Coordinator and Senior Bureau Official for Global Health Security and Diplomacy, Ambassador John N. Nkengasong. Ambassador Nkengasong will discuss the President’s Emergency Plan for AIDS Relief in Africa, or PEPFAR, the importance of establishing strong public-private partnerships for sustainability of the response, government ownership and leadership in the HIV/AIDS response.

So, as always on a Hub Call, we will begin today’s briefing with opening remarks from Ambassador Nkengasong, then we will turn to your questions.  We will try to get to as many of your questions as possible during the briefing.

So with that introduction, I will turn it over to Ambassador Nkengasong for his opening remarks.

AMBASSADOR NKENGASONG:   Thank you.  Good afternoon to everyone.  Let me extend a very warm welcome to all of you again.  Very happy to see some of the familiar faces on this platform.  The media and the press play a critical role in our collective response to disease threats, and even to our collective health care programs on the continent.  So I really take it as a point of honor to continue to engage with you all on this platform.

This afternoon I am in Gaborone, in Botswana, and I spent last week in South Africa to elevate two issues.  One is to address a roadmap or our thinking of how we should be approaching our journey to 2030 and beyond 2030 by sustaining the response to HIV/AIDS and travel that journey which we’ve traveled in the world of PEPFAR, the President’s Emergency Plan for AIDS Relief, for the past 21 years.

That discussion – the time has come for that discussion because we’ve made tremendous progress.  A country like Botswana has achieved the three 95 goals set by the UNAIDS, which is a joint United Nations AIDS program, which essentially says we needed to by 2025 make sure that each country identify 95 percent of people who are infected and they should know their status, 95 percent should be under treatment, and 95 percent should have viral load suppressed.  Botswana has achieved that (inaudible).  The fight against HIV/AIDS is not over, so we need to sustain that response, continue to treat people who are infected, and prevent the rates of new infections.

I think overall over the last 21 years, PEPFAR has invested over $110 billion, and in Botswana it has invested in our partnership with the Government of Botswana over $1 billion, and that has been part of the success story that I just described for you in Botswana.

As indicated, PEPFAR is committed to accompany the people of Botswana to achieving an AIDS-free generation hopefully by the year 2030.  So I look forward to an exciting and productive conversation this afternoon.

MODERATOR:   All right.  Thank you very much, Ambassador Nkengasong.  So we’ll now begin the question-and-answer portion of today’s briefing.  So we would ask you to please make your questions nice and short and limit yourself to one question only, and that it has to be on the topic of today’s briefing, which is the future role of PEPFAR in Africa.

So for our first question I’d like to go to Ms. Fumbe Chanda from Prime TV in Zambia, and the question is this one, Ambassador Nkengasong:  “How are you working with the respective countries to ensure sustainability in case PEPFAR comes to an end one day?  Will Africa’s health systems be able to stand on their own?”

AMBASSADOR NKENGASONG:   Absolutely, that’s a very good question, Fumbe, because we have to be thinking ahead.  HIV unfortunately is a very clever virus.  It’s a retrovirus, which means that it will take a considerable amount of efforts, if we are fortunate to have a vaccine and cure, to be able to say that we eradicated HIV or eliminated HIV, just like we did for polio – what we are doing for polio or smallpox.

So that means we have to think about sustaining the gains that we’ve made over the last 21 years in maintaining people on treatment and making sure that the rates of newly infected people is decreased.  So the dialogue is:  How do we get to our 2030 goals, which we’ve all agreed as part of the Sustainable Development Goals, to bring HIV/AIDS to an end as a public health threat and look beyond 2030?  The journey to that begins with clarity of conversations with partner countries like Botswana to say:  What can we do and what can you do so that we continue?  It’s not about ending PEPFAR; it’s more about constructing the way forward based on the success that we’ve achieved so far.

MODERATOR:   Thank you very much, Ambassador.  All right.  So second question today comes from Mr. Mqondisi Dube of Voice of America in Botswana, and the question is:  “Ambassador, what is your view on HIV/AIDS being regarded as the ‘forgotten’ pandemic?  And amid other emerging global threats such as COVID-19, mpox, climate change, and conflicts in Ukraine and the Middle East, how have these impacted funding for HIV programs in – not just in Botswana, but in Africa in general?”

AMBASSADOR NKENGASONG:   Absolutely.  Let me, first of all, state that HIV/AIDS is not a disease of the past; it’s a disease of the present.  And we should be very careful not to be vulnerable to our own success.  We’ve done tremendously well in controlling HIV.  The fight is not over.

So let me just share some numbers, which I stated earlier.  Just last year alone in this – in Botswana, the country recorded 4,200 new cases of infections, and many amongst young people.  I don’t think we – in this country, we recorded 4,000 cases of mpox or any other emerging disease.  So the HIV is still there.  HIV is still killing people, that if we know that on UNAIDS’s data last year alone there were 650,000 people in the world that die of HIV/AIDS, and 60 percent of those were in Africa, 60 percent of those.  And I don’t know that mpox has killed over the course of one year 450,000 people; that will be 60 percent of the deaths, the global deaths.  So HIV is still there.

The unfortunate thing and the warning to all of us is that HIV is a hidden pandemic.  It doesn’t just show up.  It’s very quiet in our communities and spreads silently.  So because of that, it’s not so visible.  And because of the success, the remarkable success that most – that we’ve achieved over the last two decades, we do not go to the clinics and see the face of the HIV and the ugly face of HIV all over.  So because of that, it is fair to say that it’s not very visible in the political radar of many countries as it was before.

And that’s one the reasons that I’m beginning a tour of the continent to meet with the highest leadership of each country – to say, look, we’ve made progress, but the fight against HIV/AIDS is not ended, it’s not over.  You need to continue to commit your own resources to the fight, as we commit the U.S. resources to it.  You need to shape your programs in a way that they can respond to the needs today and fill the inequity gap that exists in young children, in adolescent girls and young women, and in key populations.

So I think let’s just always remember where we’re coming from, and remember that if we cannot sustain the response, the ugly face of HIV that we saw 20 years will emerge in Botswana and in many countries in Africa.

MODERATOR:   Thank you very much, Ambassador.  So we have a live question from Carmen Paun of Politico.  I’m going to invite Carmen to ask her question live.

QUESTION:   Hi.  Thank you so much.  And good morning from D.C.  So, Ambassador, I just wanted to ask you, so how exactly does the future of PEPFAR look like in Africa past 2030?  Are you sort of, like – do you foresee less funding, less involvement from the U.S.?  How exactly will that engagement look like past 2030, as far as you can tell at this point?

AMBASSADOR NKENGASONG:   Thanks.  Thanks, Carmen.  And thanks for tracking me down in Botswana.  Carmen is always one of those strong advocates for PEPFAR and for the HIV response.

So let me say this, Carmen – I think my greatest priority now is to work with you and others, our civil society, and to continue to engage everyone to recognize that the fight against HIV/AIDS is not over.  My top priority is to continue to work with Congress so that we get a clean five-years reauthorization, so that would take us to our 2030.  So that segment is so important, so that as we think past 2030, we primarily or first of all are thinking about the journey to 2030.  That is so important, because the post-2030 will depend on the – our success to 2030.   We – as I get to 2030, I want to say, like, look, we got somewhere with the fight against HIV; we got nowhere with the fight against HIV; or we got anywhere with the fight against HIV.  That’s what 2030 will look like.

So I think my top priority is to work with everyone, mainly Congress, to get a clean five-year reauthorization.  That way we – it can enable us to have a sustained conversation with the partner countries and say, look, let’s approach our journey to 2030 in the spirit of joint responsibility and joint accountability.  We put – the U.S. Government is not transactional in the fight against HIV.  We have not – we are a committed and proud partner.  We’ve done that successfully and impactfully for the last 21 years, and we are not going to give up.

Past 2030, depending on the success, it will define a way forward.  But let me just say this to conclude:  The U.S. has been in the business of foreign assistance since 1961, under President Kennedy.  And I don’t think that foreign assistance, including foreign assistance or health programs, is going to be cut off.  How PEPFAR looks like post-2030 will depend on our success and will depend on several other determinants, which I cannot predict what will happen in 2030 from where I’m sitting now.

MODERATOR:   Thank you, Ambassador.  We have a question from Mr. Elton Mulenga, a freelance journalist from Zambia.  And the question is:  “Does PEPFAR build capacities of medics in the beneficiary countries?”

AMBASSADOR NKENGASONG:   PEPFAR – one of the things that we do not highlight enough in the PEPFAR program is the capacity-building component.  Just to put it in – share some numbers with you, PEPFAR supported the strengthening of more than 3,000 laboratories, government laboratories, in Africa.  We’ve trained over 240,000 health care workers.  We’ve strengthened over 170,000 health facilities across the continent.  And we’ve supported – we’ve been critical in supporting the strengthening of information systems, surveillance systems, and commodity supply chain management across many African countries that have served as a platform to enable countries to respond to other disease threats that they are currently facing, including mpox, COVID.

A lot of the COVID successes that we saw in Africa were on the backbone of work that PEPFAR had established.  So we are very proud partners in strengthening health systems on the continent.  We would never have achieved the goals of saving 25 million lives, preventing 5.5 million children born free of HIV without very strong systems, capacity development on the continent.  It is one of those programs that (inaudible) the knowledge that it will be the rising tides raising all boats in the sea.  PEPFAR has been transformative in changing the landscape of global public health in Africa.

MODERATOR:   All right.  Thank you very much, Ambassador.  So we have a few other questions that came into us from journalists on the call.  One of them is from Lilys Njeru of Nation Media Group, a very big newspaper in Kenya.  And the question is:  “A recent report released by UNAIDS shows that there are significant gains in Kenya.  The number of those receiving treatment has almost doubled.  However, children are still lagging behind in terms of accessing treatment.”  And then she gives some figures there.  “Could you comment on the phenomenon of children lagging behind in terms of accessing treatment?”

AMBASSADOR NKENGASONG:   The situation of children lagging behind is concerning, and should be concerning to everyone who cares.  If you think of inequities in global health and public health, access to children to treatment, and maintaining viral load suppression in children, it’s really something we should all consider seriously, and PEPFAR is prioritizing that.  PEPFAR just announced last year a special initiative called safe delivery and healthy babies.  That is a $40 million initiative that is aimed at strengthening, continuing to strengthen our partnerships to address that gap that you just mentioned.

And it’s not just in Kenya.  We see that across the world in all PEPFAR-supported countries, and we work with UNAIDS and the Global Fund and other partners to launch an alliance to fight HIV/AIDS in children.  The key question is always:  Where are the children?  Where should we find them?  How should we access them?  And how should we make sure that they stay on treatment once they start their treatment?  And very importantly, address issues of stigma around identifying children and making sure that they stay on treatment.  What kind of regimen should we have that would be friendly for children to use, and use all through the rest of their lives?  We’ve made progress, but we still have a lot of work to be done to close the inequity gaps in children.

MODERATOR:   All right.  Thank you for that.  Thank you very much.  So we have a question also from Kenya, from John Muchangi, who writes for  The Star .  And the question is:  “What is PEPFAR’s plan in promoting access to long-acting injectable ART and the new injectable” – I might be mangling some of these terms – “PrEP lenacapavir in Africa?”  I apologize if I got those terms wrong.

AMBASSADOR NKENGASONG:   No, you got it – you got it right, Johann.  We believe that the new developments that have occurred over the last couple of months – that is, the results from studies that were conducted in Africa showing that administering long-acting injectable preventable drugs can prevent the rates of occurrence of new infections almost by 100 percent, if administered twice a year.  That is the case of lenacapavir, produced by Gilead.  We are very excited in that.

We are in very active conversations with the leadership of Gilead.  We have – we met twice during the UN General Assembly, and just next week we are going to be meeting again together with Global Fund, the Gates – Bill and Melinda Gates Foundation to discuss issues of pricing and access.  We believe that it could be a gamechanger if we use that in a very targeted manner, where we identify truly the population or sub-population that are at risk, and really go in there and administer the drugs in a way that is at scale and in a way that is consistent.  Because remember, you have to use these drugs or these injections twice a year for the rest of your life.  And we are optimistic that we’ll find each other – that is, in terms of volumes and price points –  so that we can translate these new developments, scientific developments, into programs, what we call from the research labs into the arms of the people that are in need.

You also, as we speak, have oral, injectable long-acting PrEP produced by ViiV, a company that produces – the company that you mentioned.  But that intervention is administered every two months.

So again, it shows you the power of science and innovation as we fight HIV/AIDS.  Who knows, in the coming years we might actually be – if we are fortunate by science, continuous investment in science, we may have long-acting PrEP that are administered only once a year.  So again, we are very excited with the new developments with the lenacapavir, six-monthly injectable, but we still have some work to do in order to make the price truly affordable.  Yeah.

MODERATOR:   Thanks, Ambassador, for that update.  It’s very promising.  So we have a couple of questions came in from Uganda.  I think they’re somewhat related, so I’m just going to read both of those questions.  The first one is from Joyce Namugambe of Msnews in Uganda.  The question is:  “How can we help people living with HIV to come out confidently and speak?”  And then the second question from Byamukama Alozious, Mama FM in Uganda, and that question is:  “What about increased stigma of HIV patients in Uganda?”

AMBASSADOR NKENGASONG:   The two questions are related.  I think first of all let’s acknowledge the progress we’ve made in destigmatizing HIV.  And we also have to acknowledge that certain practices that have occurred and continue to occur on the continent – the Anti-Homosexuality Act in Uganda – it doesn’t allow for people to speak freely of their sexuality and then, of course, it prevents the fight against – or it becomes a barrier in the fight against HIV/AIDS.  So we have to bring down those structural barriers that lend themselves to discrimination, stigmatization, and alienization, especially in groups such as the LGBTQI – men who have sex with men, and others.  I think that is so important.  It’s also part of the challenge that we are seeing in treatment.

So it’s a collective responsibility, moral responsibility that we do not stigmatize, criminalize, and discriminate people living with HIV/AIDS.  We do not discriminate, stigmatize people living with hypertension, diabetes, or cardiovascular or cancer, so why should we segregate or discriminate people living with a disease that has a cure.  And even if the disease didn’t have a cure, it is our responsibility to provide compassion, care, and understanding and support for anyone living with HIV/AIDS.  The treatment is there.  No one should die of HIV/AIDS as – at this moment in the struggle against HIV/AIDS because we have highly effective treatments.  No one, and I absolutely mean no one, should die of – from HIV/AIDS in this day and age.

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