7th SA AIDS 2015 Conference Opening Plenary

Remarks by Ambassador Patrick H. Gaspard


(As prepared)
7th SA AIDS 2015 Conference
Tuesday, June 9, 2015


I want to thank the organizers of this Conference for inviting me to speak.  It is indeed a privilege to be among this distinguished panel and be able to address this uniquely qualified and expert gathering.  I’m humbled to be able to represent the American people in this hall of heroes; this gathering of leaders who are committed to making every sacrifice to save every single life you can.

As you know, our work in this field is largely funded by the U.S. President’s Emergency Plan for AIDS Relief, also known as PEPFAR, the U.S. government initiative to save the lives of those infected and affected by HIV/AIDS around the world.  The PEPFAR commitment by the United States is the largest by any nation to combat a single disease internationally – the United States has contributed more than $4.5 billion, or roughly 56 billion Rand, to the effort in South Africa alone.  PEPFAR has helped save millions of lives globally since it began in 2003 – many of those millions right here in South Africa.

People like Zama Maphumulo, a young woman in KwaZulu-Natal who found out she was HIV-positive from her local clinic during pregnancy.  While understandably devastated, Zama fought her fear and depression to do the right thing for her unborn child. Thanks to a successful PMTCT program led by the National Department of Health, and supported by PEPFAR, her baby boy was born HIV free.  In June, he will celebrate his second birthday, and he is just as adorable – and naughty as any other little two year old boy. These are our shared miracles.

Zama’s story demonstrates South Africa’s remarkable achievements, and we congratulate the South African government, and in particular the National Department of Health, for its successes.  We also want to say how proud we are to be part of the team − proud to work with you, through our staff and implementing partners, to deliver treatment and prevention services, as well as assist in building capacity within your health care system.

When preparing for this address, I was very happy to see the theme of the conference is “Reflection, Refocus, and Renewal.”  This sums up what the U.S. government has been doing with regard to the PEPFAR program, both here and in Washington over the past several months.

When reflecting on the past, we remember how far we have come globally, since the early 1980s,when a mystery disease began claiming the lives of so many around the world.  While those were dark years, many of you in this room committed yourselves to work to save lives, prevent new infections, and to end the epidemic within your lifetimes.

It has been extremely challenging.  Victories have often been overshadowed by the rising number of new infections and a tremendously high number of AIDS-related deaths over the years.  But no one can deny our dramatic global progress.

As South Africa’s strongest partner in combating the AIDS epidemic, the American people have reached across the globe for more than eleven years to support the South African response to HIV/AIDS and tuberculosis.  As the largest single bilateral donor to the Global Fund to Fight AIDS, TB and Malaria, the U.S. government further contributes to South Africa’s grants from that source as well.

PEPFAR has supported the South African government in a tremendous nationwide expansion of HIV and TB treatment, PMTCT, voluntary male medical circumcision, prevention among key at-risk populations, and support to orphans and vulnerable children.

However, we still see very high HIV incidence rates, including the disturbing 7,000 new infections in young women globally each week throughout Africa.  Sadly, we estimate that 2,363 girls between the ages of 15 and 24 are infected in South Africa every single week.

This is simply unacceptable and needs to motivate a moral outrage and righteous urgency in all of us. It should also inspire us to be more precise and data driven with our approach. The time has come to use evidence to put together a strategic and effective model to help South Africa gain control of the epidemic and sustain that control into the future.

South Africa is a world leader in HIV treatment, but more specifically in innovations, game changers, and leap-frogging.   We applaud South Africa’s wisdom in using the Investment Case analysis of the HIV and TB response, an analytical process which has recently revealed important findings about what is cost effective.  We also strongly support South Africa’s commitment to plan a district level HIV response through the new HIV/TB District Implementation Plans.

The National Department of Health is charting a course to go where the virus is, and to focus for impact to control HIV and TB.  PEPFAR is 100 percent in support of this approach.

To get control of these epidemics by 2020, we must reach the UNAIDS 90-90-90 targets –meaning 90 percent of people living with HIV know their status, 90 percent of them on anti-retroviral treatment, and 90 percent of those on treatment virally suppressed.

This is an excellent overall blueprint for action.  For PEPFAR, it means that to get control of the epidemic by 2020 and ultimately start to see the end of the epidemic by 2030, we need to do the right things, in the right places, right now.

And this is PEPFAR’s aim in moving forward with what we call “Focusing for Impact.”

Focusing for Impact involves working with the South African government and other stakeholders to strategically focus PEPFAR resources geographically and programmatically to support HIV/AIDS prevention, care, and treatment programs in the highest-burden areas in order to support South Africa to achieve the ambitious 90-90-90 targets.

We are prioritizing smart investments by supporting programs that are effective and efficient.  We want South Africans to test regularly for HIV, and, if HIV positive, to receive the highest quality of care and treatment services, without facing stigma or discrimination,  and to adhere to that treatment to reach  viral suppression.  By doing so, we will help those on treatment live longer, healthier lives.

We are also putting a new priority on young women and girls whom we know have been left behind in the global response.  Currently, in South Africa, young girls age 15-19 are 8 times more likely to be HIV positive than males the same age.  To address the high incidence and specific vulnerabilities of young women and girls, PEPFAR has joined with the Bill & Melinda Gates and Nike Foundations to launch the DREAMS Initiative, which will allow ten African countries to ensure that adolescent girls and young women have an opportunity to live Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe lives.

And I am very proud to be able to announce today that South Africa is one of those ten DREAMS countries.  This new DREAMS initiative is incredibly exciting because the resources received will be invested to provide the best combination of evidence-based interventions to girls and young women to help them reach their full potential and remain HIV-free.  What’s new and different about DREAMS is that we are offering girls a holistic, full package of services that they need to thrive, which touches upon: health, education and services, economic empowerment, and psychosocial support.

We are optimistic that together we can really make a difference.

After all, what we know is that when a girl has access to health services and is HIV-free, is included in economic investments, has a choice over when she marries and starts having children, and has the opportunity to realize her full economic and social potential, she isn’t the only one who escapes poverty. She brings her family, community and country with her.

It is inspiring to know we can change the game for young women and girls,  and that we have the potential to get control of the HIV epidemic by 2020 and end it by 2030.  It allows us to look forward to 2016 and the return to Durban of the International AIDS Conference.  If we draw closer to work more collaboratively and with a renewed sense of urgency, enthusiasm, and commitment, we will have a good story to tell here next year.

But what will it take?  What will renewal involve?

First, we must base our programs on the best evidence.  We must use that evidence to get the basics right at the service delivery level and build on that, remembering the individual patient is the center of all our work and always will be.

We must continue to build collaboration between government and development partners, between and among different government departments, and between civil society stakeholders at the community level.

We must constantly learn and improve our programs.  Innovation, including the use of the latest technology, will also be key to efficiency and progressing quickly toward our targets.

In fact, innovation is a hallmark of U.S. assistance in the health sector.  We are excited to see our bi-lateral  partnership flourish in this regard , with joint work on science, technology and biomedical, behavioral and implementation research driving an innovation agenda across the health sector.  Collaborative research programs are addressing priority issues from new TB drug regimens to HIV vaccines, work with global implications beyond the borders of South Africa or the United States.

Just two weeks ago, we all learned from the results of the landmark START trial, that an early start to starting antiretroviral treatment improves outcomes for HIV-infected individuals.  This study, supported by the U.S. National Institutes of Health and including South African researchers and volunteers, will improve HIV treatment worldwide.  This is an excellent example of global collaborative science in action.

Another type of innovation can be illustrated by U.S. support for the National Department of Health as they launch MomConnect, which uses mobile technology to help improve health outcomes for pregnant women and mother-baby pairs.  MomConnect has more than 420,000 women registered across the country and this number increases every month.  I hope for opportunities to further lend my personal support to getting the word out and increasing the already very successful uptake of MomConnect as an important channel for health messages.

Finally, we must not rest until we reach those in need in our communities.  This effort means extending even further into communities to reach key populations like commercial sex workers and men who have sex with men — those who are most at risk of becoming HIV infected and yet are often reluctant to visit a facility for fear of stigmatization and discrimination

In closing, this conference is a critically important opportunity for sharing of knowledge, best practices, and stories from the trenches.  There can be no better reason to come together than to save lives.  Let us all press forward, remembering that an AIDS free generation is possible and that the people of our nations deserve that chance.

Thank you.