World AIDS Day 2019 Op-Ed

Ambassador Rebecca Gonzales

2020 is right around the corner.  The start of a new year – or a new decade in this case – often compels us to pause and ask ourselves the following questions: are we living life to the fullest; and are we doing everything in our power to enable others to live their lives to the fullest?  We each only get one life to live, so these are valid and important questions to ask.  As the U.S. Ambassador to Lesotho, I care deeply about this country and the citizens of this beautiful Kingdom.  Today I ask myself – are Basotho able to live their lives to the fullest?  Due to the ongoing impact of the HIV/AIDS epidemic in this country, it is clear to me the answer right now is regrettably and painfully, no.

On World AIDS Day this year, attention must be focused on reaching epidemic control.  This is in order for Basotho to live life to the fullest for generations to come.  What does epidemic control mean? It doesn’t mean that HIV will no longer exist, but that we will see considerably lower numbers of new infections.  It means we will be able to identify people at risk and help them avoid infection, through methods like pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision (VMMC).  It means we will be able to keep people consistently on treatment so that their viral load is suppressed and they are unlikely to transmit the virus to their partners.  It means we can openly confront the stigma facing those who are HIV positive and combat the discrimination they face.  Reaching epidemic control means that more Basotho can live and thrive with the health and well-being they deserve.   It also means the Mountain Kingdom will be more stable and more prosperous as a result.

So, what is standing in the way of these goals?  I fear that the commitments to urgency and actions we make on World AIDS Day will start to fade as we all continue with our busy lives.  If we are going to reach epidemic control by 2020 and End AIDS in Lesotho, we can’t afford to let that happen.  We cannot let that sense of urgency fade and let Basotho down. As partners who care deeply, we cannot afford to let each other down. The United States, through PEPFAR, has provided more than 6 billion maloti – or $469 million USD since 2007.  We have ramped up our support to more than 1.25 billion Maloti ($94 million USD) this year to reach epidemic control, subsidizing Lesotho’s fragile health care system.  What we are striving for is exceptionally good results from Lesotho’s HIV program, as PEPFAR funding is and always has been contingent upon results.

We need urgency and commitment from all levels in the Government and from our stakeholders to address the complex issues that hold us back. We are encouraged that the Government is addressing the crucial issue of funding for anti-retroviral drugs (ARVs).  Paying for these life-saving medicines is a partnership of the Government and the international community through the Global Fund, which the United States supports.  The Government must find a way to finance ARVs on an annual, sustained basis for years to come.  Yes, this is an issue of finances, but also of the need for continued political will to provide services and to commit to taking care of Basotho.

We also note the serious issue of supply chain management, which impacts health service delivery across Lesotho.  In terms of PEPFAR programming, it hinders our ability to meet key goals related to testing, treatment, and viral load suppression.  As we have noted repeatedly, we are concerned with ineffective coordination among government offices and weak internal controls.   These issues result in lost time and energy for Basotho on treatment, who cannot get enough supplies of ARVs or access the testing and other services they need when they need it.   Furthermore, Lesotho must address the issues of longstanding service agreements with the Ts’epong Consortium in key health facilities.  Through our implementing partners, PEPFAR has provided mobile clinics for those ART patients who were turned away after quotas were reached.  But stop-gap measures cannot replace the need for a long-term solution.  As always, we stand ready to work closely with the Ministries and stakeholders involved to address these issues and improve service delivery in these areas, as it is essential to meeting our epidemic control objectives.

It is not only government officials and international partners who must take action to help reach epidemic control and end AIDS in Lesotho.  Each and everyone of us has a role to play, especially in combating stigma and discrimination that prevent people from getting tested and staying on treatment.  I have met and learned from ten Basotho who have battled stigma and discrimination personally or in their communities.  We chronicled their stories of hope in our PEPFAR Champions documentary that premiered in late September with the support and presence of Her Majesty Queen ‘Masenate Mohato Seeiso.  Her Majesty implored us all “to encourage and empower young people to make good choices for their health.” She called on men in particular “to join the campaign to become champions of your families and lead by example for the betterment of all our children…. to close the remaining critical gaps towards ending AIDS in Lesotho.”

For these reasons, as part of this campaign to be champions for Lesotho,

• We ask Basotho to Be Aware of their risk, know their status, and learn about prevention.
• We encourage Basotho to Be Honest with their partners, families, and health care workers so that we can target HIV testing services to those most at risk, especially men and youth.
• We want Basotho to Be Accountable and adhere to treatment, because in doing so, they can reduce the risk of transmitting to partners.  Remember, U=U!  Undetectable equals untransmittable.

Friends, let me be very clear on this World AIDS Day 2019, we have the tools to reach epidemic control in 2020 and end AIDS in Lesotho, so let us employ them with urgency and commitment.  Will you join me in resolving that 2020 will be the year we all do our part to ensure that Basotho can live life to the fullest for generations to come? This is my sincere hope.  Kea Leboha.  Khotso, Pula, Nala.

Drafted:               PAS – MSchumiJones,

Cleared:               PEPFAR – CHoltzman  (ok)

PEPFAR/CDC – APelletier  (ok)

PEPFAR/USAID – Kruckstuhl (ok)

POL/ECON JRodd (0k)

POL – RMoea (ok)

PAS/PEPFAR – RNkhahle (ok)

A/DCM – Agrier  (ok)