World AIDS Day 2023: Reflecting on Progress, Renewing Commitment

BY AMBASSADOR MARIA E. BREWER

As we commemorate the 35th World AIDS Day, we also mark the 20th anniversary of the United States President’s Emergency Plan for AIDS Relief (PEPFAR), an initiative that has proven to be a transformative force in the global fight against HIV/AIDS. Under the theme “World AIDS Day 35: Remember and Commit,” we seize this moment to reflect on the strides made in partnership with the global community and to commit to the actions necessary to eradicate HIV/AIDS as a public health threat by 2030.

For two decades, PEPFAR has served as a beacon of hope, extending its reach to thousands of communities with HIV prevention, care, and treatment services, ultimately saving over 25 million lives.  This monumental global effort, which includes investments for orphans as well as vulnerable children and their families, reflects the unwavering bipartisan support across four presidential administrations and ten U.S. Congresses, resulting in a cumulative investment exceeding $110 billion since 2003.

In 2022, the United States played a crucial role in the historic Global Fund Replenishment, contributing to more than US$15.7 billion in pledges to combat AIDS, tuberculosis, and malaria. This commitment underscores our dedication to a multilateral approach in the global fight against these three diseases.  PEPFAR-supported public health platforms remain vital to the ongoing fight against other infectious diseases, including cholera, COVID-19, Ebola, and Mpox.

Lesotho holds a special place in our efforts, with PEPFAR being the largest contributor to the national HIV response.  In the 2021-2022 fiscal year, PEPFAR funded 61% of Lesotho’s HIV response, alongside the Global Fund, which also receives significant U.S. support.  Over the past 15 years, the United States government has contributed a remarkable US$892 million, more than M16 billion, to bolster Lesotho’s HIV response.  In addition, as we contemplate a shift from a disease-specific approach, U.S. government investments in organizations such as global vaccine alliance GAVI are promoting comprehensive well-being. 

Lesotho’s progress, as evidenced by the 2020 Lesotho Population-based HIV Impact Assessment (LePHIA), is praiseworthy. Surpassing the UNAIDS goal of 90-90-90, Lesotho has reached epidemic control, indicating that 90 percent of individuals with HIV know their status, 90 percent of those aware are on treatment, and 90 percent of those on treatment are virally suppressed.  

Lesotho is also making strides in addressing structural factors, including societal stigma and punitive legal environments, that contribute to increased transmission and late-stage diagnoses.  The country is progressing towards UNAIDS’ 10-10-10 targets, which aim for a world in which there are less than 10 percent of countries with punitive legal and policy environments denying access to justice, less than 10 percent of people living with HIV and key populations experiencing stigma and discrimination, and less than 10 percent of women, girls, people living with HIV, and key populations encountering gender inequality and violence.

Working closely with our partners, we are also on track for Lesotho to realize the UNAIDS’ 2025 targets of 95-95-95. While we should applaud this progress, we cannot afford to take it for granted.  We must ensure that we take a person-centered holistic approach to our investments to support the overall strength of the health system and ensure the quality of integrated health and social protection services.  The stakes are high, and any regression would have devastating consequences globally. “World AIDS Day 35: Remember and Commit” serves as a poignant reminder of the over 40 million lives lost to HIV/AIDS and reignites our commitment to the mission of ending HIV/AIDS by 2030.

Our vision, consistent over these past 20 years, compels us to regularly evaluate our progress and implement changes to maximize impact on the HIV/AIDS pandemic, particularly in addressing gaps that still exist in reaching key and vulnerable populations.  Our continued response to HIV/AIDS will be challenged by other diseases and conditions, as people living with HIV face a higher risk of death and severe illness from diseases such as TB and COVID-19.

In conclusion, on this World AIDS Day, we stand at the crossroads of past successes and future challenges. Our journey with Lesotho, marked by significant achievements, demands a renewed commitment to address the evolving health landscape. This World AIDS Day serves not only as a moment of reflection but as a call to action. Together, let us continue to remember those we have lost, commit to the ongoing fight, and ensure that the vision of ending HIV/AIDS becomes a reality by 2030. 

Kea Leboha. 

Khotso, Pula, Nala.