At the ‘New Directions in Global Health’ Seminar

As Prepared For Delivery | June 17, 2015 | Molepolole

Good morning.

It is a pleasure to be here. Thank you for hosting our U.S. Mission Team in Molepolole for this important seminar.

I had a nice drive out here from Gaborone this morning. We passed through smaller villages on the way – all of the “Ms” including Mogoditshane, Mmopane, Metsimotlhabe – and I had a chance to watch out the beautiful Botswana landscape. Here and there I could catch a glimpse of life in these villages, people moving about on this cold morning and making their way through another day.

Do you ever wonder how much of what we do really matters to the people in these villages? Do you think what you do impacts the people waking up across Kweneng East District today? I am here to remind you it does –what you do, day in and out, really does make a difference.

Everything we talk about in this seminar has an impact on the people outside these doors. This seminar focuses on HIV/AIDS and global health issues. Everyone in this room works in some capacity on these issues. The journalists invited here today play a role in the response to global health concerns by raising awareness, mobilizing us to action, and ensuring we are held accountable for the policy decisions we make and the programs we manage. Everyone here, in one way or another, works towards bettering the health of this nation.

For me and my entire U.S. Mission team in Botswana – and my government for that matter – the one goal that keeps us moving forward each day is achieving an AIDS-free generation. We know that despite tremendous progress, the HIV epidemic is not yet controlled. An AIDS-free generation is actually within our reach, but to get there we need to focus our efforts even more. We are committed to re-focusing our resources programmatically and geographically so we can reach the people and communities most in need. This will make a difference. We are sure of it.

I’ve been serving as Ambassador to Botswana for five months now. I have a point to get out of the Embassy and meet many people and see many parts of the country. My very first visit after presenting my credentials was to Tebelopele Voluntary Testing and Counseling Center in Gaborone. I conducted a very public HIV Test with the media present because I wanted to show people global health is one of my Mission’s top priorities, specifically in helping Botswana change the course of the HIV/AIDS epidemic.

We want to convince people to test for HIV, as it is the only way we are going to get a handle on this issue. That’s why I tested … and that’s why all of our leaders should be out there testing for HIV. We need to show good faith and lead by example. Talking about health and the path to an AIDS-free generation may be THE most important thing I do in my role as an Ambassador. That’s also why I am here this morning.

Ladies and gentlemen, I want to welcome you to the program we call “New Directions in Global Health” This two-day seminar is organized by an interagency team from the U.S. government in partnership with your District Multi-Sectoral AIDS Committee. We have also partnered with the Media Institute of Southern Africa, or MISA, in order to bring our friends from the media aboard as partners.

The aim of this program is to create a dialogue with district stakeholders outside of Gaborone and with the media, on the successes and best practices of U.S. government-funded health initiatives, programs and research in Botswana. We also aim to persuade key policy makers at the district level to increase their commitment and coordination in the response to HIV and other global health issues. It should be an interesting and productive two days of discussions.

The world’s attention is focused on the very issues you are discussing here today: responses to Gender Based Violence; Safe Male Circumcision; services for Key Populations; studies on Combination Prevention; and new policies and support forPrevention of Mother-to-Child Transmission. Our friends from the media will have no trouble finding something relevant and timely to report on this week.

My government’s global AIDS program known as PEPFAR, or the U.S. President’s Emergency Plan for AIDS Relief, has been working in partnership with Botswana for 12 years. While the Government of Botswana has made the lion’s share of the total investment, the American investment in this joint effort has so far totaled more than $700 million U.S. dollars. That is more than 6.5 billion pula. Together, we have accomplished a lot.

But we are not done. Every single day in Botswana, about 25 people become infected with HIV. That’s about 9,100 new infections every year. If we become complacent, if we lose focus in our efforts to control the HIV epidemic, the tremendous gains we have achieved will unravel.

So how do we plan to maintain these positive shifts? It will require delivering the right things in the right places, right now.

What are the right things? The New Directions program today and tomorrow is packed with discussions on the evidence-based interventions I am talking about. Ensuring access to HIV treatment is one of the right things. This is incredibly important in our path towards controlling this epidemic. We would like the Government of Botswana to consider changing its treatment policy and adopting a CD4 500 cutoff for initiation of HIV treatment. The World Health Organization has recommended that countries move to CD4 500 in order to get more people on treatment faster – and save more lives.

Anti-retroviral treatment acts as a prevention measure and moving to 500 would actually cut the number of new infections in Botswana by 22%. This may cost more initially, but will in the long run save Botswana’s health costs through fewer infections and a healthier population. We can’t afford not to do this.

Safe Male Circumcision is one of the right things. I am proud to announce that the U.S. government is supporting Botswana with $5 million to conduct a 6-month Safe Male Circumcision acceleration campaign across 12 districts – including right here in Kweneng East District. The campaign is targeting 15-29 year old men with the hope of conducting 35,000 circumcisions. You will hear more about this later this morning.

Option B+ is another one of the right things. For those unfamiliar with Option B+, this is a program that provides lifelong treatment to HIV-positive pregnant women regardless of their CD4 count. Why is this important Lifelong treatment helps prevent infant infections, it saves mothers’ lives, it reduces the numbers of orphans, and it is cost-effective. We have supported the Government of Botswana with the rollout of this important program.

Science tells us combination prevention is important. The United States, Botswana Ministry of Health and Harvard University are working on a four-year project called the Botswana Combination Prevention Project, also known by its Setswana name Ya Tsie (YAT-SEE-YEA). You will hear more about this study over the next two days.

We need to continue this kind of research that advances high-impact detection and prevention of HIV. But we also need to begin applying now the lessons we have already learned.

Over the past 10 years, PEPFAR has moved from an emergency response program to one of sustainability and shared responsibility. We have an obligation to Americans and Batswana alike to ensure every dollar spent on the HIV response in Botswana is maximized and used to accelerate HIV epidemic control.

So where are the right places? Our PEPFAR country team will be focusing most efforts in 11 health districts in Botswana with the highest disease burden and unmet need. We looked at district-by-district data and determined it would be much more impactful to work in select areas where there are gaps, rather than spreading the investment thinly across the entire nation. That is public health work at its finest – going to where the disease is. This includes Kweneng East, which has the highest number of People Living with HIV in the country.

The right places also means focusing on the most vulnerable populations, especially adolescent girls and young women, who are at a vastly higher risk of acquiring HIV compared to young men. Gender-based violence is one reason for this. Studies have shown women who experience GBV are 50% more likely to be infected with HIV than women in non-violent relationships.

Prevalence is also extremely high among female sex workers. A 2012 survey in Botswana found HIV prevalence among sex workers to be above 60 percent, which makes them the sub-group most affected by HIV in Botswana. Today, we know if any one of our populations is left behind, all of us are left behind and we will not ultimately control the epidemic.

Scale up of effective HIV prevention activities for key populations – and this includes sex workers and men who have sex with men – needs to take place in parallel with efforts to tackle the underlying social drivers of the epidemic, including stigma, legal barriers and social and gender norms.

I know these are uncomfortable topics for some people. But they are important public health issues. You cannot isolate them from the broader HIV public health challenge. We have witnessed across the globe political environments contributing to stigma and discrimination against key populations impede access to life-saving services such as health care. This has to change. Through the courage of civil society organizations, such as LEGABIBO, it will.

For the first time since the beginning of the AIDS epidemic, Botswana has an historic opportunity to achieve epidemic control. We have the tools necessary to do this – including proven interventions like HIV treatment and Safe Male Circumcision. By strategically focusing on the right things, in the right places, at the right time, we believe we can achieve our ultimate goal of an AIDS free generation.

I hope ideas I shared this morning will help fuel your exchanges today and tomorrow. I am calling on my PEPFAR team to lead discussions that will help the residents of Kweneng East think about the best ways to implement these programs. I encourage everyone to participate actively and to take advantage of our presenters by asking lots of questions.

I thank you for your time.