An official website of the United States government

Transcript: Ambassador-at-Large Dr. John Nkengasong's Briefing – U.S. Global AIDS Coordinator
November 30, 2023

NOVEMBER 28, 2023

MODERATOR:  Good afternoon from the State Department’s Brussels Media Hub.  I would like to welcome everyone joining us for today’s virtual press briefing.  We’re very honored to be joined by Ambassador Dr. John Nkengasong, the U.S. Global AIDS Coordinator and Senior Bureau Official for Health Security and Diplomacy at the Department of State.

Finally, a quick reminder that today’s briefing is on the record, and with that, let’s get started.  Ambassador, thank you so much for joining us today.  I’ll turn it over to you for opening remarks.

AMBASSADOR NKENGASONG:  Thank you, John.  Let me start by extending my really sincere apologies for the lateness.  Traffic has been just unpredictable, and I got caught up in traffic in a way that I wasn’t imagining.  But thank you all for joining today’s hub call.  I appreciate the opportunity to speak to you about the World AIDS Day and PEPFAR. Today is the 35th commemoration of the World AIDS Day.  Every year on December 1st, the world comes together in solidarity to honor people we’ve lost and those living with and affected by HIV/AIDS.  This year’s theme is World AIDS Day 35: Remember and Commit.  The theme has special meaning for the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, because we are celebrating the 20th anniversary of PEPFAR and remembering the remarkable progress we have made over the past 20 years and committing to continuing collaboration with our partners to end HIV/AIDS as a public health threat by the year 2030.

The early days of HIV/AIDS pandemic were very devastating.  In 2003, an HIV diagnosis was a death sentence.  We all know that.  At that time, only about 50,000 people across Sub-Saharan Africa were receiving lifesaving HIV treatment that they needed.  Coffin-making was a thriving industry, and the overwhelming majority of the 15 million children under the ages of 18 who had lost one or both parents to AIDS were in Sub-Saharan Africa.

In the late ’90s, I worked for the U.S. Centers for Disease Control and Prevention at a CDC research station called Project RETRO-CI in Abidjan, Ivory Coast.  I remember looking out of the window at – excuse me – at work and seeing people bringing their dying loved ones in wheelbarrows and taxis, and crying as they left them outside in the courtyard because they didn’t have the means to care for them.  It was heartbreaking.  And at the height of the pandemic, the United States showed compassion and leadership when former President George W. Bush announced that he was establishing PEPFAR, a program to address the devastating impact of HIV/AIDS across Sub-Saharan Africa.   This bold decision by President Bush, 20 years of bipartisan support from Congress, and the generosity of the American people resulted in over 25 million lives saved, including more than 5.5 million babies who have been born HIV-free because of PEPFAR.  In my recent visit to Cameroon and other PEPFAR partner countries, I no longer see streets lined with coffins; I meet mothers who are on their lifesaving treatment and healthy babies that have been born from these mothers.  When you hold these children in your arms, you feel the future of that country and you see our generosity at work.

PEPFAR has changed the course of HIV/AIDS pandemic through supporting programs at over 70,000 facilities and community health clinics, and establishing about 3,000 laboratories, mainly in Sub-Saharan Africa; support over 340,000 health care workers; expansive supply chain management systems have been set up and they are being used extensively in supporting PEPFAR work and also assisting the partner countries in responding to other health needs.  PEPFAR partner countries have leveraged the infrastructure in responding to other disease threats, including COVID, Ebola, Mpox, cholera, measles, and many others.

Despite our remarkable progress, over – our work is not done.  As a global community, we have to continue working together to accelerate our efforts to end HIV/AIDS as a public health threat by 2030 and ensuring that we sustain the response.

Reaching key populations, including adolescent girls and young women, children, men who have sex with men, sex workers, people in prison, and other closed settings, will be critical to ensuring the most vulnerable have access to HIV prevention, care, and treatment services.  And helping PEPFAR partners countries reach the UN HIV treatment targets of 95-95-95, where 95 percent of people who have HIV know their status, 95 percent of people who know their status are on HIV treatment, and 95 percent of people on HIV treatment are virally suppressed.

Country leadership through increased domestic financing and sustained political engagement are also critical to ending the pandemic.  I have visited nearly a dozen PEPFAR partner countries since I became the global AIDS coordinator, and I have seen great examples of political will and commitment we need, including in Nigeria and Cameroon most recently.  As the largest commitment by any nation to address a single disease in history, PEPFAR remains driven by evidence and data and committed to our partnerships with PEPFAR-supported countries to end HIV/AIDS as a public health threat by 2030.

Together, we can get through the last mile in this fight, continue to save lives, and ensure that we never return to the early days of the HIV/AIDS pandemic.  Thank you for your collaboration, and I will turn it back to you.

MODERATOR:  Thank you so much, Ambassador Nkengasong.  We have a number of pre-submitted questions, so we’ll go to those first.

The first, Ambassador, is from Kate Bartlett from VOA in South Africa.  She asks:  “I understand injectable PrEPs are set to be rolled out in South Africa next year.  When exactly will this happen, and how?  Could this be a gamechanger for HIV in South Africa, and why?”

AMBASSADOR NKENGASONG:  I think that is a very good question.  We have committed ourselves to working with the Government of South Africa and other governments of partner countries to introducing the long-acting PrEP, CAB-LA.  We see this as increasing the number of tools that we have in our toolkit for prevention.  We find ourselves at an important point in the fight against HIV/AIDS, where science continues to evolve, innovation continues to bring new tools into the market, and the long-acting PrEP injectables are just one such example.  We’ve already procured those drugs, and shipped already to several countries.  And South Africa will definitely be part of that, either in the first phase or the second phase of the program.  Thank you.

MODERATOR:  Thank you, Ambassador.  The next question is from Didier Demassosso in – from Cameroon:  “The impact of HIV/AIDS on the mental health of patients is well documented.  However, just recently, in 2022, there was a joint study from WHO, USAID that discusses the importance of integrating mental health in HIV interventions.  We also know that under-financing of mental health in general – or that mental health is under-financed in general.  So what measures will be put in place to finance mental health in HIV management?”

AMBASSADOR NKENGASONG:  Didier, thank you for that question.  We – as PEPFAR, we recognize that, and if you have read the literature recently, we published a paper in the New England Journal fairly recently where we are really looking to elevating the issue of mental health and integrating that into our HIV prevention, care, and treatment program.  We know that it’s critical and we know that it has been an area that is maybe not elevated the way it should have been, but is so critical and fundamental, especially in the fight against HIV/AIDS across the three cascades.  Whether it includes people that are still not aware of their status or the newly diagnosed people, mainly young people; whether it includes people staying on treatment, and people staying on treatment to ensure that their viral load is suppressed – it will require mental health across all those three cascades.

So, we as PEPFAR will continue to work on this in the next year and the year to come so that we integrate it fully into our programming.

MODERATOR:  Thank you, sir.  The next question is from Esther Nakkazi, a freelancer from Uganda.  She asks:  “There are many prevention options, including the dapivirine ring, injectable ARVs.  These are on the table and have been researched among Africans, but African governments are not using them because of price.  Do PEPFAR funds allow for governments to use these options, or do they want the cheaper options?”

AMBASSADOR NKENGASONG:  No, I mean, PEPFAR supports the use of drugs that have been approved through appropriate regulatory systems, including of course those that have been approved by the FDA and other mechanisms.  The most important thing we should think of, Esther, is to guarantee patient safety; that we do not create a problem by – we do not solve a problem by creating another problem.  And so, we really are taking – we take our responsibility with respect to administering only drugs that have been fully approved by authorized regulatory bodies very seriously.  “Do no harm” is what – the principles we work with.

So, I think like any other products that you’re aware of, Esther, you know that these products are usually introduced with a high price, but with time we work collectively with other partners like the Global Fund, the Clinton Access Initiative, to bring down the prices.  And we’ve seen this repeatedly over the last 20 years with respect to several products that we are now using.  So, we’ll continue to work on that and to reduce the prices.

MODERATOR:  Thank you, sir.  We have one more pre-submitted question.  And I’ll just remind the journalists that are dialed in, you can raise your hand at any time or submit other questions if you’re interested.

Last pre-submitted question.  It’s from Tamar Kahn, Business Day, South Africa:  “There is a degree of anxiety in PEPFAR partner countries about the failure of Congress to reauthorize PEPFAR for another five years.  What assurances can you give partner countries that they can continue to count on PEPFAR in the years ahead?”

AMBASSADOR NKENGASONG:  PEPFAR is very committed to working with countries to bringing HIV/AIDS to an end as a public health threat.  Yes, we have still to resolve the five years clean reauthorization that the Biden administration is requesting.  We continue to work with both sides of Congress, and I remain optimistic that the good work that has been done over the last 20 years, guided by strong bipartisanship, will continue.

It is always challenging in a democracy to have the answers when you need it, but again, I remain hopeful that we will not walk away from our commitment and partnership, and that the good work that PEPFAR has done, thanks to the extensive partnership with the countries we are working in, will speak for itself.  We show the impact of saving 25 million lives, preventing more than 5.5 million children – born free of HIV/AIDS, that this work cannot be stopped at this point.  So PEPFAR is committed to working with countries to finish this fight, and make sure that we celebrate the end of HIV/AIDS as a public health threat by the year 2030.

MODERATOR:  Thank you, sir.  We have another question here from Milliscent Nnwoka from Channels TV in Nigeria:  “Are there any specific regions or populations where progress in the HIV response has been slower, and what measures can be taken to ensure equity in access to prevention, treatment, and care services?  As we enter the 35th commemoration of World AIDS Day, what is your vision for the future of HIV/AIDS response, and what actions should individuals, communities, and governments take to achieve this vision?”

AMBASSADOR NKENGASONG:  No, absolutely, and I think we have – our focus in a new strategy we launched last year, exactly one year ago, is to identify those gaps and address the gaps and we – in priority populations.  And what are those populations that are seeing – we see important, significant challenges?  They include children; they include adolescent girls and young women; they also include key populations.  I think we have to continue to identify this gap, using data and scientific evidence, and then as we identify them, we narrow the gaps; we focus our resources, our limited resources, where these gaps are and bring them to where they need to be.

We published a strategy five years ago and it includes five key pillars.  One is to identify the priority population that I just indicated.  Secondly is to sustain the response, both including political sustainability, which is to elevate – continue to elevate the issue of the response to HIV/AIDS and place that on the radar screen of the political leaders of the partner countries and the donor countries.  Thirdly is to strengthen – continue to support partner countries to strengthen their health systems, and then build partnerships, what I call transformation of partnership, partnerships that will elevate the fight against HIV/AIDS and align them with those priority areas that I indicated.  And lastly, continue to use science to – and data to drive the response.

Underpinning that are three enablers, which is community leadership, using innovation, and also making sure that science remains at the center – or community remain at the center of the response.  There is community leadership of innovation and making sure that data is a weapon that we stay very close to, as PEPFAR remains a science-driven program.

MODERATOR:  Thank you, Ambassador.  We just got one more question in from John Musenze from New Vision, Uganda.  John asks:  “What is the United States Government’s assurance regarding the sustainability of PEPFAR programs in developing countries such as Uganda, considering the evolving landscape of global health funding?”

AMBASSADOR NKENGASONG:  A very good question.  Sustainability should be all of our issue, all of our concern, not just the United States Government.  And I’m very encouraged that during my recent travels in Africa and Asia I’ve been able to see commitment from the highest political leadership.  I was in Nigeria, and the vice president made a commitment that they will increase domestic financing for health.  I was in Cameroon, and the finance minister made the same commitment – in Eswatini, in Namibia, and in Mozambique.  So, I think it is what we should all be doing together in the spirit of shared responsibility and shared accountability so that we bring HIV/AIDS to an end as a public health threat.  Yes, the global landscape for the physical needs, the things we need to do that are requiring of increased budget is just a lot, including climate change, the wars, the food insecurity, and other challenges.  I think that we have to continue to make sure that we stay committed to the cause in fighting HIV/AIDS.  So much like the theme of this year, which – for the World AIDS Day, which is “Remember and Commit,” because it speaks to that notion that we should never forget where we’re coming from, that we should always celebrate the successes we’ve had over the last 20 years and more, but we should remember that and commit that we’ll bring HIV/AIDS to an end.  And that requires committing financial resources, both from the partner countries and from the donor countries and the multilaterals, including the Global Fund.

MODERATOR:  Thank you, sir.  We just received one more question from Rutendo Mawere from Zimbabwe.  I’m going to do a little interpretation here.  I believe – so he asks, or they ask: “How much does PEPFAR use in Africa to address HIV/AIDS problem,” I think, “historically?”  And then the rest of the question is:  “Should this funding stop now or eventually so that African governments can sustain the fight against HIV and AIDS on their own?”

AMBASSADOR NKENGASONG:  Over the last 20 years, PEPFAR has invested over $110 billion – $110 billion in supporting the fight against HIV/AIDS, mainly in Africa.  And each year, PEPFAR invests about $7 billion in supporting partner countries in responding to HIV/AIDS, and this includes a contribution also that we make to include the Global Fund.   So, I think it has been a very – it has been a historic investment.  It is the largest investment that is – a country has ever made in fighting a single disease in the history of infectious diseases.  I think that is historic in itself.  I’ve been in the area of public health for 25 years, and I can assure you that I’ve never seen such a massive investment.  PEPFAR is not advocating for the resources to be withdrawn from countries so that countries take on this.  What we are championing is that we need to mobilize resources, both domestic and globally, so that we bring this fight to an end.  And the whole concept of sustainability should be seen in the lens of joint responsibility by the country and the donors and joint accountability.  What is it that we are committing ourselves to bringing to the table and what is it that we are holding ourselves accountable, that when we say we are committing those resources, we are actually doing that, and we are measuring the impact of what those resources are doing in the fight against HIV/AIDS.  So, I think that is what we should all be advocating for.

MODERATOR:  Thank you so much for that, Ambassador.  That seems like a good place to stop because we don’t have any more questions.  Thank you, Ambassador, very much for joining us today, and thank you to all the journalists who dialed in for the call.

Ambassador, can I turn it back over to you for any final thoughts?

AMBASSADOR NKENGASONG:  No.  Thank you, John, for coordinating this, and let me, before I conclude, once again extend my apologies for the lateness due to Washington traffic.

But I would just like to end by sharing some reflections about the past 25 – 20 years and above.  I’ve been in HIV/AIDS – personally, I joined the fight against HIV/AIDS in 1988.  And the story of HIV/AIDS is that of hope, and if we have to have a book – a book – a cover page of a book, it would be that.  I would like to see this as a journey from hopelessness to hopefulness.  I mean, I’d like you all, as you celebrate the 35th World AIDS Day, to think of the journey we’ve worked over the last 25 years or so, especially the last 20 years.  I would like you to reflect on the visits – you used to go to the hospitals in Uganda, in Cameroon, in Kenya, in Nigeria, and see the wards that were full of HIV-infected people.  And these were skeleton of loved ones lined in hospital beds with thin skin over them.  But I’d like you to go back again and visit those hospitals today or this week and find and see for yourselves that you don’t find those HIV-infected patients lying there.  That is the joy, that is the hope that I bring in this conversation.

I also remain hopeful that the success that we’ve all ridden on over the last 20 years will continue to guide us and enable that the next chapter of the HIV/AIDS fight will be that of hopefulness.  That will enable us to bring this fight to the end and what – in what we characterize as the higher hanging fruits, which is that the population that we are fighting HIV/AIDS now, the key population that I indicated or the priority populations – the children, adolescent girls and young women, and key populations will be – continuously be challenging.  But if we remain – we hope and we fight with solidarity, we are going to be the winners in this, and by the year 2030.   So, thank you all for joining me in celebrating World AIDS Day today.

MODERATOR:  Thank you so much, Ambassador, for those thoughts.  Shortly we will send an audio recording of the briefing to all participating journalists and provide a transcript as soon as it is available.  We’d also love to hear feedback.  You can always send us an email at TheBrusselsHub@state.gov.  Thanks again for your participation, and we hope you can join us for another press briefing in the future.  This ends today’s briefing.