The time to act on HIV/AIDS is now
SLOWLY, but surely, the abnormality of Lesotho’s political impasse is dragging into another year. And much like last year, when we were promised by political leaders that the 28 February 2015 elections would be the panacea to this nation’s political woes, we are being promised that the recommendations by the SADC Commission of Inquiry will finally bring peace.
As reported elsewhere in this edition, All Basotho Convention (ABC) leader and former premier, Thomas Thabane, assured opposition supporters that the recommendations of the Justice Mpaphi Phumaphi-led commission would be implemented “to the letter”.
Dr Thabane said the Phumaphi report would “liberate” Lesotho and its outcomes result in stability in the Kingdom. While it’s one thing to play to the gallery of supporters, it is quite another to raise false hope especially considering the improbability of such an outcome. Government is already digging in and casting aspersions on the veracity of the report as evidenced by the court challenge launched last month by Lt-col Tefo Hashatsi. The Special Forces commander is pushing for the commission’s findings to be declared illegal before they are even tabled. Even if Lt-col Hashatsi’s court challenge is dismissed, it illustrates the antagonistic posture towards the inquiry and its outcomes by the powers that be.
Added to that, a number of senior government officials have strenuously emphasized that the commission’s recommendations, however damning, would not be prosecutable. All this points to the reality that implementing the findings will be much easier said than done. It is, thus, naïve for opposition political leaders to pin their hopes solely on the SADC Commission of Inquiry. Over the years, SADC has earned for itself the ignoble title of a “paper tiger” because its role in spearheading political change and cultivating democratic practises in troubled member states is still evolving.
Although the bloc has succeeded in maintaining stability in such countries as Madagascar and Zimbabwe, it has been accused of ignoring the real causes of conflict and being unable to hold certain leaders to account for their undemocratic actions. The atrocities committed by Zimbabwean President Robert Mugabe’s henchman following his defeat in the first round of the 2008 presidential elections offers ample evidence of SADC leaders unwillingness to bring one of their own to account with the exception of Botswana President Ian Khama who spoke out against the orgy of violence.
Hundreds of opposition supporters were killed in a campaign of violence which also entailed torture, beatings, false arrests and arson attacks. However, Mr Mugabe was rewarded by SADC with the premiership of a coalition government that also included the winner of the presidential election’s first round, Morgan Tsvangirai. Using the state apparatus, such as the army and police, which were still at his disposal, Mr Mugabe managed to claw back power by hook or by crook to the detriment of the will of the people.
As the Madagascar case also shows, SADC usually succeeds in little more than papering over the cracks without addressing the root causes of the political standoff. The solution in Madagascar only came about through internal dialogue brokered by SADC after the politicians finally came to their senses. Dialogue is likely to be the ultimate solution to the logjam in our beloved Mountain Kingdom when our leaders realise this instability is a lose-lose scenario for all involved. The longer this horrid soap opera plays out, Lesotho’s standing among the community of nations continues to go down the drain. With it are the fortunes of our already impoverished economy which is already feeling the strain of the instability.
Meanwhile, opposition legislators who are supposed to serve their electors remain in the trenches with no end in sight to the impasse.
The situation demands leaders who refuse to normalize the abnormal by reaching out to their opponents to get Lesotho going again. Otherwise, the struggle continues. Every year on the first of December we mark World AIDS Day. This year we are focused on success and success starts with vision. Earlier this year, leaders from around the world, including leaders from Lesotho and the United States, agreed as part of the United Nations Sustainable Development Goals to support an ambitious and inspiring vision — that of ending the HIV and tuberculosis epidemics by 2030.
UNAIDS has laid out a clear path to follow in order to end the AIDS epidemic. That path is widely known in the public health world as the 90/90/90 path. In other words, the only way for countries to achieve control of the epidemic is to ensure that 1) 90 percent of all People Living with HIV know they are HIV positive; 2) that 90 percent of those who are HIV positive are receiving life-saving Anti-retroviral Treatment (ART); and 3) that 90 percent of those on treatment are virally supressed, meaning the treatment is effective in keeping clients healthy and reducing the virus to very low levels. The United States Government’s theme for World AIDS Day is, “Time to Act Now.” And that is what is left for us to do. Act to make our shared vision a reality.
The United States government, with the generous support of the American people, has been a major contributor to the HIV/ AIDS response in Lesotho, through both multilateral and bilateral channels. Multilaterally, the U.S. government has committed more than $11 billion to the Global
Fund, including $1.35 billion this year alone. Bilaterally, our support comes through the President’s Emergency Plan for AIDS Relief (PEPFAR).
Since the outbreak of the epidemic, through PEPFAR, the United States has committed $65 billion globally, including $250 million to Lesotho.
The United States also supports three major initiatives. Through the DREAMS Initiative, Lesotho has been awarded an additional fourteen million dollars to cut new HIV infections in adolescent girls and young women, 15 to 24 years of age, by 40 percent in Maseru and Leribe districts by 2017.
This project will work with girls, their families, communities, and schools to empower young women to stay free from infec- tion. Without such attention, they will remain disproportionally at risk of contracting HIV.
They currently account for 35 percent of new HIV infections though only make up 10 percent of the population in those districts. The U.S. is also contributing 14 million dollars to support the Accelerating Children’s HIV/AIDS Treatment (ACT) Initiative and three million dollars to the Vodafone and Ministry of Health Mobilizing HIV Care and Treatment partnership. Both of these programs are intended to substantially increase the numbers of Hiv-positive children on ART.
To stand a chance of achieving the 90/90/90 targets and ending HIV as a global public health threat by 2030, it is critical that we focus our efforts on getting as many people tested and on treatment as possible.
Lesotho is making progress, with significant increases in the number of men and women testing for HIV but progress has been insufficient in initiating people on treatment. With only 37 percent of HIV positive adults and 40 percent of HIV positive children on ART, we must do more now.
In order to increase our impact, the PEPFAR program in Lesotho is focusing intensively on the cascade of care — from testing, to treatment, to viral load suppression.
First, we have modified our geographic focus to match the burden of disease. By 2017, we aim to ensure that 80 percent of Hiv-positive residents in Maseru, Berea and Leribe initiate and remain on ART. And by 2018, we plan to reach 80 percent ART coverage in Mohale’s Hoek and Maf- eteng.
Secondly, on September 30, the World Health Organization (WHO) released new guidance recommending ART for all people living with HIV, independent of the progression of their disease. Simply put, that means the WHO is advising that those who test positive should immediately go on treatment.
The evidence is clear that initiating treatment earlier — the TEST AND TREAT model — helps keep people living with HIV healthy and, by reducing the level of the HIV virus in their blood, makes it less likely they will transmit HIV to others.
It also makes sense economically, as healthier Basotho contribute far more to the economy than it costs to keep them on ART.
As President Barack Obama said last year on World AIDS Day, “As a Nation, we have made an unwavering commitment to bend the curve of the HIV epidemic, and the progress we have seen is the result of countless people who have shared their stories, lent their strength, and led the fight to spare others the anguish of this disease.
Today, we remember all those who lost their battle with HIV/AIDS, and we recognize those who agitated and organized in their memory. On this day, let us rededicate ourselves to continuing our work until we reach the day we know is possible — when no child has to know the pain of HIV/AIDS and no life is limited by this virus.”
Successfully turning the corner on HIV/AIDS in Lesotho will take visionary and engaged leadership, accountability, strong partnerships, and courage from government, from health workers, from communities, and from individuals and their families.
Ending the AIDS epidemic by 2030 will require a collective determined effort from all of us. The vision and the goals are there. The time to act is now.
l Matthew T Harrington is the United States Ambassador to the Kingdom of Lesotho