Digital Press Briefing with U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy Ambassador Deborah L. Birx, M.D.

Special Briefing via Telephone
December 1, 2020


Moderator:  Good afternoon to everyone from the U.S. Department of State’s Africa Regional Media Hub.  I would like to welcome our participants from across the continent and thank all of you for taking part in this discussion.

Today, we are very pleased to be joined by Ambassador-at-Large Deborah L. Birx, U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy.  Ambassador Birx oversees the implementation of the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, the largest commitment by any nation to combat a single disease in history, as well as all U.S. Government engagement with the Global Fund to Fight AIDS, tuberculosis, and malaria.  A world-renowned medical expert and leader in the field of HIV/AIDS, Ambassador Birx will announce new PEPFAR program results demonstrating the United States’ enduring commitment toward achieving inclusive, resilient, and sustainable control of the HIV/AIDS epidemic.  And we’ll take questions on PEPFAR’s progress from participating journalists.

We will begin today’s call with opening remarks from Ambassador Birx, then we will turn to your questions.  We will try to get to as many of them as we can in the time that we have.  I would like to remind our journalists that the content of the briefing is embargoed until 9:30 a.m. Eastern Standard Time, U.S.  That’s 16:30 South African Standard Time and 14:30 Universal Time.  At that time, you are free to publish your articles.

At any time during the briefing if you would like to ask a question live, please indicate that by clicking on the “Raise Hand” button and then typing your name, media outlet, and location into the “Questions and Answers” tab.  Alternatively, you can type your full question directly into the Q&A for me to read to our speaker.  Again, please include your name, media outlet, and location when you do so.  If you would like to join the conversation on Twitter, please use the hashtag #AFHubPress and follow us on Twitter @AfricaMediaHub.  For our French-speaking participants, you may type your questions in French in the Q&A.  We will translate the question into English for our speaker.

As reminder, today’s briefing is on the record.  And with that, I will turn it over to Ambassador Birx for her opening remarks.

Ambassador Birx:  Thank you very much, Marissa, and really, good afternoon to all of you.  I wish I was on the continent right now, as we have been for many a World AIDS Day, to really recognize the hard work that Africa has done in combating HIV/AIDS.

We are reaching a critical milestone this year.  This – 2021 will be 40 years since HIV was identified, and although we continue to have intensive research on cures and vaccines, we have made progress, really unimaginable progress, over the last 18 years together through PEPFAR because of your hard work and our ability to really treat individuals and prevent new infections without a vaccine and without a cure.  And so today it’s really my pleasure to announce that we have over 17 million men, women, and children on antiretroviral treatment, really saving their lives today, and that has happened even and in spite of COVID on the continent, and I just really want to thank the small but mighty team at the Department of State that runs the program out of State, to all of our U.S. agencies from Peace Corps to Treasury to DOD to CDC to USAID, working together during this difficult time; and critically, to every single person on the ground who has really risked their own lives to make sure others are served well.  And I just want to thank all of you for the work that you have done.

We are fortunate that we’ve been a bipartisan-supported program from the beginning.  Eighteen years now with PEPFAR– I’ve been with them every single year, first from DOD to HHS and now State.  It’s been a real privilege to see the evolution of the program, and I think what PEPFAR has always stood for is the ability to work in partnership with countries in an innovative and adaptive way – and haven’t we all had to innovate and adapt over the last 10 months?  The number of lives that have been saved now, over 20 million, but, critically, almost 3 million babies born HIV-free, and many of those babies now are over 18, entering professional school or working today, alive today and HIV-free because of the strong work we have done together.

Through these incredibly smart investments, we have really accelerated over the last few years to really achieve the UNAIDS critical partnership goals of countries to really achieve what we call the 90-90-90, and we have evidence now that countries are achieving that.  I want to thank Lesotho and Zimbabwe for their hard work of getting their surveys done before COVID, and I hope we can launch the other eight surveys that are pending right now to really show these 10 countries that have been able to achieve the 90-90-90, the UNAIDS goals.  And behind me I have two of the UNAIDS books just to recognize how important the partnership with UNAIDS with the Global Fund is at this moment to really help with this achievement.

We’ve nearly doubled the number of people on treatment in the last four years, and I know at times when we’ve brought our partnership together of governments and communities and the U.S. Government and Global Fund to work together in this unique partnership, I know some people wondered why we were driving so hard for the policy changes that were really critical to our current success within COVID.  We could see with natural disasters and political unrest what parts of the program were compromised and why policy changes were so critical.

So I know at times it seemed like we were pushing sometimes, people thought, too hard but it is those policy changes that we worked with the ministries of health and governments across the world that has resulted in our ability to sustain treatment through this very difficult time: the elimination of fees across West and West Central Africa so people can access life-saving services; the importance of being able to give multi-month prescriptions’ worth of drugs so that people could have the drugs during this difficult time and not have to keep coming back to clinic; the work that we did with community to really provide community monitoring; and finally, the work done with particularly CDC and USAID to move to indigenous partners.  Those indigenous partners across the world and particularly in sub-Saharan Africa have sustained these programs.  I am so indebted to them.  I’m indebted to the public sector, but I’m also incredibly indebted to their indigenous partners who have worked tirelessly, and to our U.S. ambassadors who lead this program and every single country and their U.S. embassy staff.  Thank you.  Thank you for working so hard together.

We know this dual pandemic now of HIV and COVID is changing the landscape of global health.  We know that the first and most vulnerable populations – women and girls – who we’ve been working with tirelessly to ensure that they have the comprehensive structural interventions to ensure that they remain HIV-free, these will have to – these efforts will have to be redoubled.  The amount of poverty that will be created, the amount of gender-based violence that will occur in this unstable time will have to be addressed.  And if anything, we have seen clearly that what suffers the most in an economic and both infectious disease pandemic like this is not only women and girls but all of our prevention programs.  And so I’m very proud that we were able to get to 25 million circumcisions.  It would have even been greater, but we really had to suspend circumcisions significantly over the last six to eight months.  But many of those workers came and really supported critical life-saving programs.  And I really want to thank everyone who has been adaptable to this.

We will as a global community have to look at our investments in GAVI [the Vaccine Alliance] and our investments in the Global Fund and potentially increase their – the eligibility into upper-middle-income countries who were hit severely by COVID.  When we look at the countries, when we look at sub-Saharan Africa, certainly South Africa disproportionately experienced a more significant COVID-19 pandemic and will need additional support.  And we have to really – if people are going to be able to be vaccinated with COVID vaccines, these countries that had both the economic shock and the pandemic shock among their individuals, we will have to support them in any greater way.  And we have to really make sure that no family is making choices between food and medical care.  And so really increasing our orphans and vulnerable children’s programs, our DREAMS programs for young women.

I’m so proud of our DREAMS program where now the majority of countries have more than a 40 percent decline in new infections in young women and 99 percent or so of every county in which we work has been able to have more than a 25 percent decline in new infections in young women.  This program continues to be expanded across the continent.  Countries continue to adapt and adopt this program, and we’re working closely with the Global Fund to expand this even further.

So as we make these investments together, as we continue to adopt and innovate and really ensure that the policy changes are there to support everyone, we do see that the groups that have been marginalized – young women, our key populations – will need additional support through this difficult time and there will need to be a real call to action among our community support.  We’ve been investing in community monitoring but it has to be more than that; we have to have peer-led, peer-driven services and outreach where we directly are funding peer-led organizations as part of our indigenous program to ensure that peer-to-peer leadership is available to all of our key populations and young women’s programs.

I know as we approach this fifth decade of HIV/AIDS – I hate to even say fifth decade because I’ve been involved with HIV/AIDS, TB, and malaria since the beginning of the HIV pandemic, so it dates me significantly.  But what I have learned over those 40 years is these words of partnership and these words that we have and resilience that we have brought together for impact, they’re not just words.  They are actions that we live every day.

Thank you all for the work that you will be covering, and I want to really call out governments and call out communities because it’s because of that partnership that we’ve been able to establish with them in a greater degree over the last seven years that it’s allowed us to sustain this life-saving treatment – testing over 50 million people; treating over 17 million people; ensuring nearly 3 million babies are born HIV-free; almost 7 million orphans and vulnerable children and their families supported, which will have to increase in this post-COVID pandemic as we begin to recover together.

There is work yet to be done, but the fact that we have saved so many lives and changed the future on the continent together from devastation and loss to hope and vibrance is very, very important, I know, to all of us.  So I will stop there to see what questions you might have.

Moderator:  Well, thank you, Ambassador Birx.  We will now begin the question and answer portion of today’s call.  For those asking questions, please indicate if you would like to ask a question.  Then – my notes – then type in your name, location, and affiliation.  We will ask that you limit yourself to one question related to today’s topic: the announcement of the new PEPFAR program’s results demonstrating the United States’ enduring commitment toward achieving inclusive, resilient, and sustainable control of HIV/AIDS, and we’ll take questions on PEPFAR’s progress.  Again, I remind our journalists that the content is embargoed until 9:30 a.m. Eastern Standard Time, U.S.

Our first question will go to Mr. Dusabemungu de la Victoire of Top Africa out of Rwanda.  His question is, “What contributions has PEPFAR made since its inception, especially in Rwanda, Uganda, Burundi, and Kenya?”  So looking at East Africa.

Ambassador Birx:  So, thank you.  Obviously, PEPFAR invested according to the degree of disease.  And so, early on, Southern Africa and East Africa just because of their depth of burden of disease were significantly invested in and continue to be.  I can bring up the precise numbers, but I’m sure 40 percent or more of our entire investment is in East Africa.

Why is this important?  One, it was devastating to East Africa in general, but also East Africa has been very responsive to really working with us to develop the innovative policies and the innovative service delivery that will make these programs successful.  And so we’ve really maintained a high level of investment in this region as results continue to improve.  Still work to be done.  Significant work to be done in East Africa around key populations and young women and gender-based violence, and this will be – continue to be an emphasis of the program in the region as well as ensuring economic stability to our HIV-positive patients and their families to ensure that we make progress together in the post-COVID effort time.

Moderator:  Thank you.  The next question goes to Kevin Kelley of Nation Media Group out of Kenya.  The question is, “Why do you think there’s still no HIV vaccine 40 years after the virus emerged while at least two effective vaccines have been developed for COVID in less than a year?”

Ambassador Birx:  Brilliant question.  And so when I started to work a bit domestically over the last few months on COVID and I looked at what the key element was and how we have – so let’s just go back to some immunology 101.  With COVID we have people who get infected and survive, and so we know what protective immune responses are generated, and we call these correlates of protection.  And so once we could see what people generated during natural infection that resulted in them clearing the virus completely, it allowed us, then, to identify that site on the COVID virus, and that is called the spike protein.  We’ve learned over the years how to stabilize that protein to make sure that it makes the right kind of antibody that can actually prevent disease.

Now, with HIV we have a very different problem.  We don’t have people who have naturally recovered from HIV.  We don’t have those correlates of protection that says if you develop this immune response, you can clear the virus.  And so that’s the fundamental difference.  And so when you have natural immunity that’s effective in clearing the virus, then you have the roadmap to a vaccine.  And because the only people who have been cured of HIV are those individuals that had bone marrow transplants, which of course is not a vaccine, it’s made vaccine development much more difficult.  But I have every confidence.  I see the work coming out of NIH and research communities around – around the globe, and no one has stopped working on HIV vaccines or doing those clinical trials, and no one has stopped working on cures for HIV.

Because in the end, all of these individuals – the 17 million on treatment – we would like them in the future to be able to be cured of HIV so they didn’t have to take daily treatment.  But we are so appreciative every day of every single individual of those 17 because we can see that they’ve suppressed the virus and they’re not transmitting the virus, and that means that every day they’re making that personal self-sacrifice to take those drugs, to remain healthy – remain healthy for themselves and also remain healthy for others.

Moderator:  Thank you.  The next question will go live to Tamar Kahn of Business Day in South Africa.  Ms. Kahn, the line is open.  Please ask your question.

Question:  Hi, good afternoon and thank you for taking my question.  Ambassador Birx, please, would you expand on your comments about the need for extra support for South Africa?  Are you suggesting that PEPFAR steps up its funding or are you suggesting something broader to include financial support for South Africa to procure and distribute COVID vaccines?  It was a little unclear there from your opening remarks.  Thanks.

Ambassador Birx:  Yeah.  I think we don’t know – we know because we have data where the parts of the program that have really suffered during the COVID-19 pandemic in sub-Saharan Africa, and the elements that have suffered the most have been our prevention programming, whether it’s voluntary male circumcision or our DREAMS programming or our key population programming.  And so certainly, additional investments will have to be made into those programs.

But I really wanted to make the comment about our multilateral investment.  Obviously, the U.S. Government is a substantial investor in both GAVI and in Global Fund.  In fact, we’re a third of the Global Fund investment each and every year.  In addition to the prevention programs that have to be recovered, there are upper-middle-income countries that have suffered significant economic shocks because of COVID-19 and its devastation in those particular countries.

So we may need to – and I think it’s important for us to start discussing – we may need to really look at GAVI eligibility to be able to support countries to be able to have access to COVID-19 vaccinations in this time of economic instability.

Moderator:  Thank you.  We’ll go to questions that were submitted to us.  The next question is from Mr. Paul Adepoju of The Lancet/Devex out of Nigeria.  The question is, “How has the pandemic impacted, influenced, or redirected PEPFAR’s plans for Africa and what is the key message learned from the pandemic that could influence the HIV response?”  I believe you touched on this a little bit earlier, but more expansion on COVID and HIV and the impact.

Ambassador Birx:  The fund is really grateful over the last seven years.  Countries and communities worked with us to really identify barriers and obstacles and really address those policy changes.  And as I talked to at the beginning, I know many people thought these were theoretic policy needs, that they were theoretic changes, but in the end – and we could – we were always concerned about avian flu or an H1N1 flu.  We were concerned about those types of pandemics on the continent.  I don’t think any of us saw COVID-19 as a specific entity and how it – how it infected and how its global pandemic has occurred.  We didn’t think specifically of that.  But we could see that there are shocks – shocks to economies, shocks with natural disasters, political unrest – and we wanted to ensure that we had been proactive and developed a program that would be resilient even among these shocks.  And I think what you can see from the treatment numbers is the program was resilient.

The policy changes that we made together over the last several years that many thought were theoretic and unneeded were actually critical to us and our ability to sustain treatment.  And I really want to thank the State Department and the leadership of Angeli Achrekar, Amama Diyila, and the whole team – Bill Paul, Mike Ruffner, Mr. Brendan Garvin – Gavin, and really Irum Zaidi, who worked together to create the data so we could immediately see where areas of the program were suffering.  At this time, we can see every single site in sub-Saharan Africa that we provide services to, all across the globe, all 70,000 – we can see them on a regular basis.  So we know what’s happening.  We know what needs to be strengthened.

And what we saw with the pandemic – and I think what we learned and what we brought to the domestic response in the U.S., frankly, were the lessons we learned in working with communities and working with governments across sub-Saharan Africa and across the globe.  So it was really the opposite: we took what we learned about how important – when you’re talking about behavioral change and that’s your primary public health intervention, asking people to wear masks, physically distance, wash their hands, not go into crowded indoor spaces and spread the virus, we learned from PEPFAR that when you need to have behavioral change, you have to work with community.  It’s not a – you have to work with people.  Sometimes in public health we forget there’s the public part of public health.  And so, really, the lessons we learned about working with communities and working with governments have been critical for us.

What we also learned from looking at the data carefully, that what’s lost first is additional programming for women and girls; what’s lost first is economics around the lives of women and girls; what’s lost first is people choosing food over medical care; what’s lost first are prevention programming; what’s lost first are vulnerable and marginalized populations, particularly our key populations.  And so in order to have a completely resilient program, we have to look at each of those areas over the next number of days, weeks, and months to ensure that we in the future ensure that even with a shock like this pandemic that our programming beyond life-saving services can continue and our critical prevention and family support.

Moderator:  One thing that we can definitely see is the amount of passion that you have for what you’re doing.  Oh, I hope we haven’t lost Dr. Birx.  Dr. Birx, you’re there.  Excellent.  That you can clearly see the passion about what you’re doing, but you also see that it’s the data – it’s driven by data and it’s driven by science.  So I know that that’s something that our audience can appreciate.

We’re going to go to one of the questions that was typed in live in our Q&A from Patricia Ama Bonsu out of Giant Broadcasting in Ghana.  Her question is, “What other strategy will PEPFAR adopt to strengthen the message of anti-stigmatization?”

Ambassador Birx:  That is really a [inaudible] because, surprisingly to me, there’s huge [inaudible] that they have significant infection with COVID-19.  And I think stigma and discrimination runs through every infectious disease, whether it’s HIV, TB, malaria, COVID-19.  And we have to as a community – and that’s why I keep talking about peer-led services.  We have to create an environment where individuals do not see that there are barriers and structural barriers to their ability to access either prevention or treatment services.  This is the work that we have to still do because prevention programming was significantly impacted in COVID-19.  So it tells me that there’s still stigma around keeping people healthy and prevention programming versus treatment programming, no matter where we work around the globe.

And so this piece still haunts us 40 years later.  Yes, in some areas it has gotten better, but over the last decade in some areas it’s gotten worse, and there is much more stigma around key populations in sub-Saharan Africa than there was even five, six years ago.  And so in places we’re doing better, but in other places we’re doing much worse and we have to work on this comprehensively.  And we also have to remember that economic fragility brings also additional risks to women and children.

Moderator:  Thank you.  Next question will go live – live to Pearl Matibe.  Pearl, the line is open.  Please ask your question.

Question:  Good morning, Dr. Birx.  I’m Pearl and I’m here in Washington, D.C.  My question is twofold to you.  With everything that PEPFAR has done, with all of PEPFAR’s history, surely you have come across opportunities.  So what three things would you say PEPFAR lacks?  Where can PEPFAR be improved in terms of the policy side of what could make it better?  That’s one.

Second part of my question is: What other program out there in the world, that may not necessarily be a U.S. program, does PEPFAR compete with in the world?  Thank you.

Ambassador Birx:  We don’t like to ever think of ourselves as competitive in any way.  When there’s a lot to be done and, as you’ve described, areas that still have gaps, you cannot compete with one another.  And I think this pandemic, both the COVID-19 pandemic and the HIV pandemic, has brought people together that are providing services in unique and innovative ways.

So there are – we work very closely with the Global Fund.  We work very closely with UNAIDS.  They have been critical policy drivers and policy enablers around the world.  We like to believe that we also work very closely with governments to really ensure that we really together move policies forward that are critical for people to be successful.  And there are still legal barriers to women and girls around the globe that we have to continue to address.  So our policies are not just global health policies and HIV policies or TB and malaria policies; these are really policies that have to do with structural barriers that exist for women and girls around the globe and for key populations around the globe.  And these are areas that we still have work to be done.  DREAMS is still not in every single county.  We’re in the largest – the most-highest-burden counties in sub-Saharan Africa, but there are different – there are additional counties that have to have investments in women and girls.

I think we still need to identify what other structural barriers need to continually to be addressed.  And each generation of young women have to confront different issues.  And so in these areas, you have to constantly be looking and talking with people; it’s not just about the data, but it’s hearing from the individuals that are part of the program.  That’s what I’ve missed most about this World AIDS Day – normally we’re on the continent, we’re listening to young women talk about what services and what elements are critically important to them, and really ensuring that we’re programming to their needs, putting them at the center, ensuring that we’re always client-centered.  These are words that have to translate into action.  We like to believe that we’re good at that, but we can see from what happened with these dual pandemics that there is still work that we need to do.  And I think part of that work is not only indigenous partners, but peer-led community investments where the community together moves together to ensure that everyone in the community is served with the prevention and treatment services that they require.

Moderator:  Thank you.  We’re going to move to Uganda.  Esther Nakkazi, a freelance journalist in Uganda, has the following question:  “Ambassador Birx announced a change in the PEPFAR funding model and for localization with local organizations taking the lead as countries get to epidemic control, but with COVID-19, does she still expect this to happen?”

Ambassador Birx:  Well, those of you who know me, I am passionate about making progress and I think our long-term resilience requires additional funding to indigenous organizations.  We invest a lot in the public sector, and the public sector has done a terrific job, but the public sector can’t answer all the needs of their population.  Certainly, the private sector has a role and we’re very proud of our public-private partnerships.  It’s what allowed us to reach a million HIV-positive young women with cervical cancer screening with the Bush Institute and UNAIDS and Merck.  It’s what allowed us to do MenStar with our – Gilead and Vivre and other partners to really ensure that uniquely men are reached, because they have different issues and different needs and we have to meet them where they are, ensure that they have access to prevention and treatment.  It’s what allowed us to make progress in DREAMS.  So the private sector is a very critical component of the program.

But another critical component is services outside of the public sector in areas where the public sector has difficulty in reaching individuals.  We learned that in the United States, and that’s why in tribal nations and in our indigenous people there are independent clinics and service delivery directly invested to ensure that they are reached.  We have independent partners with prevention and treatment at the community level.  We need to bring that model even stronger to sub-Saharan Africa and around the globe.  We’ve been able to really invest that way in Thailand and several Asian countries.  We are still not where we need to be in peer-led organizational investment, so if anything, the model not only holds but it demonstrates how critical not only that investment was into local organizations, but how much more needs to be done there.

Moderator:  Thank you.  The next question we’ll go live to Paul Adepoju out of Nigeria.  Mr. Adepoju, please ask you question.

Question:  Yeah, thank you very much, Ambassador.  So I have a question regarding PEPFAR’s approach towards compelling African governments that are actively disenfranchising the key populations from accessing treatment and diagnosis.  Last week when the UNAIDS report was out, it – the UNAIDS executive director mentioned that progress in HIV cannot be handled without combating conservatism and disenfranchisement.  In your annual letter, you always give directions and priorities for African governments on what they should prioritize in their response, but addressing this issue has always been to left to a discussion of the governments.  Do you think PEPFAR is doing enough to ensure that key populations, in spite of legalizing laws, in individual African countries are able to access treatment or not?  Or what do you think is the way forward towards addressing the disenfranchisement issue?  Thank you very much.

Ambassador Birx:  Thank you for that question.  It’s a very important question.  In many places around the globe, peer-led service delivery is much more successful outside of the public sector for many reasons: stigma, discrimination at these public sites from the healthcare providers themselves in additional to government.  It’s how people are addressed and how people are seen and spoken to and spoken with.  So, there is not enough done in sub-Saharan Africa, and that’s why I talked about in some cases and in some countries, we’re actually seeing more stigma and more discrimination among key populations.  This is not getting better.  If anything, the structural barriers that exist now are getting higher and more difficult to address, and that’s why we have to put effort not only into setting up these peer-led services, but protecting those peer-led services so that they can be successful if the public sector cannot mobilize appropriate – appropriate ability to actually reach and overcome the structural barriers that really plague our key population programs, particularly in sub-Saharan African.

Moderator:  Thank you.  I apologize.  You hear thunder and lightning.  It’s Johannesburg – [laughter] – lightning capital of the world.  A lot of noise in the background.  Ambassador Birx, you’ve talked about this passion, you’ve really pinned that passion with data and metrics and what the United States is doing.  Let’s talk about those metrics.  What are the metrics of success for PEPFAR countries and does it vary in different countries?

Ambassador Birx:  That’s a great question.  And so, yes, we talk about treatment and services, but in the end, we work very carefully to demonstrate impact because it is not enough to say you have 17 million people on treatment.  You need to say 17 million people are in treatment and virally suppressed.  In other words, you have to have an outcome to your activities.  A lot of global health programs are counting.  We’re not just counting; we’re measuring impact every day, we’re measuring outcomes every day.

And it’s also why we do these impact surveys.  These are what we call public health AIDS-indicator surveys to really understand who’s been left behind.  And I’ll tell you who’s been very much left behind – and why we launched MenStar – was young men were not accessing testing and treatment and were not virally suppressed.  And children, particularly children between two and 14 were not adequately virally suppressed, and teenagers between 15 and 18.

So we use this granular data to identify the issues related to outcomes and impact, and then we work with governments and local communities to address them with policies and programming.  And then we look at our success, and we don’t do these things once; we continue to look at outcomes and impacts country by country.  So Lesotho and Zimbabwe completed their second survey.  They showed significant improvement, but who is still left behind?  Women are at 90-90-90; young men are not, children are not.

So this really shows us where we have gaps.  And so it doesn’t help to identify the gap; then you have to program to that gap, and I think that’s what PEPFAR has really focused on.  It’s why we meet together yearly and plan the COPs together, bringing the community with governments, with the USG, and with our advocates around the globe to really talk about how we can do things better.  Every year we want to get better, and I think what we’ve been able to do is sustain in this critical time treatment and viral load suppression, but we weren’t and haven’t addressed the gaps that continue to evolve and develop particularly with these dual pandemics.  And so we need to redouble our efforts in those areas.

Moderator:  So unfortunately, we don’t have time for more questions.  I would love to talk to you more, Ambassador Birx, about all the wonderful work that you’ve been doing and your amazing team, but I’m going to ask you for some final remarks.  And in that, if you could talk a little bit about what 90-90-90 means to our audience.  And also, it took COVID for people to recognize that the United States was not doing enough to really sort of broadcast and amplify the impact that PEPFAR has had on the continent.  We don’t want to see that, so what can we do better to make sure that the stories are being told, the success stories about PEPFAR, and how we can do better for COVID?

Ambassador Birx:  Yeah, thank you.  And thank you for the opportunity to be with all of you today and let me again thank the team, the S/GAC team that has been working tirelessly around the clock and spend their evenings and weekends making sure that I’m updated and I know what’s going on so that I can continue to be part of that programming.

I think what I didn’t talk about – and thank you – the investments that we made in PEPFAR, the investments in the laboratories, the RNA equipment that was purchased by the federal government that was brought to the countries.  That was the platform for COVID-19 assays.  Imagine if we hadn’t done that.  There wouldn’t have been any tests in sub-Saharan Africa.  So the tests being run were the investments that the United States made both through Global Fund and directly through TB and HIV to create these platforms that then were used for COVID diagnosis.

The personnel, the laboratory personnel, the healthcare personnel – we know that the public sector utilized that personnel and, frankly, when we couldn’t do circumcisions, we added those personnel to be able to confront both COVID and HIV.  And I just want to applaud S/GAC under Angeli Achrekar’s leadership that really stayed in touch with every single country to know what their needs were and how we could better support them and meet those needs and make changes and innovations, minute by minute rather than week by to week, to really ensure that both HIV and COVID were both supported with the U.S. Government resources that we had built over time.

But know that if that platform hadn’t been built, there wouldn’t have been the COVID laboratory and personnel response.  And so those 300,000 almost healthcare workers that we have added, they were critical to the response.  The investments we made in nurses and doctors and laboratorians, both the physical equipment and the human capacity, has been critical.

Thank you for mentioning the 90-90-90.  So that gets to what we were talking about.  Numbers translating to outcomes and impact.  So the first 90 is, of course, have you been diagnosed, do you know your status?  That’s testing, 90 percent of people in the country tested.  Now, of those, 90 percent of them on treatment, but the critical piece is 90 percent of them virally suppressed, because that’s what’s resulting in moms and dads and parents and grandparents being alive today to support their families, to raise their families.

When we entered this prior to PEPFAR, many households were child-led because of the level of orphaning that had occurred.  We’ve reversed that together, and so that is something to be enormously proud of.  But with – always in the HIV pandemic, if anyone has been left behind and is not achieving viral suppression or not accessing services because of structural barriers and stigma and discrimination and marginalization, then we have all failed because we from the beginning have always said that we are all in this together and no one, as UNAIDS has always said, can be left behind.  And so what COVID has uncovered is who gets left behind first, and so that’s why we really have to work to redouble those efforts.

But let me conclude by thanking every U.S. ambassador around the globe who leads these programs with their incredible PEPFAR team, Peace Corps, DOD, USAID, CDC, and the Treasury who supports these programs around the globe, our agencies here in Washington and the United States and our incredible team at S/GAC.  Thank you for your tireless work.  No one has slept in 10 months, and so I’m hoping when these dual pandemics are over, together we can get together, hug one another, and be really excited that we made it through this together by caring for one another and ensuring that we understood what our gaps are and that we have a plan to address each and every one of them so that we can go further and farther together.

Moderator:  Thank you.  That concludes today’s briefing.  I would like to thank Ambassador Deborah L. Birx, U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy, for speaking to us today and thank all of our journalists for participating.  One last reminder to our journalists that the content of the briefing is embargoed until 9:30 a.m. Eastern Standard Time, U.S.  That’s 16:30 South African Standard Time and 14:30 Universal Time.  At that time, you are free to publish your articles.  If you have any questions about today’s briefing, you may contact the Africa Regional Media Hub at  Thank you.

This translation is provided as a courtesy and only the original English source should be considered authoritative.