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MODERATOR:  Good afternoon to everyone from the U.S. Department of State’s Africa Regional Media Hub.  I would like to welcome our participants dialing in from across the continent and thank all of you for joining this discussion.  Today, we are very pleased to be joined by Dr. John Nkengasong, U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy at the U.S. State Department.  Dr. Nkengasong will discuss the 20th anniversary of the President’s Emergency Plan for AIDS Relief, or PEPFAR, as well as the Country Operational Planning – Operations Planning meeting he is currently holding in South Africa.  At that meeting, U.S. Government and partner country teams – as well as others who work with PEPFAR – will plan how to carry out the program moving forward and its long-term sustainability.  He is speaking with us here in our studios in Johannesburg, South Africa. 

We will begin today’s call with opening remarks from Dr. Nkengasong and then we will turn to your questions.  We will try to get to as many of them as we can during the briefing. 

If you would like to join the conversation on Twitter, please use the #AFHubPress and follow us on Twitter @AfricaMediaHub. 

As a reminder, today’s call is on the record, and with that, I will turn it over to the U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, Dr. John Nkengasong.  

MR NKENGASONG:  Thank you.  Thank you so much for having me in your studio.  Let me start where I always enjoy starting, which is the happy 20th anniversary of PEPFAR.  And during my stay here and over the last week, there was a big celebration in Washington, D.C., where President Bush was in Washington and with a whole host of PEPFAR stakeholders to celebrate 20th anniversary of PEPFAR.   

When people ask me what PEPFAR represents for me, I think it represents three things: one is hope; second is impact; and thirdly is partnership, the power of partnerships.  I start there because PEPFAR has transformed the trajectory of HIV/AIDS on the continent of Africa in a dramatic way.  For those of us who have been in the field of HIV/AIDS for many, many years – I personally joined the field of HIV/AIDS in 1988 – and before PEPFAR was announced on the 29th of January, 2003, there was total sense of helplessness across the continent.   

But today, we have seen the power of partnership, hope, and what PEPFAR has transformed and how PEPFAR has transformed the trajectory of HIV/AIDS: 25 million lives have been saved, 5.5 million children have been born free of HIV/AIDS, systems – health systems have been strengthened in a remarkable way, remarkable way.  Laboratory systems – up to 3,000 labs have been strengthened and accredited across Africa.  340,000 health care workers have been trained and they’re currently being used in the fight against HIV/AIDS and other disease threats.  Over 70,000 facilities have been strengthened.   

There are other very positive consequences of or impacts of PEPFAR.  Immunization rates have increased by 10 percent in countries that PEPFAR supports – that is general immunization in children.  Life expectancy has bounced back to about 12 to 15 years in countries that PEPFAR has had investment.  GDPs have increased by up to about 2.9 percent.  So PEPFAR has not only had an impact on saving lives; it’s also had a developmental impact in the countries that PEPFAR has operated in more than 20 years.   

So truly a moment to reflect, sit back, and reflect what PEPFAR has done and where we go from here.   

MODERATOR:  Thank you, Dr. Nkengasong.  We will now begin the question-and-answer portion of today’s briefing. 

We do ask that you limit yourself to just one question and that that question be related to today’s topic, which is the 20th anniversary of the President’s Emergency Plan for AIDS Relief, or PEPFAR, as well as the Country Operations Planning meeting taking place in South Africa. 

So for our first question, Dr. Nkengasong, you mentioned the 20th anniversary of PEPFAR, and that’s quite a milestone.  So what would you consider the program’s biggest contribution in HIV/AIDS response?   

MR NKENGASONG:  The biggest impact has been shift the trajectory of where the continent of Africa was heading towards – a total catastrophe caused by HIV/AIDS.  Remember, before PEPFAR only 50,000 people – 50,000 people on the continent of Africa who were infected were on treatment.  Fifty thousand.  Today, over 20 million people are receiving life-saving antiretroviral therapy.  That is remarkable.   

PEPFAR has also transformed the way that we perceive transmission of HIV in children, where to the extent that in some countries like Botswana we’re actually working with that country to completely eliminate HIV transmission from mothers to children.   

So really, as I said earlier, saving 25 million lives, preventing transmission of HIV/AIDS from mother to infant and over – and saving over 5.5 million children is just remarkable.  Remember, 20 years ago it was a death sentence.   

MODERATOR:  Thank you very much.  That’s quite an impressive record.  So that goes a little to the question which was submitted by Mr. Onishias Maamba from Kwithu FM of Zambia.  And Mr. Maamba asks, “How many lives have been preserved in the 20 years of PEPFAR’s existence?”  I think you addressed that, although if there are any further details you’d like to offer, I’m sure we’d all be interested to know that.  And he further asks, “How much has been spent on the program?” 

MR NKENGASONG:  Let me further emphasize the impact.  As I said earlier, and I really want to amplify this, that the economies – the economy of countries that PEPFAR is invested averagely have increased, and their GDP has increased by up to about 2.4, 2.6 percent.  That is remarkable.   

Why is that?  Because if you remember, PEPFAR – before PEPFAR was launched, HIV/AIDS was killing young people.  And your human capital is the greatest asset that you have.  And PEPFAR reversed that trajectory; people are living now with HIV/AIDS, people are going to school and working and contributing in the economy.  So that is very powerful.  It should never be ignored. 

PEPFAR has also had a significant impact on what I call the health security, on national security.  Imagine those – if the trajectory had continued the way it was projected to continue, you have so many orphans on the continent, and those orphans would be without hope, they would be despaired, and that could easily lead to a serious security threat – serious security threat all over, because any human being who is – who lives with despair and hopelessness doesn’t – it’s not difficult to become vulnerable to security issues across the world, like terrorism and others. 

Financially, PEPFAR has invested over 110 billion – 110 billion – over the course of the program.  That is remarkable.  It is the largest program in the history of infectious diseases devoted by one country to solving one disease.  I have not – we’ve not seen that in 100 years.   

PEPFAR also represents, in my view, the greatest manifestation of the values of the people of America, because it’s truly a gift from the people of America to the people of Africa and the rest of the world in solving a unique problem that reflect the core values of what America stands for.  

MODERATOR:  Once again, those are some very impressive superlatives.  Thank you for sharing those details.  Just one quick follow-up on that.  So the lives that have been preserved by the program and the money that’s been spent on the program, would you say that most of that has been spent on the continent of Africa?   

MR NKENGASONG:  Oh, 95 percent of that has been spent on the continent of Africa.  We have PEPFAR programs in Southeast Asia, like in Cambodia, Vietnam, Thailand, India, Kazakhstan.  But the majority of PEPFAR spending has been on Africa, rightfully so, because Africa carries the largest burden of HIV/AIDS in the whole world.  Just to put that in context, last year there were 1.5 million new cases of HIV/AIDS, and over 60 percent of those were in Africa.  And last year of the close to 650,000 people who died of HIV/AIDS, 425,000 were in Africa.  So I think that the large amount of attention and the devotion of the resources in Africa is very proportionate to the burden of the disease.   

MODERATOR:  That’s very clear.  Thank you.  So I’ll move again to another question which was submitted in our chat.  And we are of course joining all these journalists from South Africa, and you are here for a conference which is being hosted in South Africa.   

So Ms. Tamar Khan of South Africa’s Business Day asks, or she remarks that, “The number of people on retroviral – antiretroviral treatment in South Africa has flatlined at just over 5 million people since 2019-2020.”  And she goes on to ask, “What does South Africa need to do differently if it is to accelerate the number of people on treatment and reach the 95-95-95 targets?”  By the way, perhaps you could also clarify the concept of the 95-95 targets. 

MR NKENGASONG:  Yeah, that is a very good concept.  Let me, before I answer that question, clarify what we are collectively – what the world has agreed to do.  The world has agreed that by the year 2030, we should bring HIV/AIDS to an end as a public health threat.  That is UN Sustainable Development Goals that we’ve all agreed on.   

We’ve also agreed as a world that the pathway to getting to 2030 is to be sure that countries achieve the 95-95-95.  What does that mean?  It means identifying 95 percent of people who are HIV-infected so that they know their status.  Once the 95 percent of those who know their status are identified, getting them to treatment.  And once you bring them to treatment, make sure 95 percent of those achieve viral load suppression, which is they have undetectable virus.  Because we’ve seen the power of the virus when it’s undetectable.  When patients who are HIV-positive receive treatment and the virus is undetectable, it benefits the individual; it also benefits the community because transmission is almost zero.  You can actually deliver, a pregnant woman who is HIV-positive, an HIV-negative baby.  And then of course you lead a normal life with that.   

We saw during my stay here in South Africa, we went to a clinic just last week with a group of senators, and we saw a young man who was HIV-negative and knew that the spouse was HIV-positive, but because they received the treatment they had two wonderful children that were all HIV-negative.  That is the power of the treatment program, that you can lead a normal life with your HIV status.   

That’s what it means by 95-95-95.   

In South Africa, they have – they’ve done a remarkable job in identifying people that are infected and knowing their status.  About 94 percent – remember, of the 95.  They have done 94 percent.  But where the challenge is, is to bring those 94 percent to treatment.  There’s a big gap there.  So I think that’s where the efforts should be.  So continue to identify people who are HIV-positive so that they know that they are HIV-positive, and very importantly, link them up to treatment.  And once you link them up to treatment, ensure that they remain on treatment, they adhere to treatment and achieve viral load suppression.   

MODERATOR:  All right, thank you very much.  So obviously South Africa is a big player in our program, and thank you for addressing that.  I’ll go to one of the other larger countries perhaps where you operate: Kenya.  So Mr. John Muchangi of The Star newspaper in Kenya asks, or rather he observes, that in the 2023 guidance letter to PEPFAR beneficiaries, PEPFAR emphasizes that it will prioritize its funding on projects that support key populations such as men who have sex with men and sex workers.  How does the program navigate legal hurdles because, as Mr. Muchangi observes, homosexuality and sex work are illegal in Kenya and there are legal challenges in other African countries as well?  So how does the program navigate that legal landscape? 

MR NKENGASONG:  So let me clarify something, first of all, which is extremely important: that it is not PEPFAR in Kenya navigating that; it is the people of Kenya, the Government of Kenya leading the response, and PEPFAR is your partner in supporting Kenya’s effort to bring HIV/AIDS to an end as a public health threat by the year 2030.  That distinction is very, very important, so that it’s not seen like it’s an American program coming into Kenya and to do and address other structural issues there.   

So that brings me to what I usually characterize as the power of partnership.  We must work closely with the Government of Kenya, supporting their efforts – they are the leaders in these efforts – so that we all sit down together with the community leaders and find a way to address the inequalities and inequities that exist in those, what we call priority populations.  And we have said in the same letter that we issued that there are three priority populations that we should focus efforts, and one is children, because we see remarkable inequities in children; second is adolescent girls and young women; and thirdly is key population, men who have sex with men, LGBTQI, female sex workers are all a key population.  And each category of the priority populations requires a strategy, and that strategy cannot be dictated or conceived in Washington.  It has to be conceived locally.  Because who else knows the context, the socioeconomic, cultural context, than the country?  That’s why I emphasize that country leadership is key.  We are a partner. 

So what does that mean in men who have sex with men in Kenya?  That we see this truly as a public health issue that we address.  We want to address a public health issue.  We recognize that if we do not address HIV/AIDS in key populations, including men who have sex with men, female sex workers, we would never arrive at our target.  The target is to eliminate HIV, to bring HIV/AIDS to an end as a public health threat by the year 2030.   

So again, no one has a silver bullet on this, but I believe that we have to work collectively with the civil society, with community leaders, religious leaders, and political leadership to find ways that we can begin to break down the structural barriers.  We have to build bridges with the communities, and build bridges that will enable us to solve the problem that is at hand, which is to bring HIV/AIDS to an end, rather than build walls.  Okay, if we build walls between us and different subsets of community, we will never be able to successfully bring HIV/AIDS to an end by the year 2030.   

MODERATOR:  Okay, thank you very much.  So you touched a little bit on the way you work with the health systems in the various countries where you operate.  So we have one related question to that from one of our journalists here in South Africa, Pamela Koumba from South African Broadcasting Corporation.  So Pamela asks, “How has PEPFAR strengthened the health system in Africa and are there any examples that you’d like to point out?”   

MR NKENGASONG:  Pamela, good to hear from you again.  PEPFAR has – in order to achieve that impact that I just described – saving 25 million lives and most of them in Africa, and directly impacting and saving 5.5 million children born free of HIV/AIDS – PEPFAR has had to invest (inaudible) assets in strengthening public health systems, including surveillance systems, information systems, laboratory systems, human resources, across the board, including infrastructure innovation – building hospitals, laboratories across the multiple countries that PEPFAR has operated in.  And those same infrastructure is being used today in fighting other emerging infections, like the current COVID pandemic.  PEPFAR, their infrastructure and architecture that PEPFAR put in place was extremely, extremely valuable and handy in fighting COVID, including scaling up vaccination, infection prevention and control measures, rolling out testing, and conducting contact tracing there.   

So I think that is really the other benefit of the PEPFAR platform that has been put in place over the last 20 years.   

MODERATOR:  Okay, great.  Thank you so much for that answer.  So I’d like to go to another submitted question which we have online from BBC, Anne Soy.  So Anne asks, “The development of pediatric ARVs, antiretroviral drugs, have been left behind since virtually no child is infected with HIV in the developed world.”  Okay, so she points to a systemic problem there.  “That has meant that often, children in Africa or in lower-income countries who get infected are given adult regimens, and that those adult regimens are split at the discretion of caregivers.”  She remarks, “That is never accurate.”  So is that an area where PEPFAR has been doing any work, and if so, what?   

MR NKENGASONG:  Yes, absolutely.  PEPFAR and other partners have been doing a lot of work in that area, and PEPFAR is part of the global alliance that was just launched in Tanzania by the first lady of Tanzania just in I think the first week of February.  PEPFAR is part of the Rome Consultation, which is all focused on pediatrics.  I was there in Rome in December with my team to continue to support a collective approach to that.  Anne, you are absolutely right: that has been – there is drugs, specific drug adaptation, formulation for children has been a problem.  But the good news is that there are now new formulations for children that have been made, and we committed to expanding that.   

I just announced at the Country Operations Planning meeting that there will be a fund that will set aside up to about 40 million that will continue to push countries to scale up and address those inequities that exist in children, that exist in key populations, that exist in adolescent girls and women.  It doesn’t exclude the country’s own programming, but it’s an additional funding that will enable countries to compete for if they have bold ideas to reach our children more using innovative ways there.   

So we are looking at taking the problem very seriously.  When we say in our five-year strategy that children, adolescent girls, and young women and key populations are a priority, we mean it.  It is truly a priority, because that is where the burden of the disease is.    

MODERATOR:  Thank you.  Thank you very much.  That’s very clear.  So we have another question that’s sort of related to that in the sense of the science and the pharmacology of the treatments.  So Mr. Beldeen Waliaula from Standard Media Group in Kenya asks, “What are the scientific developments in the HIV and AIDS sector, and what does the future look like?” 

MR NKENGASONG:  I am very positive of the future of the tools that are developing in the pipeline in the fight against HIV/AIDS.  And possible for several reasons, one is that we have a pipeline of molecules or interventions that are coming on that we’re calling PrEP, which is pre-exposure prophylaxis, that actually will help us in the prevention, okay, where – injectables that the adolescent girls and young women and key pops can inject when they come, and you see them only after three months, okay, and this PrEP, this is for HIV-negative people that are at risk.  That is remarkable because inasmuch as we want to get to the 95-95-95, which is mainly treatment-driven, we want turn off the tap.   

I always use the kitchen sink analogy and say, well, if your kitchen sink is leaking and water is on the floor, you’re wiping it up, consider that to be people we are treating.  Right.  Unless you turn off the tap, okay, which is new infections, you continue to clean for so long.  So we are trying to have new tools, like the long-acting injectable pre-exposure prophylaxis, that will help us turn off the tap.  That is, reduce the rate of new infections, especially among key populations – adolescent girls and young women.  I think that is very, very promising.  

We also know that over the years, because of science, we’ve moved from a patient receiving a cocktail of drugs as a handful of pills a day to one tablet a day.  That is remarkable.  And who knows, going forward we may actually have in the pipeline development of drugs that you may just take once every month or so.  I think the pipeline is looking very good.  Is the pipeline looking very promising for vaccines?  Not so much for vaccines.  Just want to be clear that a vaccine will be very important if we ever have the hope of completely eliminating and eradicating HIV/AIDS – this is the first time I’m using the words “eliminating and eradicating HIV/AIDS” – just like we did for chickenpox.  It will require a vaccine, right.  So, but we are not yet there.  But we have these other molecules that I just described that are in the pipeline.  You have the ring vaginal products that women can use at their will.  So the pipeline is looking very, very promising thanks to – thanks to the science.   

I mean smallpox, not chickenpox.   

MODERATOR:  Thank you.  So if I could continue with one more question – there’s a couple of questions actually which are related which also go to the pharmacology, to some of the science.  So Mr. Yousuf Bah from Al Jazeera in Guinea and Ms. Patricia Bonsu from Luv FM in Ghana asked similar questions.  So obviously coronavirus has had a big impact on the continent, and how would you say that the impact of the coronavirus epidemic and also other viral infections like Marburg, for example, how have those impacted the work of PEPFAR in addressing the HIV/AIDS? 

MR NKENGASONG:  Very good question.  I have always said that in my public speaking on global health, for the last 25 years, HIV/AIDS have defined global health.  By strengthening the system that I just outlined – that we are beginning to see how emerging infections like Ebola, Marburg, monkeypox – or Mpox, as it’s now called – and COVID are threatening the HIV program because they are disruptive.  Each time you have emergence of such infection, what happens?  We stall the HIV program because we’re paying attention fully to those – to eliminate those programs.  I mean, we know what happened with COVID when COVID was – at the height of COVID, it disrupted TB program, malaria program, and HIV program.  And we started to see excess mortality among patients that were receiving ARVs, or HIV-infected patients who subsequently died because of the other infections other than because of HIV.  So we continue to see that.   

We also have to admit that we are seeing an increasing rate of emergence of diseases.  Just in 2002, it was a remarkable 2022 rather – it was a remarkable year because WHO declared public health emergency of international concern in – with three diseases: Ebola, COVID, and Mpox.  It has never been seen in the history of, in the last 75 years, in the history of the WHO.  It just tell us that we are now in a world that diseases are emerging more frequently.   

Just to put that in context, the first case of Ebola was identified in the DRC in 1976.  It took 20 years later before the second outbreak occurred in the DRC.  But nowadays, we see more frequent occurrence of Ebola, almost yearly, and because of that, resources are always channeled or attention is moved away from HIV and focused on these other infections.  So that’s what you continue to see.  That’s why in a new strategy, we have elevated a pillar called Public Health Systems and Security, which means how can we position assets that are used for HIV/AIDS in such a way that when you have a new outbreak, you can quickly, quickly and intentionally mobilize those assets, take care of that emerging infection so that we can get back to HIV/AIDS. 

Just remember, COVID killed about 260,000 people in Africa in three years.  HIV alone killed 425,000 people in one year.  So that is how serious and how the threat that we still have in front of us with respect to HIV/AIDS.  The tricky thing is that the young people don’t see HIV/AIDS the way we saw HIV/AIDS, because we’ve done a very good job with PEPFAR and Global Fund at cleaning the nasty face of HIV/AIDS, so people don’t see that threat.  It’s not as evident as COVID, where you get a fever and you stay home and you’re sick and you cough and then perhaps you get treated or you die from it.  So that is the threat we are seeing, where emerging infections are becoming a serious threat to HIV/AIDS, disrupting serious delivery, affecting people that are HIV-infected in a way that they cannot fight off these new infections.  We’ve seen that in – during the COVID-19 pandemic; at the height of it, people that were HIV positive were not able to clean up the virus quickly, and that became a very serious threat for them.  

MODERATOR:  So, Dr. Nkengasong, we’ve had a few questions on one topic which – obviously a major concern or interest here.  From John Muchangi of The Star newspaper in Kenya, from Anny Soy of BBC, and also from Cara Anna of AP.  So they’re all interested to know, how do you see the budget and resources trend line for the program?  And if there – well, regardless of what the budget and resources trend line might look like, is there any work on assisting the beneficiary governments, in particular the African governments, to begin to contribute more to their effort or to the PEPFAR effort, whichever one it might be?  

MR NKENGASONG:  Let me just say that two weeks ago I was in Addis Ababa to attend the African Union head of state summit.  And I did present to the head of states, about 33 of them who were there, the head of states, that in the orientation committee of the AU NEPAD, which is the developmental organ of the AU, the 20 years’ impact of PEPFAR.  And it was very well received; it was the first time that PEPFAR was presented among such a large number of head of states. 

Then we had another consultation with the partners and the government two days later, and they issued a declaration.  And if you look at the series of declarations on the AU website, on page 66 of that, you see a declaration that the head of states have issued a statement or declaration that are saying that they are committed to the Abuja declaration of the – or recommitting to that, which is that 15 percent threshold for financing, domestic financing.  They are recommitting to the fight against HIV/AIDS.  They have asked actually AU NEPAD and Africa CDC to develop a sustainability roadmap (inaudible) from now to 2030.  And they have agreed that a special summit will be hosted, that they will organize a special summit by head of states and focus on HIV/AIDS and other pandemics.  I thought it was a remarkable political commitment, a remarkable achievement that I had during my stay in Addis Ababa.  

So I think everybody is aware and acknowledges that we need to sustain the response.  We still have a lot of work to do to get to 2030.  Donor funding is just one component of the funding, including bilateral like PEPFAR, we need the Global Fund.  But you need to sustain this response.  You need increased domestic financing.  And it’s not a new conversation.  South Africa contributes in excess of 80 percent of its own resources in the fight against HIV/AIDS.  Neighboring Namibia contributes more than 70 percent in the fight, and Botswana.  So we know countries but is everybody doing the same thing? No.  Other countries are stretched financially, and we will be developing – sitting down with the countries to develop a sustainability framework so that their companies, whatever the AU would develop in terms of a roadmap to getting to 2030.  

So I think the goodwill is there.  The commitment is now to follow so that we all are seeing – looking in the same direction and headed in the same direction.  Just to say that this is a very important year for PEPFAR.  PEPFAR needs to be reauthorized this year, and I’m very encouraged that a series of senators, there were five or so who were here in South Africa, reviewed the program and they left with a very positive impression of the impact that PEPFAR has had in saving lives on the continent.  And I’m hoping that that positive energy will translate to a PEPFAR reauthorization, which will happen this year, which will mean that we continue to have additional resources in supporting the fight against HIV/AIDS on the continent.  

MODERATOR:  Thank you, Dr. Nkengasong.  You’ve been very generous with your time.  I think we probably better try to bring it home with maybe just one or two more questions, if that’s all right with you.  


MODERATOR:  So Sarah Jerving from DEVEX is asking about the ongoing conference that you’re a part of, the country operational plan process.  And I think, given that you’re in the midst of that process and those meetings right now, it would be interesting to hear if you have any preliminary insights or any takeaways you can share.  And Sarah’s specific question relates to the planning process, and she notes that it’s shifting from one to two years.  So how do you see that as affecting the process? 

MR NKENGASONG:  Sarah, thank you, and good to connect with you again.  Sarah was one of – we now call it a team, as the whole team that I worked with during my time at the Africa CDC.  And I must say, together with Anne and a whole host of other journalists on this call, they did a remarkable job in covering and fighting the COVID-19 pandemic.  

So the reason I’m here in South Africa this week and next week is that we have made – very intentionally shifted the way PEPFAR planning occurs.  First is we are really emphasizing country leadership, where we’re saying, look, if we agree on the two things that I mentioned earlier, i.e. that we get – bring HIV/AIDS to an end by the year 2030 and achieve 95-95-95 goals by the year 2025, we need to shift from one-year planning to two years’ planning so that we give time for implementation.  So we all come here to plan, and with ministers, civil society has had a very big voice.  Yesterday was the opening; civil society all discussed the People’s COP, which will be factored into it. 

So we started off early.  In previous Country Operational Planning, we used to meet countries at the tail end and now we are making the countries early, so that three things happen.  The countries tell us where their epidemic is.  As I’ve said, the theme is know your epidemic.  Who else knows the epidemic and who else can lead the epidemic, the fight against the epidemic other than the country?  So the countries are doing that.  

Then we, as a partner, PEPFAR as a partner, will come in and say, look, we see where you want to go with this, and this a five-year strategic plan, and let’s see how we can align.  Civil society comes in and says, these are things that we see in the community that we must address.  So we have kind of a triangular conversation.   

At the end of the stay here, we hope that there will be a common framework emerging so that when they get back home, they can very quickly sit down around the table in the next eight weeks to 10 weeks, complete the whole planning.  Okay, that way we are co-planning it, we are co-creating it, and it’s not PEPFAR leading the response; it’s the country leading the response.  PEPFAR is a partner as any other partner.  So that is new. 

I’ve also made sure that I took money off the table.  We’ve sat in a location that tries to say, look, South Africa, you get X million.  Kenya, you get X.  And that way we don’t come in here to speculate what are the programs we will fund.  So money is off the table.  

What I wanted to do for the next one week here, this week and next week, is to focus on the issues.  The issue is, where is your epidemic?  Where can – what can we do together to get to 95-95-95 and subsequently to 2030?  

MODERATOR:  So it sounds to me that this shift in the planning process from one to two years is a method of both putting in place some long-term planning and also perhaps facilitating the beneficiary countries’ ownership and their own involvement in the processes.  

MR NKENGASONG:  Yes.  And the ability to have — to keep them here, and how do we sustain this.  One thing I should also add is that we are bringing in new partners, what I call transformative partnerships.  The African Development Bank is here with us for the first time.  Their vice president is here.  Senior leadership at the Mastercard foundation is here.  The World Bank was not able to be here, but they zoomed in live yesterday.  

So I’m bringing all these partners to say, look, we have to look at resources from all angles – domestic resources, donors, bilateral resources like those from PEPFAR, but also the development banks on the continent and foundations that are operating on the continent.  Because in my previous job as the director of Africa CDC, I saw that if you engage people and articulate the issue well, there is always funding around.  The Afreximbank, who was invited, was a bank that was able to leverage about $2 billion to enable the AU to procure vaccines at the height of the COVID pandemic. 

So if you bring people around the table, there is power in collectivity, there is power in unity in solving a problem like HIV/AIDS.  So we should bring those banks together, foundations together, so that we synergize the common pot of resources to bring HIV/AIDS to an end by the year 2030.  

MODERATOR:  All right.  Thank you very much for that.  And once again, thank you for being so generous with your time with us today.  I think we got to an awful lot of questions on a lot of very different and diverse topics, and I know that I personally feel that I’m a lot better educated about this topic now than I ever have been.  So it’s been a really valuable experience.  

So before we bring it to a complete close, I wanted to find out if you have any final thoughts that you didn’t get to, if you have any final thoughts for our listeners.  

MR NKENGASONG:  My final thought is always to the media, that I work with the media very closely.  I mean, I believe, and believe strongly so, and those who have worked with me – Anne, Sarah, and others – will know that it’s always a partnership.  When I started up this conversation, I said PEPFAR represented hope, it represented impact and partnership.  And partnership with the media is always one of my priorities because that is the segue to – I mean, the population, reaching the population, that – transparently with the key messages and with the actions that we are taking.  

I’ll just end by saying that just today I read – there’s a CNN article that says the United States has saved 25 million lives, but nobody knows about it.  You can google and see that article.  That is really an example of why working closely with the media is so important, okay, so that that story is told not in terms of publicity but in terms of impact, in terms of reality.  There’s a lot of gains in positivity, in sharing positive stories, remarkable stories such as the one that PEPFAR has created.  So that’s a very good article that speaks to why working with the media is so important for me.  

MODERATOR:  Well, thank you very much, and working with the media is important to us as well.  So it has been a really, really valuable experience for us to have you here with us today, and I hope it’s been valuable for the journalists who have joined us today as well.  And I hope that they will remain in touch with us closely. 

So let me thank Dr. John Nkengasong, U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy at the U.S. State Department, which is our parent agency here at the Africa Regional Media Hub, for joining us today.  And thanks to all the journalists for participating.  If you have any questions about today’s briefing, please contact us, the Africa Regional Media Hub, at  And please note that a recording and a transcript of today’s hub call will be available to you as soon as we can produce it.  So once again, thank you, Dr. Nkengasong, and thank you to our journalists. 

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U.S. Department of State

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