By the Former President of Mozambique, Joaquim A. Chissano, at the Conference of SADC Ministers responsible for HIV/AIDS under the theme “Our Pathway to Sustained HIV Epidemic Control”
Windhoek, Namibia | 13 June 2019
Your excellencies, ladies and gentlemen, our sad reality in southern Africa is that AIDS is still very much with us. We, as Champions for an AIDS-Free Generation have a slogan that says, “A stronger, more visionary and outspoken leadership must come from the continent most affected by this epidemic”.
Excellencies, ladies and gentlemen, the SADC region has demonstrated that leadership for sustaining and ending AIDS without leaving anyone behind, is key. The region, while bearing the greatest brunt of the epidemic has also provided commendable leadership. We are comforted by the leadership of His Excellency Hage Gottfried Geingob and the support of UNAIDS in convening this very crucial conference. It comes at a critical time when we should be visionary and forward looking to protect our gains and to advance our goal of ending AIDS as a public health threat by 2030. If we can end AIDS in this region then it can be ended on the continent.
Excellencies, ladies and gentlemen, I am a member of the Champions for an AIDS-free Generation. I bring warm greetings from my fellow Champions. I, along with twelve other Champions have committed to prioritise and sharpen our focus and advocacy on complex issues that continue to challenge us in ending AIDS as a public health threat. In this regard, we are dedicated to advocating for increased commitment to address political, social and legal barriers and blockages to fast-track the response in Africa. We lay a great deal of emphasis on key and marginalised populations and adolescent girls and young women and their partners. We address sustainability of the response through increased commitment to domestic investments for HIV and health. The majority from our group of Champions are former heads of states from the SADC region - your own brothers and sisters. They are from Botswana, Malawi, Mozambique, South Africa, Tanzania, Zambia and my brother His Excellency Hifikepunye Pohamba of Namibia.
In September 2018, we the Champions for an AIDS-Free Generation and UNAIDS convened, as you have done this week, experts, members of the SADC Parliamentary Forum, Ministers of Health, National AIDS Commissions, diplomatic corps, Private Sector, Civil Society and partners from the SADC region, to engage and interrogate the prevailing funding environment and how we should move towards a sustained response. We recognised that the funding gap continues to grow and that the impact of this will undo the progress we have already made in this region. Together, we reviewed viable options for increasing domestic contribution to the response. Today, we are most encouraged by the leadership of the Government of Namibia and UNAIDS for convening this landmark conference, which further deepens the commitment of the SADC region to sustain and transition the response for attaining our goal of ending AIDS as a public health threat by 2030.
We recognise the tremendous scale up of the AIDS response on the continent, and more especially in the SADC region. We recognised that this scale up has greatly benefited from the tremendous mobilisation of international, regional and national efforts and commitments.
As Champions we continue to be concerned by the growing threats to the remarkable progress our countries have made. However, we are not out of the woods yet. Our progress remains fragile and is continually under threat from complacency. We are seeing complacency from our leaders, our development partners, communities even young people themselves. We must continue to remain vigilant otherwise we will lose the progress we have already made. AIDS can and will be ended in our region.
Excellencies, ladies and gentlemen, just as we feared - not too long ago when we formed the Champions initiative rates of new infections among youth are unacceptably high. We are informed by UNAIDS that 2 in 5 new infections are among young people, with 7 in 10 of these being adolescent girls and young women. Africa has the fasted growing youth population, a great asset for the development of our continent. More than 30 percent of the population on our continent is between the ages of 10 to 24. Your excellencies ladies and gentlemen, tragically this is the demographic space where the highest new infections reside and it is growing at unacceptable rates. Ladies and gentlemen, this is a crisis. Unless we curb these new infections, we are set to lose the fight with AIDS. Prevention! prevention! prevention! is key to ensuring that no one is left behind.
We have heard this week that key populations account for 17% of new infections in east and southern Africa. Stigma, discrimination and exclusion continue to derail us from achieving our prevention goals for key populations. Ladies and gentlemen, elimination of stigma and discrimination and full recognition of human rights are the cornerstones of sustainable progress. We must repeal laws that undermine access to HIV and health services for all and ensure that no one is left behind. We must enact protective laws that guarantee access to sexual and reproductive health and rights and services without any discrimination. There are Member States within our region that have done well in addressing these challenges. I want to take a moment to recognise the recent High Court Decision in Botswana along with the January decriminalisation of same sex relationships in Angola. We must learn from them and others that came before, like my own country Mozambique. We must ensure that Africa’s potential for attaining a healthy and productive continent, free of discrimination and stigma is attained.
No nation can succeed and be competitive in this globalised world without investing in its own people. People remain the most valuable resource for all countries. Investing in AIDS and health is investing in the people and it is therefore investing in the future. Excellencies, ladies and gentlemen, as Champions we remain gravely concerned by the ongoing funding crisis that is not only affecting SADC region but the entire continent and the world. Worldwide, the funding for prevention and treatment has flatlined. We are informed by UNAIDS that about US$21 billion was spent on the AIDS response, while US$26 billion are needed annually. We fully agree with UNAIDS’ conclusion that if the gap is not bridged, the funding shortfall will result in a reversal of the achievements we have made. We cannot afford that.
Your excellencies, ladies and gentlemen, following the positive economic growth of some of our countries in the region, the reclassification from low income to middle-income category has meant that these countries have lost access to official development assistance. It is estimated that worldwide, official aid for health declined from 33.6 percent of health expenditures among low-income countries to 19.4 percent of health expenditures among lower middle-income countries. Our experts, including UNAIDS, confirm what we have all observed: in countries where external aid is being provided, the emphasis has shifted strongly from funding the resource gap to demonstrating that resources deliver results. The assistance is seen as a catalyst to transition to sustainability.
Excellencies, we are encouraged as Champions that our countries recognise the importance of closing the funding gap created by the flatlining and in some cases, the receding external support. Domestic resources, mainly public, continue to be the main driver of the increase of resources for the response to HIV. The percentage of domestic resources out of the total is 56% on average for all low- and middle-income countries. We are seeing gradual increases in the domestic allocations for HIV and health, with some of our SADC countries funding more than 50% of the response from domestic public resources. A very encouraging development indeed. However, we are concerned that 25 countries in sub Saharan Africa are investing less than 25% of the total AIDS budget. We must move with urgency to do more.
Excellencies, brothers and sisters, SADC and the continent are making commendable efforts in domestic resources mobilization innovation. Some of the innovations include the HIV and AIDS Levy Fund; the mainstreaming of HIV funding requiring a 2% allocation to AIDS by all government sectors; a funded President’s Comprehensive Response plan in one country; and establishment of HIV trust funds, among others. However, we must ensure that innovations are sustainable and are additional, not a replacement of existing government allocations. We must continue to innovate and continue to engage with private sector to be fully board. We must continue to strive to improve efficiencies in using the available resources to allow us to save what we have so that we can use it for generating additional outputs. We have to do more and do better with less.
Sub-Saharan countries cannot and would not end AIDS alone. AIDS is a global challenge. Meeting the 2020 targets and Ending AIDS by 2030 is at risk unless the scale-up of services and funding is increased. The end is only possible if the international and donor community, the private sector and governments sustain and step up their funding particularly for economically constraint countries bearing the greatest burden of AIDS.
Excellencies, ladies and gentlemen, in conclusion, there is no denying that the political, economic and social environment on AIDS has shifted significantly from 10 years ago and continues to change. We are now in a different space that requires stronger political will, commitment and forward-looking leadership. We need leadership that is poised and determined to prioritise health and sustainability, a leadership that puts communities at the centre and a leadership that demands inclusivity and an HIV response that is free of stigma and discrimination.
I thank you.