Delivering the HIV Prevention Ambition: Partnership, Country and Community Leadership, and Shared Accountability

Okay.
Good afternoon.
As I am probably the least important voice you'll hear today, I'm going to go ahead and get started and I will uncharacteristically speak very slowly to allow more colleagues to join us in this room for what is an incredibly important session.
My name is Mitchell Warren.
I am the Executive Director of AVAC an organization that focuses on HIV prevention.
But for today, more importantly, I am privileged to be the co chair of the Global HIV prevention Coalition under whose auspices we meet today.
Today, we meet at such a critical moment and you all wouldn't be here in the United Nations if you didn't know this was a critical moment.
But I want to welcome you all, and I want to ensure that all protocols are observed.
Because if I began to do it in the proper way, A, we'd be here quite some time hearing about the distinguished people you will hear from today.
But inevitably, I will miss someone.
I will simply welcome ministers, heads of UN organizations, distinguished colleagues, and state all protocols observed.
Okay.
As I said, this is an incredibly important moment in the HIV AIDS response.
You all wouldn't be here sitting here in June 2026 if you didn't already know that for this high level meeting.
How many of you by a show of hands, sat in these rooms in 2001? A few of you are too young, Lillian to even remember.
In 2001, history was made in this hall and in various conference rooms and back offices that changed the way in which the world addressed HIV and AIDS.
It led to making what then was described as impossible possible.
The idea that we stand here in June 2026 to even utter the words that an end of HIV and AIDS, the end of this pandemic is possible, was a pipe dream 25 years ago, and yet we sit here today and know that it is real.
It is possible, but it is incredibly at risk.
The discussions that will take place over the next couple of days that will get us, we hope, to a political declaration that is as historic and valuable today as it was in 2001 is our task.
There are many issues that we grapple with financing, ensuring that everybody in this world living with HIV has access to antiretroviral treatment, ensuring human rights are respected for everyone everywhere, ensuring that research and development continues to drive scientific innovation.
All of that is core to the declaration.
But for the next 65 minutes or so, we will focus on HIV prevention.
It's not that HIV prevention is more important than the other issues, but it is as core to the AIDS response as any other issue and it is so often left behind.
Prevention is harder and messier than antiretroviral treatment, but it is core to sustainability.
It is core to helping ensure that those living with HIV can access treatment by not adding to the numbers of people needing that treatment.
So prevention has never been more important, nor has it ever been more opportunne.
I am so grateful and right in the middle of our panel, and this is a very distinguished panel, but in the middle of it is the Minister of Health from South Africa from whom you'll hear in just a few minutes.
I had the great privilege two weeks ago to be hosted by him and the President of South Africa for the launch of their injectable Lena Capave program.
It was thrilling as someone who is old and jaded as I am, It was an inspiration to see not only the scientific innovation, but more importantly, the political leadership that says we can make a new scientific innovation possible.
You'll hear more about that, I think in the course of the next hour or so.
I welcome you all for what is a critical conversation.
As I said, I co chair along with Nuku Colonsa who unfortunately is not able to join us from Kenya today.
She and I co chair the coalition, but importantly, for now almost ten years, it has been co convened by UN AIDS and UNFPA.
The leadership of those two agencies and more importantly, of the two individuals that lead those agencies helps make prevention possible.
I'm delighted to now turn it over in turn to the Executive Directors First of UNAIDS, Winnie B anda, who needs no introduction to this fora.
But I am so grateful, Winnie, for what you have done in what has been a relatively short tenure, although it must seem like a lifetime to you over the last couple of years.
But let's start with you, please and welcome.
Thank you, Mitch.
I too will save all protocols observed.
Excellencies, distinguished delegates, friends.
What a privilege it is to be with you today.
Thank you for being here.
We meet at a true inflection point in the HIV response.
Almost a quarter century ago, the World Health Organization launched what was called three by 3 million people living with HIV accessing HIV treatment by 2005.
Many had doubts, can it be done in low income countries, in Africa? Can we afford it? Today, we have not three but 32 million people living with HIV on treatment across the world, a true success story of global health and multilaterlism.
The inflection point before us is the next step forward to ending AIDS.
Today, we launch the 40 plus 20 milestones.
40 million people living with HIV accessing treatment by 2030 in four years time and 20 million people accessing the powerful prevention options, including innovative long acting products that science has given us.
Our model shows that 40 plus 20 is what is required to achieve our 2030 goals.
Reducing AIDS deaths by 90%, reducing the number of people acquiring HIV by 90%.
With 1.2 million new infections per year against a target of 200,000 by 2030, you can see we are too far away to be complacent.
But with the powerful tools at hand, we are too close to slow down.
The new global aid strategy developed by all of you and the 2030 Prevention A Framework, describe what is needed for prevention, which is a focus of this session.
What will it take? First, the three 20s needed for prevention.
20 million people using ARVs for prevention, in other words, different prep options.
This includes the groundbreaking long acting injectable prevention.
It means 20 billion condoms.
You see the three 20s.
The second 20 is 20 billion condoms for prevention.
Basic prevention options like condoms and harm reduction must remain widely available, affordable, and within reach of every community.
Then the third 20 is 20% of domestic HIV investment allocated to prevention.
Today, the allocation of governments to prevention in their total HIV funding is too small.
We are aiming at 20%.
Always an HIV response is always an HIV response based on data and evidence.
Country led, sustainable systems built on equity and dignity, where no one is turned away, no one is judged and no one is left behind.
Community leadership from start to finish, communities in the driving seat, shaping decisions, delivering services, and holding power to account.
It means listening to communities.
Women and girls are telling us what they need to stay HIV free.
We listen to them, we deliver what they want.
This means a real choice of prevention options, including the apivalen vaginal ring.
Choice is power, choice is prevention.
As we all know, inequality is driving this pandemic.
Rights violations are fueling it.
Violence against women and girls is fueling it.
Until we address this for key populations, for women and girls, for men, for young people, we will not end AIDS.
How will we get there? In 2027, 120 countries, 120 countries will receive long acting prevention injections than a cup ofveer at $40 per person per year.
Thanks to agreements with generic manufacturers.
But I keep saying that this is a drop in the ocean.
We're talking of 20 million.
We're talking of achieving 2 million.
The pipeline is also rich.
There are longer acting formulations under development.
For example, a four monthly CB and a one yearly.
The duo prevention pill and a monthly oral pill could potentially be introduced within two years if advanced trials are successful.
A good pipeline of powerful innovations.
This is a moment of extraordinary scientific promise, but promise is not progress.
Tools on a shelf do not prevent new infections.
People do when they have the information, when they have the choice, when they have the dignity and the rights to use those tools.
That is a work ahead.
That is where UN Aids will keep showing up.
We will fight for affordable access.
We will help countries put communities at the center to deliver.
And we will defend without compromise the rights of every person to prevention, to health, and to a life free of stigma and discrimination and criminalization.
We will support as HIV is integrated into broader health and social systems, not to dilute the response.
Integration must not mean dilution, but strengthening.
Integration done right means more people are reached, more cost effectively with no one left behind.
Integration done wrong means that key populations are pushed back into the shadows.
We have to get this right.
We must back this up with domestic financing for prevention.
Sustainability is built at home.
It's about governments investing in their own people and their own systems.
This is what will sustain the response through this moment and beyond.
But we can't ask countries to invest more while the global financial system pools resources out faster than they come in.
Debt servicing is crowding out health spending, fiscal space is shrinking.
Tax systems are rigged in favor of rich and powerful companies.
If we are serious about domestic financing for prevention, we have to be serious about debt relief, debt restructuring, about fair taxation, and about reforming a financial architecture that is failing the global South.
The UN will be there alongside you to deliver on the prevention goals, 40 plus 20, and all the goals in the political declaration can mark a true inflection point in the HIV response if we move together as fast as we can and for as long as it takes.
Thank you.
Winnie, thank you so very much.
Everything you said so important, but I can't help but just be reminded of four simple words promise is not progress.
Thank you for that.
I do want to also highlight there is a call to action, the 40 plus 20 agenda that was put out by the Global Prevention Coalition is a longer prevention framework, but a short call to action is available, I think at both exits.
Please do grab it, read it, and most of all, do it.
Um, Next, I want to call on the other co convenor of the prevention coalition at UNFPA, the Executive Director, DNA quieta, and it's never just about HIV, it's about sexual reproductive health.
It's about rights, it's about gender equality, and UNFPA's role is so very important.
Thank you so much, dear Mitchell and thank you very much, Winnie, for your both outstanding leadership for setting out the 20 plus the 40 plus 20 HIV prevention target, and the urgent need to move from target to deliver at scale.
Your Excellency, Motsuy Minister of Health of South Africa.
Excellency Sliman Quinni, Deputy Minister of Health from Zimbabwe.
Your Excellency, Monsieur Mr.
Carlos Masoli, permanent representative of Botswana to the UN.
Monsieur Claude Kmenga, Director of the Cabinet, African CDC, misses Lillian, Marcose Executive Director of Deir Tanzania, Excellencys esteemed colleagues, distinguished guest, all protocol observed.
Investing in HIV prevention is not just a public health decision.
It is a deliberate political choice.
You heard it from Nuwini right now.
It takes courage to remove barriers and protects the rights of those most often left behind.
I am honored to stand with the ministers and leaders here today who have shown that true leadership means prioritizing the dignity and autonomy of all populations.
UNFPA is proud to co convene this discussion.
Prevention is the anchor of a human rights based HIV response and a core part of comprehensive sexual reroutive health and rights.
We have better prevention tools and innovation than ever, but this tool can only be effective if everyone can access them equitably and sustainably.
Four principles guide UNFP HIV prevention commitment.
First, it is important for every person should have decision making authority to decide about their own protection and live free of stigma.
That is why we say that rights and body autonomy are indispensable to ending AIDS.
No prevention strategy can succeed if people cannot make free and informed decision about their own health and future without fear, stigma, or discrimination.
Second, we must confront the inequalities that drive HIV risk.
For many adults and girls and young women, this risk is shaped by poverty, unequal power dynamics, gender based violence, and a fundamental lack of agency.
For key populations, legal and social constraints limit their choices.
To end the epidemic, we must address the structural drivers and expand access to comprehensive combination prevention, including comprehensive sexuality education, condoms, anti retroviral based prevention technologies.
Long acting HIV prevention innovation offer real hope, but realizing their immense potential depends on how fast we move from pilot programs to scaled routine delivery.
This means integrating this long action option directly into the family planning, maternal health, and sexual protective health services that women already trust.
This is particularly urgent for pregnant and nursing women.
When we fail to support mother during this critical window, the consequences extend to the next generation.
Around 120,000 babies are still born with HIV each year.
About 24,000 are infected because their mother acquired HIV while pregnant or breastfeeding.
A further 19,000 cases occur when an HIV positive woman is unable to keep up antiretroviral treatment during these critical periods.
All of these can be prevented.
These figures remind us that we cannot end AIDS without closing the prevention gap for women and girls.
Long acting pre exposure prevention can help close that gap, but only if we can ensure equitable access and integrate it effectively within the services women already use.
Third, technological innovation is critical, but not sufficient alone.
How we deliver care matters as much as the tool we use.
We have so much new medicine and yet if you can't access it or not allowed to use it, you can't enjoy the benefit of it and protect yourself.
This is why integrating HIV prevention into comprehensive sexual aro health services and primary health care is imperative.
In an environment where health workers are stretched thin and resources are tight, running silo delivery system is unsustainable.
In fragment care drives up costs and fade the very people we need the service most.
Finally, national ownership is key.
Sustainable prevention require robust health system, strong partnership, increased domestic financing, and true national sovereignty.
Communities are at the heart of this.
The power to reach people other, miss and demand quality care is the ultimate cornerstone of accountability.
Although this is a global issue, today, the highest HIV rate is on the African continent.
We know that African countries are full partner in this fight and at the Global Fund aid replenishment, African countries pledge over 51 million, including a $36.6 million public private commitment for South Africa to support HIV prevention.
While global and domestic investment must continue to grow, these pledges mark a profound shift toward shared responsibility and long term national leadership in sustaining the HIV response.
Excellency, dear colleagues.
We have unprecedented opportunities before us.
Science is advancing.
The evidence is clear, the tools exist.
The question now is simple.
Will we match this moment with political will to deliver them equitably and at scale? The response should be absolutely yes.
We shall invest in the right resources, human, financial, and supplies.
UNFPA stands resolute in our commitment to government, community, and partners to drive an HIV response rooted in human right, gender equality, and national ownership.
Together, we can transform the HIV prevention from an aspiration, as Win rightly said, into an undeniable reality for everyone everywhere.
I thank you for your kind attention.
There are many themes you will hear repeatedly of integration of sustainability, of equity so that for everyone everywhere, the end of the epidemic is true and possible.
Thank you so much, doctor Quita, and you set up the next presentation so well because as much as we need global leadership and luckily we have both of you here, if it doesn't happen at the country level, it doesn't happen.
And I can't think of a country that has demonstrated that and political commitment that was on display two weeks ago with the launch of injectable La Capr than what came from President Ramposa and administer of Health Masoledi.
I want to thank you personally.
I want to state in this room and every room that you lead a free and fair and democratic country, no matter what my country might say some days.
I welcome you here to hear what you are thinking in leading the largest HIV program in the world and one of the most innovative.
Thank you very much.
Thank you very much Chairperson, Excellencies, colleagues and partners.
South Africa appreciates the opportunity to contribute to this important dialogue at a pivotal moment in the global HIV response.
While scientific advances have transformed HIV into a manageable condition, inequality, financing pressures, and fragile health systems continue to threaten hard won progress.
South Africa car is one of the world's largest HIV burdens, but also one of the largest treatment programs.
Our experience show that what is possible rather at scale.
We align fully with UNH global AIS strategy 2026 2031, recognize that ending AIDS as a public health threat by 2030 requires strong country ownership, domestic leadership, and alignment with shifting financial landscape.
South Africa has made significant progress in HIV testing, exceeding 20 million tests annually over the past three years and achieving the first 95 target with over 96% of people living with HIV now knowing their status.
This provides a strong foundation for prevention.
Importantly, South Africa funds the majority of its HIV response.
Over 75% through domestic resources.
However, we acknowledge that historically, most of these funding supported treatment while prevention relied heavily on external partners.
As global funding shifts, we are acting decisively.
We introduced emergency funding to stabilize services during 2025, 26 financial year.
We are integrating prevention into domestic budgets over the medium term.
We are re engineering our health system, strengthening primary health care and its financing to prioritize primary prevention.
For adolescent girls and young women, this group remains at the highest risk.
We are integrating comprehensive prevention into clinics, schools, and over 2,500 youth friendly civic sites.
We are absorbing previously donor funded programs into national budgets, expanding digital platforms, and have recently introduced long acting prevention options as part of a combination prevention approach.
For key populations, We are integrating services for sex workers, LGBTQ, IA plus communities, and people who use drugs into primary health care, ensuring continuity of care, despite declining donor support.
We are strengthening data systems and exploring sustainable financing models to support long term delivery.
On our condom programming, South Africa maintains the world's largest public sector condom program, distributing over 1.5 billion male condoms and 50 million female condoms over the past three years with over 600 million South African rents, that translates into $35 million invested in the 2026 financial year.
For adolescent boys and males, voluntary medical male circumcision.
South Africa has performed over 7 million voluntary medical circumcisions since 2010, with over 800 million that translates into $46 million invested in the 25 26 financial year.
This program is now being integrated into broader men's health services, ensuring sustainability and cultural alignment.
On pre exposure prophylaxis and innovation.
We are expanding access to oral prep and introducing long acting options such as linear capavl.
We are positioning prevention technologies with routine health care, focusing on choice, accessibility, and system readiness.
South Africa invested 1.8 billion South African rents.
That is $105 million in HIV prevention services in 25 26, covering post exposure prophylaxis, oral pre exposure prophylaxis, and HIV TB integration.
This investment is in addition to the condom and voluntary medical circumcision program budget.
Colleagues, South Africa does not see the current global transition as a crisis, but as an opportunity to an HIV prevention within sustainable country led systems.
We also call for increased partnership and strengthen multilateral financing mechanism because prevention is the critical pillar in ending AIDS by 2030.
We remain committed to a people centered, integrated response.
We are increasing domestic investment, prioritizing prevention and leveraging partners for innovation and scale.
We call on all global partners to move beyond traditional donor recipient models towards GenEco investment, mutual accountability, and sustained shared responsibility.
To by strengthening country leadership and protecting prevention.
We can and we must achieve our shared goal of ending AIDS by 2030.
I thank you.
Minister Mazoleti, thank you so very much.
I love the fact and I wish everyone with funding would use the word investment.
It's not a donation, it's not charity, it's not assistance.
It's an investment.
And you've demonstrated that in your actions and in your words just now.
So thank you very much.
We next turn to a regional perspective and I will say when one looks back on global health and obviously disruptions of the last year, when you look back on the last seven or eight years, the development and establishment of the African Centers for Disease Control and Prevention, the Africa CDC will be remembered in history as one of the shining examples of what happens in the midst of thinking about national and regional sovereignty and leadership.
I'm delighted to welcome doctor Claude Kmengo who leads the executive office and is the chief of staff, representing doctor Jean Quisea, the head of the Africa CDC, to provide input into the Africa CDC's role in the midst of everything else it's doing on the continent, which I know is a great deal right now, and we're grateful that you were able to make time for HIV prevention.
Thank you, moderator.
Allow me to stand on the established protocol, ladies and gentlemen.
I'm very honored to join you on behalf of the Director General of Africa CDC, who would have loved to be here this afternoon.
But as you know, with the ongoing Ebola outbreak in DRC and Uganda.
He had to travel yesterday to the DRC and he's currently in Bunia.
So he sends his greetings and he's with us in spirit here this afternoon.
I recognize member states, communities, partners, and advocates working to deliver the HIV prevention ambition.
In an OPD published this morning in the Guardians in support to the Common African position, written by the Director General of Africa CDC, together with the African Union Commissioner for Health, Humanitarian Affairs and Social Development, the message is clear, Africa must end aids on its own terms.
The Common Africa position on HIV is Africa speaking as one through member states, institutions, experts, and communities on what it will take to finish the job.
This vision is grounded in continental leadership.
In February of this year, African Heads of State endorsed the Africa Health Security and Sovereignty agenda as the continent's Framework for Health Transformation.
This agenda is championed by African heads of state across pandemic preparedness, local manufacturing, human resource for health, community health, and maternal and child health.
It is leadership translated into action.
Recent outbreaks, especially the ongoing Bundibugyo Ebola outbreak, have taught us the same lesson.
When health emergencies strike, Africa cannot depend on distant supply chains, delayed commodities and goodwill alone.
The continent must be ready to make, move, and deliver the tools that keep its people alive.
The fight to end it rests on the same truth.
Africa has made extraordinary progress.
Millions are alive today because treatment was scaled up.
But we must be honest.
We will not treat our way out of the epidemic.
Treatment saves lives.
Prevention stops the next infection.
To end AIDS, we must do both at scale.
This is why the 40 plus 20 agenda matters.
It connects sustained treatment and virus suppression with the urgency to expanding effective prevention options for 20 million people by 2030.
For Africa CDC, three priorities are clear.
First, prevention must be country led and financed to last.
It cannot remain an externally funded project.
It must be built into national budgets, primary health care, universal health coverage, and social protection systems.
Ministries of Health and Finance, must plan together while partners aligned behind one national plan, one budget, one monitoring framework, and one shared accountability for result.
Second, prevention innovation must become prevention access.
Then Nakapa V could change the prevention trajectory for millions, but only if it's affordable, procured through African bargaining power and eventually supported by African production.
One of donations will not build the prevention future Africa needs.
Through the African Pol Procurement mechanism, the African Medicine agenda, regulatory harmonization and local production, Africa CDC is helping turn scattered demand into continental bargaining power and shorten the path from science to delivery.
Third, prevention must be rooted in communities and resilient systems.
The AIDS response is one in clinics and communities, not in communities.
Young people, women, people living with HIV, key population community organizations must shape prevention choices from the beginning.
HIV prevention must be integrated into resilient primary health care systems, supported by country own data, community led monitoring, and accountable institutions.
Global solidarity remains essential, including from PEPFAR, the Global Fund, and the Fit for purpose UNAIDS with its co sponsors.
But solidarity must not Solidarity must now support Africa leadership, systems, and production, not perpetuate dependence.
The prevention ambition is achievable, but Africa's HIV prevention future cannot be donor dependent, import dependent, or community blind.
If we act with urgency, Africa can turn prevention innovation into prevention impact and help us get closer to ending AIDS by 2030.
I thank you.
Thank you, doctor Kminga.
You brilliantly said and your three point plan is spot on, and I'm particularly excited by the third point because it's the perfect segue and with the greatest respect to heads of UN agencies and a Minister of Health and a chief of staff at the Africa CDC, if we don't center communities, As we did not early in this epidemic, we don't achieve that impact.
We don't translate that promise into actual impact.
I am thrilled to welcome not the most important person on this table, but certainly the most important perspective.
That comes from a dear friend and colleague Lillian Benjamin Wkosse from the United Republic of Tanzania.
Lillian runs an organization called Dare based in Tanzania, is also a member of the African Women's Prevention Community Accountability Board that has become a driver of African Women's Voices for Prevention, and I will also say a former AVAC advocacy fellow.
Before you go, Lillian, I'm also going to introduce the gentleman to your left, Mahesh Hellingm who is the chief of staff at UNH, who after Lillian, is going to take us through a panel discussion.
But Lillian first to you.
Yes.
Thank you so much, Mitchell.
Protocol observed, a very good afternoon to you all.
From the communities their organization serves every day.
I want to bring to you a voice, something that possibly data cannot capture, the voice of a young woman in the Doma region in Tanzania, who knows prep exists.
They have heard about long acting HIV prevention options and still to date cannot access any of them.
She's not an outlier.
This is the case for many young women in Sub Saharan Africa.
As already said by many speakers today, we are at a time where we have prevention tools, the most actually range of HIV prevention tools ever in the epidemic and yet lived experiences show that product availability does not necessarily equal access where we're failing.
For women and girls that we serve, the gap between what exists and what is reachable is filled with several barriers, some of which include stigma at facility, in their homes, in their communities.
We have policy barriers in terms of access, age restrictions, regulatory delays.
We have affordability issues which have been mentioned in terms of at individual level, but also at national level.
We have seen how recent funding cuts have exacerbated our access to prevention services.
But also we have weak delivery systems that also equal stockouts and facilities are not friendly enough to cater to the needs of girls and women.
These collectively lead to absence of choice, which is really central to HIV prevention, a prevention method a woman can use on her own terms, and these issues or barriers that I've mentioned are not peripheral.
They are the reasons we are not able to date to achieve some of the targets we continue to set.
The few asks, I'm going to present to you are not new.
It's what communities over the years have been demanding for and very loudly.
One of them is centering HIV prevention in choice, making sure that we have access to genuine, rights based, non judgmental prevention options that fit our diverse needs, bodies, life seasons, and realities without affecting the quality or comprehensiveness of services.
Second would be on community leadership.
We are not just beneficiaries of prevention programs.
We are the most effective delivery platform you have.
Only if you fund communities, trust communities, and give communities seats at the tables where decisions are made.
When we bring solutions to the table, implement them because the gap we have at the moment between our proposals and your action is exactly what makes the epidemic thrive.
Then additionally, I would add meaningful engagement in research and innovation that extends beyond trial phases and make sure that these trials eventually translate into affordable, accessible products equitably.
And additionally would be accountability that goes both ways at community level, but also from our leaders with data transparency and community monitoring that is real and not performative.
For context, I've been in the HIV advocacy space for a while now.
It's been exhausting for me, particularly to share the same same things in terms of recommendations and what we have been asking for.
But I remain hopeful today that this room listens So I believe the four plus 20 ambition is achievable, but only with deliberate intentions to remove the barriers that keep prevention out of reach for communities to our country leaders, invest in our community led delivery, domestic resource mobilization, remove policy barriers, and we know you can do that and bring communities into implementation architecture.
This time around not just as beneficiaries but experts and partners to partners and finances in the room, invest in community organizations where possible directly, flexibly, and at scale, bearing in mind, trust takes longer to build than a grand cycle.
Last but not least to everyone in this space today, we all have the building blocks.
We have the tools to end this epidemic.
What is missing as saved by my colleagues is the political will to center the people the targets are supposed to reach with urgency because until we find it, we will keep gathering in rooms like this one, making the same commitments and wondering why the results don't change.
Thank you so much.
Thank you very much, distinguished panel, for your interventions.
We'll now move to the second part of our panel discussion today.
As I invite the panel members to come on stage, may I take the opportunity to invite His Excellency Charles Masole the permanent representative of Botswana to the United Nations in New York to say a few words, please.
Your Excellency.
Thank you, moderator.
Honorable Ministers, the UN A's Executive Director, and other distinguished discussions.
We've heard very powerful messages from our political leadership and our institutional leaders on the HIV response.
As Botswana has indicated in my plenary remarks, Botswana stands as a global leader of what is possible, having suppressed U Oh Quentin.
Can His Excellency, get the microphone, please? Thank you.
I went on lunch.
Okay.
Yes.
I know that we had had very powerful messages from our political and institutional leaders on our HIV response.
As Botswana, as I indicated in my plenary remarks, Botswana stands as a global leader of what is possible, having surpassed UNAIDS 905-90-5905 target ahead of the 2030 deadline.
Currently, over 37% of people living with HIV in Botswana know their status.
95% of those diagnosed are on sustained antiretroviral therapy, and 95% of those on treatment are virally suppressed.
Botswana has effectively rewritten a new positive narrative on the elimination of vertical transmission of HIV, making Botswana a pioneer of an AIDS free generation.
We recently achieved a prestigious or the prestigious WHO gold tire certification for the elimination of mother to child transmission.
Botswana's aggressive combination prevention strategies have yielded a massive drop in incidence, lastly, largely fueled by robust domestic political willpower and resources.
Botswana has achieved a 96% reduction of new annual HIV infections since 2010.
We are on track, and we are proud of our achievements, but we have not yet reached the end of age and achieve will not stop until we do so.
And I thank you.
Thank you very much, Your Excellency.
We have a distinguished panel in front of you, but the biggest challenge that this panel places is time.
We have a hard stop in another 18 minutes, so I will dispense with all the formalities and first straight go off to Amira and ask her to tell us in 2 minutes what are the barriers that face prevention programs in Latin America.
Please kick us off, please.
2 minutes.
I come from Ecuador.
Press the white button, please.
I come from imidina, Ecuador, an NGO with search services in all the country and also in a regional platform between different countries of Latin America, giving healthcare, community health care prevention combination the main barriers are the political will.
Because we as countries, our challenges are not the macroeconomic indicators, but the inequity.
As I say, the political will is the integration between countries to give a comprehensive response and to maintain the communities in the center of the response.
What is happening is that the services are seen as the offer of services and not the reality of people, the center in people's needs, in people's local realities.
I think that is one of the main challenges.
The other challenge is that in reality, Latin America in the last 18 months has a No more almost 40% of the cooperation and our mortality rate continues to not be controlled.
What is happening in that situation is that coordination between the state, the community.
The external cooperation is a need.
All of us know that we are in the mile in the last kilometer, but people are dying of AIDS, people are dying of advanced disease in Latin America, we don't have a very good information, and we are very concerned about the changes that are happening.
For example, in the UN system with UN AIDS.
Really for us in our region, we see that gap that is existing with this decline of the presence of units are affecting a lot.
The governance, the community governance, the social participation, the presence of the voice, and the decision of the communities.
We are asking also that for the multilateral cooperation, what we are doing a Together, what are we going to do together with the UN as well to assure the community voices and the community decisions? Thank you very much.
Our next speaker is Mar Win Rock from the Global Fund.
Maria, I will put my question in four words.
GCA prevention? How much are you going to invest? I use a little bit more than forwards to answer that one.
Anyone who following the global fund has seen that over the last couple of months we've worked with a lot of partners and countries to support the implementation, the introduction of aka in many countries.
The first time that the new tool is being rolled out in low income countries at the same time as high income countries.
I really would like to commend the countries for making the necessary preparations.
Though Minister Moteledi has been very active in that, but also all the partners who supported that.
Then a couple of new tool also have given new energy to the HIV prevention agenda.
But a single tool will not end HIV.
We must look holistically across health and HIV, support national responses that are really tailored to the local epidemiology and evidence based.
So TC eight is just launched.
We have the first window of TRP starting today, and we really encourage countries to invest in holistic HIV prevention, which does include differentiated HIV testing, prep, all sorts of prep, not just a cup of beer, harm reduction, condoms programs, community and KP programming, and interventions to reduce human rights barriers to access.
We know in all of these areas there's big gaps and countries have to make those decisions in a situation that's economically very constrained and that supporting countries making those tough decisions really requires the full partnership to come together.
The global fund is ready to continue working with the Global Prevention Coalition and all its partners on this topic and to turn the prevention ambitions into measurable deliveries and outcomes guided by country ownership and leadership and in the definition of the global fund, country ownership is not just the government, it includes civil society communities and all the stakeholders at country level and increasingly funded from domestic financing because we've seen that the heavily reliant on external funding makes those programs at high risk, and we've seen the playing out over the last couple of months.
We fully support the 40 plus 20 agenda.
For us, that's not just a target setting exercise.
It's a real test of the partnership that we are able to deliver.
Thank you.
Thank you very much.
Mark.
I'm glad everybody is supporting me with the time limit as well.
Our next speaker is Deputy Executive Director Nari.
For you, ma'am, the question is what needs to change to respond to the realities of adolescents and young women and girls.
Thank you.
Thank you so much for this extraordinary moment.
I think it's both what needs to change and also what is great, which has been happening, which needs to be scaled up.
That is not just about change.
First, it's about leadership.
What I see in this room is leadership.
That leadership which dares to sustain the discussions, whether it's the commitment to gender equality in the high level political declaration, or it's the commitment of the Sadac resolution, the Commission on the status of Women on HIV women and girls, or its honorable Minister from South Africa, whom we hear all the time and you sustained the conversation on community, or it's really the co facilitators standing and working late, or it's you, UNAIDs executive director, my sister Winnie there.
And a team really positioning the issues of women and girls.
But leadership that is also about communities themselves.
We must scale up that which we've learned from COVID and which we learned from HIV community systems deliver prevention.
And that leadership is important.
Secondly, is data.
We need the numbers, and that behind every number is actually the real life that is experienced by women and girls.
Data is very important, and we've seen that whenever we mention immortality, actually, we are talking about a woman dying, we are talking about bearing, we are talking about leaving children, we are talking about really community loss the data on people living with HIV, their human rights situation, and also the trends that we very important and that requires coordinated work and investment within our data system.
Steadly is around affordable, accessible, and friendly services, Services that target young people in a strong way, we've heard the young leader from Tanzania say that very eloquently, that we need services that also address issues of mental health.
Mental health, child marriage, and which addresses the multisexual approach.
The services discussion should not be linear.
We must sustain the multisexual approaches that we have as we provide services and fourth, it is critical and must violence against women.
Violence against women is a mast it's critical.
We are talking about a little girl who presents a young woman, presents herself at the hospital, is tested for pregnancy, she's pregnant.
She's tested for HIV, you are positive.
Bring your partner, the partner is the rapist.
Go home and bring your relatives or your parents or somebody because you're a child, but it might be the same environment that also is part of colluding to the situation.
When we talk about young women and girls, we need to understand the complexities.
Three other quick points in the c resources.
The security of any nation is when its people and its young people are healthy, are educated, have jobs.
The security of a nation is not its military power, it's the well being of its people.
When it comes to resources, really my members, our member states, our governments, our people, our partners, we can reduce military expenditure.
The trillions in military expenditure and invest in healthcare.
Every government can do that, buy one helicopter less, one drone less, and put those resources to healthcare services because that is where the future of prevention lies, and this is very important.
Equally to the ministries Our Ministry of Economy, Finance, we can plug the leakages in our economy, and those savings can actually support our public services.
This is also so important so that it's not just a distribution of what is available, but it's also a mobilization.
I'm very excited about CDC and the Africa position of using the resources within the continent.
Last Mechanisms matter.
We spend a lot of time, good time with our member states and us in the UN these days talking about UN reform.
As UN women, we are very clear as we commit to continue to sustain the work that restructuring the way we deliver, redefining our means of delivery is not equal to deprioritization of gender equality, young people and women's rights.
It's not the same.
Therefore, as we move forward, we are committed to continue to uphold the UN system, the General Assembly, EcoSok and other institutions that have committed to gender equality to women's rights and to the critical issues of the empowerment of women because inequalities lie at the heart of the HIV response that we have, and therefore, each one of us can take the necessary measures to find solutions.
I invite you to CSW 71 and for us to continue the conversation.
Thank you very much.
Thank you so much.
I do have 3 minutes, so I'm going to ask each one of you to outline and possibly two or three sentences one practical action that one can take to make the targets of 40 plus 20 a reality.
Monica, can I start with you first? I would have liked to have a heads up on that.
I think it's really important.
You heard it very clear from Minister Motuili Claude from the Africa CDC that it's really about working with countries to increase domestic resources for health and reduce the reliance on external funding because that's going to remain very critical.
Thank you.
Amira.
Yes.
It's important for us that a civil society, we cannot hold the line alone.
We urge governments and the international community to ensure care continuity, accelerate access to new health technologies, including long acting ARVs, and defend the rights of key populations and sexual and reproductive rights.
Our communities do not seek charity.
We call on government to fulfill their role as guarantors of rights through evidence based actions, sustained financing, and the courage to stand with the most left behind.
Thank you so much for those powerful words.
Nada, any last words from your end? When we empower young women and girls, when we secure their rights and they have access to services and opportunities, we unleash the greatest potential of our nations.
Therefore, let's have the leadership of young people, the leadership of communities, the leadership of women at the center of the prevention agenda.
As we prevent HIV, as we prevent violence, we are also building stronger communities.
Thank you very much.
Thank you very much.
On that note, may I invite Michael from the Global Black Men Game and Connect to close us off with the closing remarks.
Michael, over to you.
Thank you.
I'm going to try to speak with you slowly like Mitchell did at the beginning.
From a CSO perspective, I would like you to leave this room with three messages.
First, community leadership matters.
Every successful HIV program has communities at its center.
We cannot exclude communities from the response and expect to end the AIDS epidemic.
Second, while preventive opportunities are expanding, key populations are becoming less visible, missing data, shrinking indicators and anti LGBTQI laws, and the absence of clear targets are making it harder to measure whether prevention is reaching those most affected by HIV.
Third, we cannot reach preventive prevention goals without funding the response.
Funding key population prevention programs should not be a choice.
It is a necessity.
We need a key population fund now.
As countries move towards integration HIV services into broader health systems, let me say this clearly.
There cannot be integration without reconstruction.
We cannot dismantle community health system before investing in what comes next.
Integration must strengthen community responses, not replace them.
As a teenager growing up in Nigeria, one of my first experiences seeking sexual health services came when I believed I had contracted STI.
I went to a government healthcare facility looking for testing and support.
Instead of receiving services I needed, the healthcare worker called over several colleagues and what followed next was a conversation about me looking for Jesus and finding God.
Instead of providing what I needed for me, they gave me Bible and pamphlets.
I shared the story not criss government or healthcare workers.
I shared because it taught me an important lesson.
For many key population, access to health care has never simply been about whether services exist.
It has always been about whether those services are safe, trusted, and capable of reaching people without judgment, fear, or exclusion.
This is why community leadership matters.
Much of the progress we celebrate today happened because communities build trust, generated demand, challenged stigma, trained providers, and rich people whom public health system often struggle to reach.
Let me be honest, many of the people who carried these responses for decades are community health care workers, peer navigators, outreach workers, and activists.
They know the communities.
They know where people live.
They know why people do not come to clinic.
We should stop treating them like volunteers and start recognizing them as health care professionals.
Communities are not coming to this conversation empty handed.
Vet Rafael will tell you that young people from South Africa are ready right now.
Midnight who is in the room actually from Asia will tell you that Asia has been ready, especially populations has been ready to roll out land for a long time.
My sister Erica will tell you transgender communities from Latin America to Africa to Asia have been ready for years.
What they need now is simple.
Counters, includes, and funders.
That is why I am alarmed at the very moment where prevention opportunities are expanding, key populations are becoming less visible.
It is one message I hope you take away today.
It is that a prevention ambition that cannot demonstrate impact among key population is not yet complete without prevention ambition.
We are talking about today or many prevention options.
It is one of the most exciting prevention opportunities many of us have seen in our lifetime, but N is not the end of the story.
There are other prevention options in the pipeline.
Science is moving faster than ever before.
The question is not whether innovation is coming.
The question is who will benefit from it? Who is selfish enough or who is willing enough? If we are successful in reaching 3 million people with globally, how many of them are those people are key population? How many are gay men? How many are sex workers? How many are transgender people? Because if we cannot answer these questions, then we are not ready to end AIDS.
Today, I'm calling UN AD, the Global Fund, Gates Foundation, Gilliad, government and all partners Support Prevention scale up to tell me what is the target for key population.
We have 40 20.
I am saying we need a five.
We need five to be added 2040 as well for key populations.
I'm winning, please, I beg of you, we need the KP target for prevention because it's only if you set target for us that our governments see us seriously and take us seriously.
That's the only way government will look in their country to set target because if you say they have target, they would not do anything.
I can tell you that if we don't have a global target for key populations, countries will not take prevention options forward for key population.
So we need a 20, a 40, and a five for key populations.
Thank you.
Thank you very much, Michael.
Very clear.
Give us key population targets.
As communities, we are ready.
Therefore, let me close with a few points.
The prevention ambition of 40 plus 20 will not be delivered by the health sector alone, but it will not be delivered by products alone.
It will require country leadership, community trust, multi sectoral coordination, and delivery systems that can reach people where they are.
For that, we count on your support.
Thank you all for coming and thanks for being here with us today.
Thank you.