WITH Africa, IN Africa: Ensuring Access to Life-Saving HIV/AIDS Treatment

Ladies and gentlemen, Excellencys distinguished colleagues and those who will be joining us on UN web TV.
It's my great pleasure in my capacity as permanent observer of the Sovereign Order of Malta to the UN and as co sponsor of this important event to welcome you today to this discussion on ensuring access to lifesaving HIV treatment in Africa.
I'm honored to join this distinguished panel on the margins of the General Assembly's high level meeting on HIV AIDS, and I extend a particularly warm welcome to the ministerial representative, experts, and practitioners and partners who have gathered here today.
I would also like to express my sincere gratitude to our co sponsoring delegations, the permanent missions of Dibbouti, Eswatini, Germany, Malawi, and San Marino.
As well as our colleagues from UN aides for their invaluable support and commitment.
The story of global HIV response is in many ways, one of humanity's greatest public health achievements.
Through scientific innovation, political commitment, community leadership, and international solidarity, millions of lives have been saved and transformed.
What was once considered a death sentence for many has now become a manageable condition.
And for millions of people, particularly across parts of Africa and other highly affected regions, access to lifesaving anti retro viral treatment remains uncertain.
Fragile health systems, funding constraints, conflict, persistent inequalities, and the enduring stigma surrounding AIDS continue to interrupt treatment pathways and place lives at risk.
At a time when humanitarian and developmental priorities are under increasing pressure and resources face growing uncertainty, and in light of the demands of the military industrial complex, there is a real danger that the hard won gains of recent decades could stall or even be reversed.
We cannot allow that to happen.
And this is why the theme guiding our discussion today with Africa, in Africa is so important.
Sustainable progress cannot be built through temporary solutions or distant disinterested decision making.
It must be shaped by the leadership, expertise, and respect for the priorities of African countries, healthcare workers, communities, and people living with HIV themselves.
International partnership remains indispensable, but true partnership means listening, accompanying, strengthening local capacity, and ensuring that all those closest to the realities on the ground will help define the path forward.
The sovereign Order of Malta has long sought to uphold the dignity of every human person as a God given gift, especially those who are vulnerable, marginalized or suffering.
We firmly believe that access to health care is not merely a matter of service delivery, it is an affirmation of human dignity and solidarity.
With the tools, knowledge, and the treatments available today, countless people living with HIV can lead healthy and fulfilling lives.
No one should be denied that possibility because of where they live, the resources available to them, or the stigma they continue to face.
Let us, therefore, renew our collective resolve to protect and to grow the progress that has been achieved, to strengthen resilient health systems, to support community led response, and to ensure that access to treatment remains uninterrupted for all who depend on it.
In doing so, we reaffirm a simple but profound conviction that every life has equal worth and that our shared humanity calls us not to indifference, but to action and love.
I thank you for your presence and engagement and now I have the pleasure of handing over to our moderator for this panel discussion, miss Sandra Thurman, who I will say, as by way of introduction, is one of the leading persons in the fight against AIDS globally.
Among her many credits was her work as the Chief of AIDS work and projects during the Clinton administration.
A mission that she has continued through her career right up until this very day advocating for health care globally for those who are in need and who cannot always access it.
Cindy.
Yes.
Thank you, Mr.
Ambassador.
I so appreciate that and welcome to all of you gathered today and those who are joining us on UN TV.
This is a great pleasure and I have to say that we have been very fortunate to gather together some of the leading experts in HIV and AIDS to share their perspectives with you today and I'll introduce them each as they begin to speak.
But I want to first introduce doctor Angelie Astracher who is the Deputy Executive Director of UN AIDS.
She has been doing this work for many years.
She's had leadership positions at the State Department and at the Centers for Disease Control and Prevention, but more than that, she's a very dear friend.
She will help us put this in perspective as we all begin to share some of our particular experiences and progress and challenges in bringing HIV and AIDS as we know it to an end.
Angelie, will you give us some perspective, please? Absolutely.
Thank you.
Good afternoon.
It's great to be with you all Excellencies, colleagues and friends, I really, before I begin, really want to pay respect and thank you to the Sovereign Order of Malta, Dibouti, Eswatini, Germany, Malawi, and San Marino for convening this important discussion on HIV treatment.
To put things into perspective from a global level and then a continental level, HIV treatment is one of the greatest public health success stories of our time.
Two decades ago, more than 2 million people were dying of AIDS each year.
Three quarters of them were in sub Saharan Africa.
Today, millions of lives have been saved through expanded access to treatment and AIDS related deaths have fallen to their lowest level since 1990.
What we know now is that more than 32 million people are now on lifesaving treatment globally, and that treatment coverage in sub Saharan Africa has reached 83%.
These are data that UN AIDS works with countries to gather, disseminate, to really help continue to guide where the investments are going.
These gains demonstrate what is possible when political leadership, community action, data, and sustained investment have come together.
These gains are possible because treatment works.
It saves lives, it restores health, prevents new infections, keeps families together, strengthens communities, and enables people living with HIV to lead long productive lives, supporting economic growth and development.
Sustaining this progress requires a long term vision.
As countries across Africa continue to grow economically and strengthen their health systems, the HIV response must become increasingly resilient, nationally owned, and sustainably financed.
HIV services should be integrated into broader health systems while maintaining a strong focus on equity and results.
I do want to emphasize the important gaps, however, that remain.
We know that nearly 9 million people living with HIV are still not receiving treatment.
Many of these people that are still in need of treatment are children, men, women, members of key populations, and other marginalized populations.
Reaching these populations is both a public health and an ethical imperative.
Every person, regardless of who they are or where they live, should have access to that lifesaving HIV treatment and HIV services.
So as member states consider the next phase of the global AIDS response, we must remember that to date is still no vaccine or cure for HIV.
We have to make sure that we work together to close those treatment gaps and ultimately make certain that all 40 million people living with HIV have access to lifesaving treatment.
Africa's experience, and I know we'll hear on the panel today, Africa's experience has shown that progress is possible even in the most challenging circumstances.
The task now is to build on that success to the end with stronger domestic leadership, sustainable financing, empowered communities, and continued international solidarity.
If we do so, we can indeed both protect the gains of the past two years and also work to end AIDS as a public health threat for everyone everywhere.
Thank you.
Thank you.
Thank you so much, Angelie, and thank you for joining us today in particular.
I know you have a pretty extraordinary schedule in the last couple of days, so thank you for that.
Let me next introduce Father Gerhart Lglater, is that correct? I think I hope I didn't butcher the last name.
I always worry about that.
I It was president of the Order of Malta Brotherhood of Blessed Gerard in Madini, South Africa, which is about an hour north of Durban.
It's a premier nonprofit community development and AID relief center operated by the Sovereign Order of Malta, established to combat the high regional HIV and AIDS rates over 60% in some areas and higher than that when Father began, I think.
It provides comprehensive care, including a hospice antiretroviral treatment and a children's home for orphans.
Father? Thank you, Madam Chair, Distinguished guests and distinguished members of the House.
Can we start the video? There we are.
The Brotherhood of Pled is the relief Organization of the Order of Malta in South Africa.
It was founded.
It was founded in 1992 with the aim to organize the charitable work of the Catholic Church in the Greater Madini area properly.
We are the South African Public relief benefit organization, and we serve the needy irrespective of their creed color of skin, sexual orientation, and political affiliation.
We serve an impoverished community and have to finance our work entirely through grants and donations.
We are named after Blessed Jerod, the founder of the Order of Malta.
Now about our HIV treatment program, about AIDS treatment program as heart program.
We started.
We started in August 1995 with the groundbreaking of Pleser Geir Care Center, which later on housed the AIDS treatment program.
Drum magazine was talking about our area as Death City, the AIDS capital of azulu Natal.
We had in January 2004 76% of HIV tests positive.
Of course, people only go to a test if they feel sick.
But anyway, it was a pocket of high infection rate.
We opened the care center in 1996, we expanded our services to provide compassionate inpatient care.
Home nursing home care, we have 120 250 palliative care patients which we could visit in their community, social support and care for the community in their problems.
Can you Sorry for that.
Now, there we are.
And we have children's service, which means we look after not only AIDS orphans, but other children who are in need of care.
You remember the first AIDS conference which we had in 2003? The BBC came and did an interview with us.
Doctor Aanderaluba said, He was worried about administering drugs and support and monitor and outreach.
What we did is we accepted the challenge within nine months and had developed and launched a treatment program which did exactly that.
In August 2003, the South African Cabinet instructed the Department of Health to develop a national ARB rollout plan.
We prepared for retroviral therapy.
In September 2003, we were invited by the H desk of the Southern African Catholic Bishops Conference to participate is a pilot site in the planned Catholic antiretroviral treatment program.
The South African Cabinet approved the operational plan for comprehensive HIV and AIDS care management and treatment in November 2003.
Lionel Charlie, the uazulu Natal Premier, visited our care center in December 2003 and publicly recognized our program.
The professional milestones in training, our management, doctors and the nurses involved in the program were trained through the Foundation for Professional Development in HIV AIDS management and advanced training in ante viral treatment we got from the Southern African HIV Clinician Society.
The official launch of the hospice and heart program was on the 1st of April.
The program included counseling, HIV testing, treatment, training.
Treatment of opistic infections, antiretroviral treatment, blood monitoring, adherence support, and home care.
The heart program became the third Catholic heart program in the whole of South Africa.
It is one of the flagship South African Catholic Bishops Conference, AIDS relief treatment centers and became a model site for the community based HIV care, adherence support, and antiretroviral treatment delivery.
Let's Next.
The ITV interviewed, can we go back? Okay.
Then we carry on next.
In June 2004, we held the first preparatory course held for clinical personnel and AIDS treatment patients about highly active anti viral therapy for the provincial hospital in Sanger.
We are proud that we as an NGO, we are helping the state hospital to start their AIDS treatment program because we had the experience and we had the programs developed.
We had in July 2004, the first heart readiness course.
Which was a four weeks course where we in four steps prepared the patients to take their medication properly.
The first formal heart treatment counselors training at our hospice, we did in July 2004.
In August 2004, we were accredited by the Gazula Natal Department of Health as an intertviral therapy treatment center.
Our first aid patients started intertviral treatment through our hospice in September 2004.
In the same year we came up to 35 patients on treatment and the treatment numbers developed like this graph is showing.
2005 was a rapid expansion phase.
It expanded through community adherence counseling, home visits, and increasing treatment enrollment.
By the end of 2005, we had 70% patients on treatment.
In March 2006, we became a member of the Hospice Palliative Care Association of South Africa, and our patients increased to 105 in 2006.
In 2007, we had 140 patients on HRT.
Strong adherence monitoring systems, increasing outpatient treatment, and extensive counselor involvement reports.
Major extensions were then from July 2007 to 2008, including expanded treatment facilities for our AIDS program.
We expanded Prince Care Center facilities and officially it was opened by Bishop Moleno Cuaro on June 2008.
And we increased our patient number to 159.
We consolidated and had quite a large scale growth in April 2009.
We consolidated our health care projects in AIDS treatment, palliative care center, and poor sick fund, childcare projects, early childhood Development Center, Child and Youth Care Center, malnutrition clinic, and bursary fund, and an emergency fund for people who ran into big trouble and the patient number increased to 225.
In 2010, we were registered as a non profit organization and increased our number to 319.
In 2011 to 2014, we had a very rapid expansion and in 2014, we had a historical peak in our treatment program with 736 patients involved.
2015 to 2020, we had roundabout 700 long term heart patients annually and this program is our largest service which we give as our care center.
COVID 19 period and recovery 2020 to 2021, home visits were disrupted counseling, patient monitoring and transport systems.
But despite this, lifelong treatment continued uninterrupted for 625 patients.
During the COVID pandemic, we distributed 2,180 food packages, and if one package fits for people for 30 days with three meals a day, it is 784,800 food portions which we gave to our heart patients and our home care patients.
Our program transitioned increasingly into long term chronic HIV management.
2022-24, from 615/606 to 584, The recent development in 2025, we reported 547 patients on lifelong heart.
The program continues as an HIV chronic care system as a hospice and palliative care service, and as a community health program.
This year in our current patient number is 544 heart patients on lifelong treatment.
We were first funded from February to August 20, 2004 through Code Aid, and then PEPFAR came in 2004-2014 via the Southern African Catholic Bishops Conference and today we are funded or we get the medication and our laboratory from the Kaag Department of Health.
So we transitioned from emergency relief to public health integration.
The funding transition was successful.
We succeeded to become a mature long term partnership, enter into a long term partnership with the Kuala Natal Department of Health and We must adapt to the new developments.
All know about new injectables, which are going to be a revolutionary help.
The impact on prevention is helped by that and of course, the flexibility of the system.
Next, again, the number of patients and the next slide.
Then we can stop with it.
You may download this presentation on this QR code.
Thank you very much for your attendance.
Thank you so much, Father.
That is an extraordinary program for sure.
Now we want to turn and talk about the prevention of mother to child transmission with Mr.
Oso Osooko how did I do? That who is visiting us from the Ministry of Health and Sanitation in Malawi.
He's a public health professional who is currently responsible for coordinating the HIV program and has previously worked as a program officer in sexually transmitted infections.
Thank you, sir.
All right.
Thank you very much, Chair, for pronouncing the name in a new way for today.
Greetings.
I bring greetings from Malawi, specifically Minister of Health, Department of HIV and Viral Hepatitis.
My remarks today will focus on one of the most measurable test for any HIV program.
Whether a child born to a mother living with HIV is born free of HIV, stays free, attain his or her aspirations of life.
Before I go any further, let me just give you a snapshot as where we are in terms of the HIV epidemiology in Maawi.
So we have an estimated population for about 21 million and then we have around 1 billion people living with HIV.
And out of that, around 900,000 plus people are on treatment, antiviral treatment.
Our epidemic is generalized with some geographical variations.
We have some regions with high HIV paid compared to others.
So our interventions are more targeted in these areas where we have a high HIV paden.
Going specifically to prevention of mother to child transmission, Malawi was a best setter in as far as the implementation of Option P plus is concerned.
Malawi made a board decision in 2011, a couple of years back where a determination was made that each and every woman HIV positive, pregnant or breastfeeding should start antraval treatment without checking even the city for count, irrespective of the CFO count or taking HIV.
We started that in 2011, and so far we have registered a lot of achievements.
2011-2025, we have estimated that we have averted new HIV infections among infants of around 154,000.
New pediatric infections from mother to child transmission fell roughly from around 15,000 in 2010 to about 2165.
This is not mean achievement in as far as the HIV program is concerned and taking into consideration our situation in Miami.
The prevention of mother to child transmission has also a maternal benefit.
If a mother starts ARTA, they are protected from HIV and obviously there will be health and ensure that their infants are raised by their biological mothers.
How did we come up with these achievements? We attribute the successes to some of the bod decisions which Malawi made.
The first one being an integrated testing, HIV, hepatitis, as well as syphilis.
So what we do is bando testing.
If adinal mother comes to a facilitate, we test for these three diseases in alignment with the WHO triple elimination target.
Strong political commitment is another very important aspect in as far as the provision of HIV services is concerned.
We also took on board task shifting, especially the issue of testing.
The testing services in Malawi, I'm talking about HIV specific.
CDs and hepatitis B are done by recorders.
So we trained recorders to be providing testing services.
We call them HIV diagnostic assistance, but nowadays, we need to change the name because they are not only testing for HIV, they are also testing for cephads and hepatitis B.
Most of these people, the HDAs were recruited by our implementing partners.
So you can agree with me that the stopic order, which we all know, affected testing services in Miami.
We also attribute our achievements due to a strong M&D system, including a very strong and vibrant supply chain system.
You cannot achieve if you don't have commodities.
You need to have test, you need to have ant tobado treatment, you need to have all the commodities in as far as the management of HIV is concerned.
At this point, we are formally on the WHO path to elimination.
We have developed a national validation roadmap, and we are targeting the WHO good tire status for elimination by 2028.
We cannot celebrate without GPs.
In as far as the BMCDC program is concerned, we still have GPS.
We are still registering new HIV infections, especially during pregnancy and breastfeeding.
The major cause is the default of mothers on ARB.
That's the major cause of these new infections.
As I've said earlier on, our problem this time around is no longer primary diagnosis, but irritation.
So we are grappling in as far as the retention is concerned.
In some other aspects, these retentions are not real retentions.
These defaulting are not real defaulters because we also have some silent defaulters.
So there are some mothers who get treatment from other facilities without having a formal transfer out arrangement with the original facility that they were getting the ARVs from.
We have not sat back and relaxing.
We are doing something to rectify these challenges that I've talked about.
In terms of retention, we are scaling up defate, people centered, postpartum follow up.
We are also strengthening community health worker support.
Psychosocial and adherence counseling cannot be overemphasized.
We also have programs related to mother infant pair tracking because our data shows that rotation falls from roughly 80% at one year to around 70% by two years.
In terms of the new maternal infections, we are intensifying the repeated HIV testing.
Through that is through pregnancy, as well as breastfeeding.
We are also expanding the testing to the male partners.
We are also strengthening male engagement in as far as the PMCTC program is concerned.
Let me also indicate that Malawi also embraces new technologies in as far as the PMCTC program is concerned.
We started providing HIV pre exposure prophylaxis, of which pregnant women, breasted women are also beneficiaries.
Way back in 2021.
We started small, but I'm happy to say that this time we have grown more than 440 facilities providing prep across the country.
And in 2023, we also started providing long acting prep, that's the carbography through an implementation size study, which is being conducted in collaboration with Georgetown University.
As well as other implementing partners implementing HIV prevention services in Malawi.
We have learned a lot of lessons through this study, and we hope it will inform our future policy direction in as far as the HIV prevention is concerned.
Lately, we have received our first consignment of another long acting injectable prep, that is La Kaavil.
It has been procured by PEPFA through the global fund mechanisms.
So we have done all the preparations, and I'm happy to report that this week, yesterday, the first malaria got a job of La Kavel.
So our implementation will be first targeting geographical areas with high HIV incidence.
Not not ruling out equity as well.
Super thanks.
I'm going to hurry up just a little bit because I want to make sure everyone else gets to speak.
Let me stop there for now.
Is that okay? All right.
Thank you so much.
This is very exciting news.
Um in the spirit, doctor Sybry of hurrying up, I'm just going to introduce you quickly and see if we can move a little faster because I want to make sure we get some time for comments and questions because this information is extraordinary.
Let me introduce you all to doctor George Siberry who's the former chief medical officer at USAID and former leader of the work at the President's Emergency Plan for AIDS PEPFAR and is a an absolutely brilliant pediatric infectious disease doc by training.
George, Very kind of you, Sandy.
Thanks to you and the organizers for inviting me to this really esteemed panel.
I just want to take a few minutes to highlight some of the achievements alongside the gaps in vertical transmission prevention of HIV and pediatric HIV with a proposal that hearing about those achievements will motivate us to be very hopeful about being able to address those gaps.
We've heard a bit already from Mr.
Osituosua about the specific achievements and gaps in Malawi, but this is a more global idea.
So we've gone from 50% ART coverage in pregnant women globally in 2010 to 84% as of 2019.
That's tremendous, the most important intervention to prevent infection in children.
But we've been stuck at that 84% or so level for several years.
And in some places, especially western Central Africa and lower prevalence areas of Eastern and Southern Africa, it's closer to 60%.
That's a gap we can address.
Vertical transmission stood at 25% to even 50% in areas with breastfeeding before ARV and interventions were available.
But by 2024, globally, it was down to 10%.
That's still too high.
What we know and heard a little bit already is over 90% of those infant infections are not due to failure of ART.
It's failure to recognize women who are being infected during pregnancy and breastfeeding, failure to help women stay in care once they've established care in ART, and failure to diagnose and start ART.
Those are things that we can also address.
When it comes to children, We've cut in half the number of children living with HIV from the peak of about 3 million in 2005 to where it is now.
That is tremendous and that is Not only it is mostly due to the prevention of vertical transmission, even at the same time as we have extended survival.
We've cut deaths from almost 400,000 peak in 2002, annually in children to about 75,000 annually now.
But as Angie mentioned, ART coverage, while fantastic in adults, over 80% in many places, lags substantially in children.
It's still 50 to 60% in many places.
In addition, children with HIV saved from HIV by their anti retroviral therapy are increasingly dying of other health problems that could be better addressed.
Another gap that we need to address.
When it comes to children orphaned by AIDS, those numbers are incredible.
There were 1.3 million new orphans in the year 2000 alone.
That was when it peaked.
It went down from there, but we hit a peak of almost 20 million orphans living in 2012, and we brought that down to 13.8 million in 2024.
Children orphaned by AIDS are still there.
They're surviving.
They're older by and large, but they are still there.
But the gap that I want to highlight here is that children are orphaned not just by HIV, they're orphaned by malaria, they're orphaned by violence, they're orphaned by other things that are killing their parents.
An approach in Africa to thinking about how to better address the problem of children orphaned by HIV should also think about how to address the problem of children orphaned by all causes that are prevalent and important there.
Just as we think about a framework then for how to address these gaps, I think it's several areas that are all community driven and community informed.
And they start with making access easier, integrating HIV services into general care services, continuing to address stigma and thinking about innovation.
I'll briefly say testing and treatment is easier than ever now.
So there's no reason we can't do a better job delivering it.
In areas that are not in the big cities or the big clinics.
The workforce in Africa are incredibly experienced.
They can manage this and the ability to deliver through general health care settings means it'll be easier for women and their families to get to their local clinics to get the prevention and treatment services they need for HIV and for everything else.
The integration part of this, this is key.
I think when we separate HIV from the other health needs, it just makes it more burdensome for women and families, for children, and it actually, I think perpetuates some of the gaps that we have.
Bringing them together where you have one place at your local health center that can manage HIV along with the other health needs is, I think the way to really bring down the gaps in ART coverage for pregnant women, ART coverage for children, and to reduce vertical transmission and to prolong survival.
I'll mention two other things quickly, stigma.
Talk about it a lot, but the bottom line is when you talk to people living with HIV, it is still a big problem.
It's a reason they try to travel far to a clinic that has people who don't know them or a reason that they're reluctant to go to clinic at all.
We need to make sure that when we're delivering care, patients are counting on us for our medical judgment, not counting on us to pass moral judgment.
We need to make this just part of the health system, part of what the health system addresses.
Finally, innovation.
These gaps will benefit from innovation like long acting drugs for both prevention and treatment of HIV and how those can be incorporated into general services and integrated services.
We count on our community to make sure that the voices of women and children are part of the discussion about innovation.
Women and children are included appropriately when those are rolled out and even when the research is done, and maybe that's where we count too on the donor resources that we have and the private sector that stands to benefit from selling those products.
A, integration, stigma, and innovation, I think, will get us over those last steps to address those gaps.
Back to you.
Thank you, George.
That was brilliant and very concise, we appreciate that.
I'm going to go ahead and then move now to the Minister of Health from the Kingdom of Viswaini, the Honorable Mmduzi Matsabua to make comments, please.
Thank you, moderator and greetings to everyone from the Kingdom of Esuadin.
Chair, Eswadin appreciates the opportunity to be part of this panel, a platform where we share ideas and experiences to better serve the people that we represent.
EVA did it despite being a small, resource constrained country.
Esadin surpassed the UN targets before time, made possible through high level political commitment where the head of state, the king, His Majesty, leads a from the front when it comes to HIV issues.
Strong community involvement and country ownership, anchored by partnership with local and international stakeholders like your PEFR Global Fund, and others.
We have made significant progress in expanding treatment, yet we are clear sighted that treatment alone will not end AIDS.
Sustained investment in prevention is equally essential.
Over and above the introduction of Len, by the way, we introduced Len A Kaavia in December 2025.
We need lasting social structural barriers at rest that continue to drive new infections in our community.
Then on equitable access, we have done a lot, not just by procuring 94% of our ARs, which is mainly the first line, and we are dons apeid on patriotic and second line using domestic funding.
But we've also deployed fully equipped mobile trucks with X ray machines and AI powered diagnostics for TB, cancer screening, and HIV services, bringing integrated services directly into rural and underserved communities just to bridge the gaps between facilities.
But we still have a lot to do towards 2030 and beyond to protect the gains.
And effective enforcement of our sustainability plan.
As we can tell that donor funding is shrinking.
We are already working on our sustainability plan.
In terms of serving the underserved communities in the rural areas, we are utilizing the rural health motivators, the programs.
They are the backbone of our primary health care and over and above that, we also use our faith based institutions who are all subled by government.
They don't just depend on donor funding, but government also sult them.
And we also have what we call NTA, which is the National Emergency Response Council on HIV and AIDS, which is an entity, a semi autonomous entity that coordinates the country's multisectoral emergency response to HIV AIDS.
It is pitched at the highest level in the Prime Minister's office working with the Ministry of Health.
We also have Congo, the coordinating Assembly of non governmental organizations As a network for NGOs working with primary health care.
All these factors, including political will, including community involvement, schools health, rural health motivators, decentralizing our services to primary health care, investment in equipment and commodities, Digitalizing our systems, which helps in terms of data collection and analysis, ensuring that we have the right data to make the right decisions in terms of budgeting and other factors.
All these have contributed in ensuring equitable access to HIV treatment, including the hard to reach areas, and But more than anything, the way that the country has moved in terms of treatment, we owe it to the Head of State.
I'll stop there for now.
Thank you so much, Honorable Minister.
That was very helpful.
Then let's now turn to doctor George Kippels who's our Vice Minister at the Federal Ministry of Health in Germany to finish up and then we'll have some comments and questions and answers.
Thank you, sir.
Thank you, Madam Chair, Excellencies, ladies and gentlemen.
The sovereign Order of Malta has long been dedicated to dignity, solidarity, and breaking the stigma so that no one is cast out.
These are values that are more important today than ever.
It is therefore an honor to be part of this event.
Global fight against HIV AIDS is a powerful example of what international cooperation can achieve when countries act with determination and long term commitment.
Effective prevention and therapeutic interventions have been developed while access to health systems has been expanded in many countries worldwide.
But that success remains uneven and work is far from being done.
Every year, 1.3 million people still get newly infected with HIV.
This is a big challenge, especially against the backdrop of a changing global health landscape and financial constraints.
As we respond to this public health challenge and promote prevention, equitable access to treatment and care is of utmost importance to Germany at all levels.
Internationally, We support the global fund to fight AIDS tubular coosis and malaria, which has contributed to saving more than 70 million lives worldwide.
This includes the funds outstanding contribution to reduce the annual cost for antiretroviral treatment.
Germany recognizes these achievements and demonstrates its continued commitment to the global HIV AIDS response, which is also reflected in our most recent replenishment pledge of 1 billion euros for 2026 to 2028.
Germany also support UN AIDS with 6.75 million euros in 2026 to foster their valuable work in achieving a sustainable global HIV AIDS response in the countries most effective bilaterally, We fund projects such as Germany's global program Backup Health.
This project complements the work of the global fund in selected countries like Malawi, Nigeria, Uganda, and Cameroon.
It helps to better integrate HIV services into national health systems.
Above all, Germany supports partnerships to build manufacturing capacities and promote voluntary licensing agreements.
Our goal is to improve access to affordable medicines and lifesaving products for those who need them the most.
At national level, we support civil society projects with an annual budget of 6.5 million euros.
These funds aid projects for education and prevention on HIV, as well as secure access to treatment and care.
All these efforts, civil society plays a crucial role.
More precisely, it is civil society that helps to ensure that everyone has access to information information diagnosis and treatment free from stigma and discrimination.
It also helps to strengthen accountability of the overall HIV response.
For many years, we have seen that the involvement of civil society is a cornerstone for successful HIV policies in Germany.
Progress we see today is the result of our past choices, choices to invest in evidence based science, and international solidarity, and in meaningful global, regional, and bilateral cooperation.
Now it's our responsibility to shape the future.
For Germany, this means continued political commitment, strong multilateral institutions and partnerships at an equal footing.
Thank you.
Thank you so much.
Now, I want to first thank everyone for their comments.
This is a lot of really great information and we are so grateful for that.
Let me turn to the audience and see if anyone has questions or comments that they would like to make to the panelist before we start the dialogue up here.
Anyone? Yes, sir.
Can you hear me? Yes.
Minister of health mentioned that funding is shrinking.
We see that in a number of donor countries for various reasons, funding for anti AIDS HIV has been greatly reduced.
How do we deal with that? What are the current strategies to bridge the gap? Thank you.
That's a very important question.
I'm going to perhaps put Angie on the spot with this one.
I think she's more than anyone else at the table dealing with this on a daily basis at the moment.
Angie? Thank you so much.
That's a really astute question in this particular environment where our financial resources are indeed constrained.
What we're seeing, and this is over the past few years, we've seen about a 23% decrease overall in global funding going toward the global HIV response.
That's from multiple countries for multiple reasons as you note.
What does that mean in terms of how countries and regional institutions and global institutions are responding to that? The Minister of Health Escatii also spoke about sustainability planning and I know my colleagues from Malawi as well and Sustainability planning is absolutely critical.
What's been happening over the past couple of years is that countries around the world have been putting in place sustainability roadmap, sustainability plans which are taking into account shifting funding landscape, but also within that shifting funding landscape, what needs to be prioritized and what needs to be done more efficiently, for example.
For example, Within the Honorable Vice Minister also noted the importance of prevention of the 1.3 million, now it's 1.2 million new infections that are happening globally.
There are more innovations that are coming out that will make the costs of delivery less as we move into the future.
Focusing in on prevention is absolutely critical to decrease out your costs in the future, which is a strategy that needs to be pursued.
Another is, as we've heard from every member of the panel here, how do we ensure that services are being delivered and through the community systems.
Both because they're more effective, but also because they're more efficient.
They're not only discussions, there's planning and operationalization that's beginning to happen at the country level that's guiding this decrease of what's happening in the financial landscape and how countries then are stepping up their own resources, but also being more efficient and effective with their resources.
Thanks, Angeli.
Do any of you have something to add to that? Let me also add that as a country, we have gone back to the basics.
To intentionally invest in primary health care, just to reduce the expenditure of tertiary.
Prevention is always cheaper than tertiary interventions.
We have deliberately invested in primary health care and some self introspection, if I may put it, is critical in this case.
Better utilization of the available resources is critical at this juncture.
Let me also add that we're taking advantage of the new compact that we have with the US government, which encourages co funding with government investment increasing each year while the donor funding is decreasing.
It is forcing us to take ownership of our health care system.
Thank you, sir, others? Yes, sir.
Similar to Satini.
The same issues are happening in Malawi.
We are also strengthening the community systems so that services are provided right in the community.
The other issue is what B highlighted, the issue of reprioritization.
What do we take on board? What do we scale down? And what do we drop completely? We have been working on this and related to the same, we are also simplifying our service delivery models.
We are developing a simplified guidelines, simplified service delivery modules, and an integrated guidelines, so to say.
So our plan or our vision is to have one consolidated HIV guideline.
Because at this point, we've got a lot of fragmented guidelines, prep guideline, STI guidelines, testing guidelines, but we are now in the process of developing one HIV consolidated simplified guidelines aligned with the national priorities.
Thank you.
Excellent.
Anyone else? George? I love this topic.
I think the fact that treatment and testing in prevention interventions are so simplified now and there's such capacity and experience in the national programs that the time is right for that streamlining and integration and delivery through the primary health care and community systems.
It can be done.
I'm hoping the donor funds will be enough with some joint planning to help those who need a little extra help to get there and not just a drop.
And then I think the question is maybe what donor funds are still there? One of the priorities I think may be for them to partner with governments and others on the innovation.
Because I think what's already known can be done better in a more streamlined way through country systems already.
But we don't want to lose the chance for the innovation.
I do think that is something we should push for the donor funding in partnership with national governments and community organizations to maintain as a priority.
Thank you, doctor Syberry.
Any other comments, Lips? Yes, sir.
Could you tell us who you are, please, before you start? Thank you so much.
My name is Patrick Pava.
I'm the principal secretary in the Minister of Finance and Economic Planning in Malawi.
I wanted to make an intervention on the agenda at hand, especially with regard to the 23% reduction in aid to the HIV area.
This reduction in financing is not only in the health sector, it is across the economy, even in the economic sectors.
And as of Malawi, as much as we are celebrating the successes that my colleagues has mentioned, but from the Minister of Finance perspective, we are experiencing a constrained budget, which now with the reduction in aid into the healthy sector, it gives us a very big challenge to sustain the successes that we have already achieved in line with the same um, as much as we have to push for domestic resources, but we feel like it would help if we could have a policy space, like a period to prepare for that because an immediate drop of 23% cannot immediately be substituted by domestic resources, at the same time.
So it is as much as the resources are constrained, but we would appeal to the international communities to look at the huge investment that has been done in this area, that if we don't make or review this, obviously, we are going to lose the huge investment that has been put into this area and immediately we'll get back to the 1990s where we're losing a big population due to HIV AIDS.
It is very crucial and important as we're discussing this subject matter as long as we understand that the resources are scarce, but at the same time, I think the life of human beings cannot be compared by any other substance of economic value because life is paramount.
Now, I would like to also understand I followed with keen interest on the success stories that the orders of MAT have done in South Africa.
I understand that after supporting the government of South Africa, there are opportunities that maybe other countries can benefit from the experience and the support.
If a country like Malawi would want to benefit the support to close some of the gaps that we have.
What would be the steps that we can follow to access the support into the country? I submit.
Thank you so much.
Thank you.
Thank you, sir.
A very appropriate question regarding how we as an organization can assist and help the minister from Esttini talked about the importance of faith based organizations in being collaborators in the fight against a number of things, not only AIDS, but many of the social ills that befall countries around the world, including our own, faith based organizations are usually there at the forefront.
They are the groups that are attempting to remedy, to provide solutions and to provide help and support.
And certainly the Order of Malta in its work around the world.
Now we are operating programs, not all of them AIDS related, but certainly programs in a whole variety of different areas such as yesterday when we opened our first hospital in Gaza since the tragedy that has befallen that part of the world.
We're here to assist to help 120 countries are currently recipients of our support.
Certainly, through our central repository of aid and support, Maltese International, which is based in Germany, with, I have to say, the support of the German government has been instrumental in enabling us to reach out to many parts of the world in ways in which we would otherwise find very difficult.
We have offered to provide support and to help replicate models such as the Blessed Jarod Center, which can and could be replicated and are being replicated in other parts of the world where support is necessary and where there is a need.
Um, so certainly many countries that have established diplomatic relations with us are obviously close to the order because of that fact, but other countries that have not established a diplomatic relationship are still under the watch and under the care of our organization.
We have a Very governmentally defined bureaucracy centered in Rome.
You can be sure, however, that if you reach out, your voice will be heard.
Thank you.
Yes, sir.
Do you allow a member of the panel to also ask questions? Yes.
Are we restricted? Yes.
Not restricted.
Go right ahead.
I think my question also goes to Matt as well.
Which areas do you specifically support? Because we have some donors who are specific in terms of areas of support.
Do you support everything or it's only HIV, agriculture? What specifically do you support? It's an extension to what the P has asked.
Thank you.
Certainly, the Order of Malta is essentially focused on health and well being.
That is our major focus.
Founded in Jerusalem 900 years ago.
We began as a hospice for the dying and the injured and the ailing and that is a mission over 900 years which we are still and which we continue to support.
The variety of areas in which we are engaged and involved concern areas like running hospitals, maternity hospitals, supporting hospitals, and centers for the aging, for the elderly, many of whom are indigent and do not have the resources to care for themselves.
And we provide a lot of first aid training, ambulance services in various parts of the world.
Our work also with the homeless, with the hungry, involving food kitchens, but involving also agricultural projects in Africa and in Latin America to help people grow and depend on their own resources to be able to find food.
We are very deeply involved in areas such as human trafficking.
Where we run centers, not only in other parts of the world, but here in America, centers for women and children in particular who have been the victims of human trafficking and who need to put their lives together, and we have been able to supply the resources to enable that to happen.
That is the range of activities that the order is engaged in.
Anything that touches on the dignity of the human being involving health, welfare, well being.
We are focused on those who are left behind and those who are forgotten.
Thank you, Mr.
Ambassador.
I do think that Malta might ought to consider doing a master class in sustainability because 900 years of consistent service is pretty impressive.
I just wanted to mention that do other people have questions or comments? Yes, sir, please.
Thank you.
Thank you so much.
My name is Harry Parks and I work with the Greek Orthodox Archdiocese of America.
Thank you, especially to the Sovereign Order of Malta for this wonderful side event and for the distinguished panelists.
The question that I have relates to the innovation end of HIV prevention and treatment.
With that to all the panelists, but particularly to Mr.
George, I'm sorry, my eyes aren't very good, so I can't see your last name.
But What are specifically the kind of innovations or innovative efforts and projects that you are seeing in the HIV AIDS treatment and prevention space that you, let's say, if you wanted to give a pitch to donors, you would highlight? You might guess by my first name, George, that Greek is part of my background.
It's nice to be asked a question by you.
I think the one that people already know a lot about is Delena cavir that already feels almost like not an innovation now because people are already using it in country.
But long acting products and there are long acting oral products that are on the horizon that may allow for a pill once a month for prevention or some formulation that could even allow for less than one a day oral treatment, those kinds of things could greatly reduce prices and greatly improve access and I think success of HIV prevention and care delivery.
There are several different lines of HIV products being developed, some very close actually to final testing that I'm keeping my eye on.
The other area is in the testing area.
There are novel approaches that are low technology, multivalent, meaning testing for HIV, but also say for syphilis as well as hepatitis, people interested in triple elimination or basically wanting to treat people, not a disease, wanting to be able to test for the things that matter to a person, not that matter to a program.
I think some of the innovations in technology and multivaleny for testing approaches could also be the innovation that could could improve outcomes and be very well received by communities and health systems in Africa.
I'll stop there.
I'm sure others have heard of things too.
Vice Minister.
Yeah.
Thank you very much.
Just a brief comment.
The challenges of HIV AIDS is that it is a dangerous disease that at an early age is often not detected.
So We have to make sure that we have early diagnosis in order to have the information and with La Cabvia it is obvious, the more complicated a therapy is, the higher is the risk that patients are not going to adhere to it in the long run.
There's no acceptance rule, there's errors, and then they no longer adhere to therapy.
If with few doses such as just one pill per day or ideally, in a vaccination even, then the success for the population is the biggest.
That's why I think pharmaceutical companies are also looking into it to see whether a vaccination could help to have a long term protection.
This is, of course, the ideal case, but this is something that we all have to look into.
Thank you.
Thank you so much.
I think we're about to come to the end of our time together.
I want to see if the panel has very quick comments.
We've got about 2 minutes if people would like to make a comment before we close and we'll wrap up.
Anybody? Yes, sir.
Thank you so much, moderator.
Just a word of appreciation, appreciating the work done by the faith based organizations.
It is not just limited to moral issues, but also to health, education, and equipment, including infrastructure development in our countries.
We really value and appreciate the support that we get from the faith based organization.
And to assure the order of Malt that in the event they want to expand to Swain, land is readily available there.
We will definitely make sure they get land to expand to Suin.
Thank you.
Thank you.
Anybody else before I turn it to the ambassador to close this? I think it's over to you, sir.
Thank you.
Thank you very much indeed.
Well, I thank the panelists for their contributions and for their insights, Father, Gerhard, for giving us an overview of a practical application of the work that we do in this area and for our panelists for giving their own perspectives from both a national viewpoint, but also from the larger perspective of the bigger picture.
Funding clearly is a major issue.
In many ways, however, AIDS has the concept of AIDS is very different now from when it was originally identified.
When it was identified, it was seen as something that perhaps was passing that was just a fly in the medical ointment.
After it was obvious that this was not the case and that it was here to stay, then fear, resentment, anger, as well as compassion came to the fore.
I think the years that have passed by have shown us that human care, human ingenuity, and human compassion combined with knowledge, science and technology have given us tools with which to ease the lives of those who are afflicted.
To the point that for many people nowadays, the actual affliction is not the issue.
The issue is the self understanding, the self awareness, and the self realization that comes with that.
We have a lot of discussion at the moment this week at the UN on this topic.
I'm very grateful that the UN has taken the time to produce a high level event that is bringing together so much in the way of thinking, ideas, thought.
I'm glad that we've had the opportunity to make a little contribution to that, but we are by no means finished with an area and a topic.
That is going to continue to need our attention, but in different ways, in different ways as it evolves and as it develops.
I thank you all for your participation and for your interest.
Sandy, thank you very much indeed for managing us all.
Thank you.
Thank you.