Dr. Sundeep Gupta
U.S. Center for Disease Control and Prevention Country Director
Keynote Speaker, ZAMPHIA Dissemination Meeting
2 December 2016
Good morning. It is truly humbling to be here today representing the United States Government, and I want to extend my appreciation to the Ministry for this honor. I have only been in the country for five months, and many have worked on ZAMPHIA for the past couple of years, and others have been fighting Zambia’s epidemic for even longer.
I want to start by recognizing my U.S. Government colleagues here today from the State Department, USAID, Peace Corps, and the Department of Defense; we are privileged to have toiled together for the past 13 years fighting the epidemic.
Many of you have been fighting this epidemic for longer, for decades; and almost all Zambians have been sorely affected, multiple times and in very personal and challenging ways, by this virus. More than 1 million Zambian lives have been taken, and this continues with another estimated 500 HIV related deaths occurring during this National Health Awareness Week.
World AIDS Day is about remembrance, hope and action. Remembrance of families and communities which have been devastated, hope for better interventions such as a vaccine or cure, and the hard to imagine reality of an AIDS Free Generation. And action, the best way for us to honor those who have sacrificed. Interestingly, this epidemic has forced us to repeatedly imagine a better future and then act in innovative ways – examples include the start of the treatment era in Africa, rapid HIV testing, Option B+, test and start – and new possibilities appear to be coming soon – pre-exposure prophylaxis, self-testing, partner notification and contact tracing, and rapid incidence testing.
PEPFAR also fits into this category. In 2003 President Bush felt the call to act and honor those that were dying, stating that he found it “morally unacceptable for the United States to stand aside while millions of people died from a disease we could treat.” He initially received a proposal for less than $500 million and said ‘no’, he wanted something bigger. No one was clamoring for a $6 billion initiative – the United States did it and continued under President Obama because the country could, and believed it was and is the right thing.
As it turned out, the United States has benefited also. We have made many friends in new places. We have helped those who are thrown out by society reclaim their rightful dignity, while as a country, holding up our own, in our actions. We have tightened relationships built on genuine trust with Heads of State and Ministers. And honestly I do not believe we ever expected to end up taking so many lessons from Africa to use in fighting our own domestic epidemic.
Most of you have heard the Minister’s speech yesterday by now with the initial 90-90-90 results. ’67 – 85 – 89’. How far we have come.
When I first heard the results on a call with my headquarters a couple of weeks ago, the Director of our Division of Global HIV and TB, and our overseas office branch Director were both on the line. They were both past country directors in Zimbabwe, having started our office there 16 years ago and then continuing it. I have never heard such emotion in their voice – after all the modeling, estimates and projections, hearing directly measured results for the first time which definitively affirmed their life’s work. The study results are an affirmation of the struggle, sacrifice and positive persistence of thousands.
They are also an affirmation of an incredible collaboration which conducted a groundbreaking survey, groundbreaking on many levels. Many were not sure if this kind of study was even possible, and at times many of us involved had our questions. I want to appreciate the very tight partnership with the Ministry of Health, and the implementers, ICAP, CSO, TDRC and UNZA, as well as members of the Steering Committee.
It is truly an honor to have Dr. Jessica Justman today, the Principal Investigator for the global PHIA project, which you will hear more about, from ICAP headquarters at Columbia University in New York. ICAP is managing surveys in about 13 countries simultaneously, and has successfully done something no one has ever done before. CSO and TDRC have also been incredible in the intensity and quality of their efforts, which you will hear more about shortly directly from them.
Unfortunately, time for celebration is usually short, as there remains much more which needs to be done. ZAMPHIA will help guide us. Where are the 10-10-10? Or in Zambia, where are the 33-15-11? For each of these numbers on the cascade, where do they live, what age are they, what sex, what do we know about their lives, their access to HIV services, and their disease status or outcomes? ZAMPHIA was designed specifically to help with these answers. We look forward to the country’s discussions ahead of what the results today, the further analyses, and further results in 2017, will help guide Zambia about what, where and how to do next.
In closing, I want to appreciate the opportunity to say a few words today, and the many types of partnerships which have made progress and this study possible, congratulate all of those who have worked tirelessly on this study since the day it was conceived more than two years ago, and on behalf of the U.S. Government, I want to specifically congratulate the Government of Zambia for the amazing progress made.