Strengthening HIV treatment cascade is critical to achieving widespread impact – Op-ed

Ambassador Maria Brewer: Sierra Leone Telegraph: 01 December 2020:

The United States joins Sierra Leone in observing World AIDS Day 2020 today 1st of December. Annually on this date since 1988, we pause to remember those lost to HIV/AIDS, to reflect upon our global journey towards ending the HIV/AIDS epidemic, and to renew our shared commitment to an AIDS-free future. (Photo: Maria Brewer – US Ambassador to Sierra Leone).

Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United States has saved more than 18 million lives worldwide and prevented millions of HIV infections.

Working together with our partners in 54 countries, including Sierra Leone, which is the U.S. latest partner PEPFAR country, we have moved the HIV/AIDS pandemic from crisis towards control – community by community, country by country.

In Sierra Leone, an estimated 1.6% of the population – approximately 78,000 people – lives with HIV.  Seventeen years ago when PEPFAR began, HIV was a death sentence in many parts of the world.

Now, for the first time in modern history, we have the opportunity to control a pandemic without a vaccine or a cure.  But to go forward, we must go together.  Partnerships are the cornerstone of PEPFAR’s success, and we need all sectors and diverse partners working together to achieve our collective goals.

These goals include increased impact and enhanced resilience for all.  As there is no vaccine or cure, epidemic control is needed to stop the spread of HIV/AIDS.  PEPFAR is dedicated to ensuring that all ages, genders, and at-risk populations know their HIV status, receive life-saving HIV prevention and treatment services, and are virally suppressed if they are living with HIV.

More specifically, epidemic control is achieved when 95% of people living with HIV know their status, 95% of these HIV positive people are on continuous treatment, and 95% of those on treatment achieve viral suppression, meaning that the virus is not replicating and thus cannot spread to others.  Known as the HIV treatment cascade, this approach emphasizes a comprehensive response to HIV/AIDS that promotes sustainable results.

Strengthening the HIV treatment cascade is critical to achieving widespread impact, so we are innovating at the community level to reach populations that are often being left behind, including young women, younger men, and other key populations.

And, we are working closely with local partners to realize a future where HIV is a manageable chronic disease, and where new infections are rare.  For example, PEPFAR is supporting interventions in Sierra Leone for people living with HIV, specifically in key high-risk populations, by focusing on health facilities in high-burden districts in Western Area, Port Loko and Kambia, areas which account for the majority of HIV treatment in the country.

PEPFAR’s life-saving work is made possible through the U.S. Government’s unwavering commitment to the program and the American people’s compassion and generosity.

Thanks to the leadership of the U.S. Government, PEPFAR’s investments have also strengthened the systems that drive effective, efficient, resilient, and sustainable health care.  These efforts have helped make the world a more secure place by better equipping partner countries to confront HIV and other health challenges, even in times of adversity.

In April 2019, Ambassador Maria Brewer announced the opening of a new skills lab, library and computer lab at the School of Midwifery in Makeni, a project supported by PEPFAR.

About the author

Maria Brewer is the US Ambassador to Sierra Leone.


  1. This is good news for Sierra Leone. Indeed it was under President George W Bush, perhaps one of the most popular US presidents in Africa, that launched this health initiative to combat the Aids epidemic across the continent. He, more than any other president championed this cause, and through his efforts and dedication, helped to save millions of Aids sufferers that otherwise didn’t stand a chance of survival, given our poor health infrastructure across the continent. Uganda, Kenya, South Africa, Zimbabwe and many other countries saw their populations wiped out before this intervention. President George W Bush is Africa’s favourite son. When I say our country is blessed, touch wood just like the recent COVID19 pandemic, we haven’t suffered the effects of it so much like other countries.

    In my analytical mind, there is something about Sierra Leoneans, I cannot put my finger to it; that tells me when we are confronted with a common enemy, we as a nation are able to put aside our differences aside and work for the common good. In other words, once we identify the disease, and know what causes it and told to avoid the causes, we tend to follow the rules without our politicians whipping us to obey the rules, because it just comes out natural.

  2. There is a saying that, “He who is on the receiving end of a gift, kind gesture or favor should always put on a very tight muzzle in order not to offend his benefactor, even if their gift isn’t up to par.” Its an attitude of gratitude and politeness many people find truly admirable. The story the Ambassador has painted about the gains and successes attained in our struggle to save lives and keep HIV/AIDS from spreading is truly inspiring and worthy of our commendation but that’s not the full picture of the harsh realities on the ground. The story of HIV and all it entails in Africa, is a complicated one – sometimes exhilarating and in other instances, challenging and heartbreaking.

    Firstly,there is an acute shortage of qualified health care workers and caregivers ready to respond to the life-threatening needs of people living with HIV. Madam, that is a huge problem that needs to be solved as urgently as is humanly possible. Lives are being lost! Again, all across the African continent, there have been authenticated widespread reports about hundreds of thousands of people being misclassified as HIV patients, including many who have unnecessarily started standard antiretroviral therapy according to data presented at the Epidemic Intelligence Service or EIS conference. Misdiagnosing patients is a big problem also in Sierra Leone. Although our government will refuse to admit it is true, reliable sources have told me that many people who were suffering from malaria and other curable illnesses ended up being misdiagnosed and treated as HIV patients. Efficient training of medical personnel and a rigorous education of the masses is what our nation urgently needs, in order to increase awareness and stop the rapid spreading of HIV/AIDS in Sierra Leone and Africa.

  3. A very good initiative indeed. However, I would like to know if the number of people infected is increasing, decreasing or has stabilized in the country, due to the work carried out by PEPFAR. Well done Madam US Ambassador this time around and may God bless you.

  4. It is a very good effort and idea in working with the United States in resolving the epidemic infectious issues in Sierra Leone. America is an advanced nation in Medicine and its expertise is needed greatly.

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