Distinguished ladies and gentlemen, I would like to thank the National AIDS Council and the Ministry of Health for inviting me to commemorate Zambia’s National Voluntary and Counselling Testing Day. Indeed, the theme of “know your status to access care and support” is apt as HIV counselling & testing truly is the gateway to HIV prevention, treatment and care services, and needs to be linked to prevention and care to increase the coverage of services around HIV.

VCT  is especially critical in a country such as Zambia, where over 40% of the population is under the age 14 years[1],  as it provides a platform to empower young people with the knowledge  to protect themselves from HIV, by ensuring access to HIV testing and prevention efforts with and for young people in the context of sexuality education. It has also been shown that HIV Couples Counseling and Testing decreases the transmission of HIV by more than 60% within discordant couples and reduces sexually transmitted infections and unplanned pregnancies in all couples.  VCT, if carried out correctly, can further directly increase gender equity in HIV and AIDS programs by promoting the testing of men and women together, which innately increases male involvement; and reduce post-test violence.

Before I speak to the situation in Zambia, allow me to provide a brief snapshot of voluntary counselling and testing across Sub-Saharan Africa. On the continent, the total number of health facilities providing HIV testing and counselling services increased by 50%, from 11 000 in 2007 to 16 500 in 2008[2]. Nearly 90%[3] indicated having national HIV testing and counselling policies, an increase since 2007 when 70%[4] had HIV testing and counselling policies.

Regarding access to testing & counselling, there are wide variations with some countries reporting large increases, for instance in  Ethiopia, 4.5 million individuals were reported to have received testing and counselling during 2008, up from 1.9 million in 2007. While  in Swaziland, the reported uptake of testing and counselling increased from 52 000 during 2007 to 81 000 during 2008.

National testing and counselling campaigns have been planned and implemented in Burkina Faso, Kenya,  Malawi, Namibia, Rwanda, South Africa, Swaziland, Uganda and the United Republic of Tanzania, and innovative approaches have included offering tests at workplaces such as in Rwanda and Zimbabwe, through mobile units or at people’s homes.

I would like to highlight the case of South Africa in particular, as it is a testament to what bold, ambitious, focused, political and social movements around combating HIV can look at.  South Africa has launched the biggest national mobilisation around any single issue since the end of apartheid; and the largest HIV counselling, testing and treatment scale-up in the history of the HIV epidemic, by launching a national HIV campaign to test 15 million people by 2011. Furthermore, South Africa increased its national HIV budget by 33%, allocating $1.1 billion this year. This is truly an example that should be emulated across the region, if we are to attain the bold  vision that UNAIDS is advocating which stresses: “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.[5]”

Allow me to highlight some significant milestones in HIV prevention, treatment, care and support in Zambia. There has been a drop in HIV prevalence from 16% in 2001 to the current 14.3%[6]. Furthermore, the coverage of the ART programme increased from 32.9% in 2006 to 70% in June 2009; this in addition to the increase in HIV positive pregnant mothers that were receiving anti-retroviral prophylaxis from 29.7% in 2006 to 50% in June 2009. Finally, the 2009 level of new childhood infections represented a 57% reduction of the peak level of new infections in children in 1996.

These achievements would not have been possible without high level political commitment from government, the tireless efforts of civil society organisations and communities, and the support of cooperating partners. 

However, clearly many challenges remain in increasing VCT uptake, and harnessing its potential to increase coverage of services in HIV prevention, treatment, care and support.   While over 1500 VCT sites were established nationwide, only 15% of women and men aged 15-49 received a test in the last 12 months and know their results.

In other words, 85% of Zambians do not know their status.

Challenges to VCT uptake, are varied and systemic, and include limited physical space at counselling sites; continued stigma and discrimination; threat of violence; and system wide human resource challenges, which included the high attrition rate for CT counsellors. Other challenges include the insufficient coordination of test kit procurement and distribution; the poor distribution of facilities offering CT services, and  inadequate funding and implementation of the quality control programme for rapid testing.

Regarding, the  elimination of mother to child transmission of HIV: by the end 2008, 936 ANC facilities offered PMTCT services[7]. However, as was noted at Zambia’s first ever prevention convention, the quality of PMTCT services remains a concern. Among 162 ANC clinics offering PMTCT services in 9 districts assessed in 2008, only 6.2% had all basic elements of infrastructure, staff, guidelines, equipment, supplies and registers available in order to offer quality services.

I would like to encourage the Ministry of Health, the National AIDS Council and its partners, to continue to strengthen the voluntary counselling and testing component of the overall national strategy and to further stress the elimination of mother to child transmission of HIV within this strategy. This is an ambitious but achievable target that can help ensure the survival of mothers through the provision of basic sexual and reproductive health services, and the promotion of linkages with and referrals to antenatal care, maternal and child health and a full sexual and reproductive health package.

Before I conclude my brief remarks, I would like to acknowledge and commend the incredible work of Civil Society Organizations, in particular networks of people living with HIV, who continue to ensure that treatment remains a reality for many, and further remind us of the urgency of connecting HIV positive people to prevention, treatment, care and support.

In addition, I wish to commend the important role that development partners continue to play in partnering with the government and citizens of Zambia in tackling HIV.  Finally, on behalf of my colleagues from the UN family, I would like to reaffirm UNAIDS and the co sponsors commitment to supporting countries including Zambia to achieve Universal Access. This is in line, with Michele’s Sidbe, the UNAIDS Executive Director’s recent call for the renewal of the Political Declaration of Commitment made by the UN General Assembly in 2006 at the just ended UNAIDS Programme Coordinating Board meeting. A renewal would extend the global commitment and mandate to achieve universal access to 2015—bringing it in line with the MDG deadline: as he notes, “this way we can ensure that one of the MDG targets—to achieve universal access for all—is linked to and reinforced by the other MDGs. This will enable countries to maintain their momentum in reaching and reporting on universal access through 2015.”

Thank you.