Confirm Dr. John Nkengasong as U.S. Global AIDS Coordinator

March 24, 2022 – Last September, the White House offered its nomination of Dr. John Nkengasong to serve as Ambassador-at-Large and Coordinator of United States Government Activities to Combat HIV/AIDS Globally. Last week, Dr. Nkengasong, Director of the Africa Centers for Disease Control and Prevention, finally received his long-overdue Senate confirmation hearing.

The Council for Global Equality calls on the Senate to swiftly confirm Dr. Nkengasong to lead PEPFAR, the United States President’s Emergency Plan for AIDS Relief. Dr. Nkengasong, with three decades of experience in global health — including serving as founding Director of Africa CDC since 2016, following extensive service with the World Health Organization and with the U.S. Centers for Disease Control’s Center for Global Health — is eminently qualified for this position. 

It is now more than two years since Dr. Deborah Brix departed PEPFAR’s day-to-day leadership to join the White House coronavirus task force under the previous administration. It has now been more than two years that PEPFAR has lacked permanent leadership while COVID-19 disrupted HIV prevention and treatment services, along with supply chains for condoms, lubricants, and antiretroviral medications, as noted by a UNAIDS report.

The largest and most successful global health program in U.S. history, PEPFAR represents the largest commitment of U.S. support overseas for gay/bisexual men, other men who have sex with men (MSM), and transgender women. As two of several “key populations” in the HIV response, gay men and other men who have sex with men are at least 25 times more likely to aquire HIV, and a recent study suggests transgender women are up to 66 times more likely to become HIV infected than the general population worldwide. Despite these grim statistics, studies also suggest that only 2% of all AIDS funding targets key populations, even though key populations accounted for over half of all new infections. 

The Council for Global Equality’s 2020 Biden-Harris Transition Paper, “Centering the Rights of LGBTI Individuals in U.S. Foreign Policy,” outlined its recommendations for reforming PEPFAR under the new administration. In particular, the Office of the U.S. Global Aids Coordinator (OGAC) must direct PEPFAR programs to better serve gay and bisexual men, transgender women, and other key populations. Key population-targeted funding has been minimal at best, while failing to address the many ways LGBTI populations are criminalized and otherwise vulnerable both to public bias and to discriminatory service providers that reduce access. 

In addition, resources continue to be concentrated in large mainstream organizations at country-level (sometimes government-run) or large international non-governmental organizations, barely reaching these populations because they generally bypass grassroots organizations led by impacted communities. 

The COVID-19 pandemic has dealt significant setbacks to HIV prevention and treatment services, according to a recent report from the Global Fund. In that context, it is all the more remarkable that PEPFAR has maintained its status quo in providing HIV treatment and prevention services in dozens of countries. 

However, without the leadership and diplomatic power of a confirmed Ambassador, PEPFAR cannot transcend the status quo, and the status quo is failing LGBTI people and other key populations. 

We need rapid confirmation of Dr. Nkengasong to lead OGAC and to bring PEPFAR in line with the White House Presidential Memorandum on Advancing the Human Rights of LGBTI People Around the World and UNAIDS’s Global AIDS Strategy 2021-2026. 

Dr. Nkengasong’s declaration, in his confirmation hearing that “The enemy is the virus, not people” aligns with the inequalities framework guiding both the Presidential Memorandum and the new UNAIDS strategy.

The Council for Global Equality endorses the UNAIDS strategy to reduce the inequalities that drive the HIV epidemic and to prioritize those key populations who are not yet accessing life-saving HIV services. To accomplish this — to reach the goal of ending HIV/AIDS as a public threat this decade — we need evidence-based strategies grounded in human rights principles.

Dr. Nkengasong’s leadership will be essential. In his confirmation hearing, he explained that, “It is my brief that we need to capitalize on the capacity and experience of those in the countries where we work, coming to the table with a deep respect for their perspective and needs, taking advantage of their knowledge of local contexts and their reservoirs of expertise.”

Nearly 700,000 people died of HIV in 2020, with much of the burden of that falling on gay and bisexual men, other men who have sex with men, transgender women, and other key populations. With the HIV pandemic continuing to threaten our most vulnerable community members, the Senate must act. The confirmation of Ambassador Nkengasong cannot wait any longer.