THE FOREIGN SERVICE JOURNAL | JULY-AUGUST 2025 37 on life-saving HIV treatment, and that 95 percent of people on treatment have a suppressed viral load. Maintaining viral suppression of HIV extends the lives of people living with HIV and prevents transmission to others, enabling HIV epidemic control. We work closely with our Ivoirian counterparts through cooperative agreements with the Ministry of Health and other government partners, as well as with local and international organizations working in Côte d’Ivoire. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) supports life-saving HIV treatment for more than 300,000 Ivoirians at more than 500 clinics throughout Côte d’Ivoire. FSJ: Any recent CDC victories at your post to share? AKL: Côte d’Ivoire is making great progress toward the 95-95-95 targets. When I started supporting this CDC country office in 2018, Côte d’Ivoire was at 73-78-77, meaning that 73 percent of people living with HIV knew their status, 78 percent of those who knew their status were receiving HIV treatment, and 77 percent of people receiving treatment had reached viral suppression. These percentages have since increased to 82, 88, and 88 percent, respectively, as of 2023 estimates. The percentage of people aged 15 to 49 years who live with HIV in Côte d’Ivoire was at its highest at 7.4 percent in 1995 and has since dropped to 1.8 percent as of 2023 estimates, in large part because of PEPFAR’s work to prevent and treat HIV. CDC is supporting the Ministry of Health to conduct a national population-based HIV impact assessment (PHIA) in collaboration with the National Agency of Statistics and other partners. The survey is assessing key indicators such as HIV incidence, prevalence, viral load suppression, and risk behaviors. My understanding from talking to Ivoirian colleagues is that HIV really felt like an ominous threat in the 1990s. According to a survey conducted seven years ago, only about 40 percent of adults living with HIV were virally suppressed. While we still have a long way to go, HIV is much more of a manageable issue now, and we expect that the most recent PHIA results will show improvement in these metrics. We will continue to use the survey results to guide Côte d’Ivoire in determining where remaining gaps can be addressed. CDC also supported Côte d’Ivoire to conduct its first-ever “7-1-7 evaluation” to improve early and effective action to contain infectious disease outbreaks. The abbreviation, 7-1-7, stands for the goal of taking no more than seven days to detect a suspected infectious disease outbreak, one day to notify public health authorities to start an investigation, and seven days to complete an initial response. The evaluation measures how well the detection and response system is working and helps countries determine what is working well and what needs to be improved. In total, 58 human, animal, and environmental outbreaks occurring from 2021 to 2024 were included in the evaluation. In September 2024, bottlenecks and enablers for the 58 outbreaks were presented to the deputy director of health, representing the Ministry of Health, the National Institute of Public Hygiene executive board and staff; Regional Emergency Operations Center members; technical, financial, and implementing partners; and various partners from the human, animal, and environmental health sectors. Seeing the value of 7-1-7 for rapid performance improvement, Côte d’Ivoire has committed to beginning to use 7-1-7 for future outbreaks to continue to improve their global health security capacities. FSJ: What do you wish Americans (ordinary Americans as well as FS members) knew about your work on behalf of the U.S. government overseas? AKL: My experiences and conversations with Ivoirians highlight that the United States is a trusted partner. PEPFAR supports HIV testing and treatment that reaches farmers and laborers in Côte d’Ivoire who produce cocoa, cashews, coffee, and other products that Americans consume daily and that benefit our bilateral commerce. Most Americans probably don’t think about it now, but they have benefited from the continuous hard work to prevent and treat HIV—making HIV much less of a global issue than it was 20 years ago. In fact, PEPFAR has saved more than 26 million lives globally since its founding. An estimated 7.8 million babies have been born HIV-free thanks to this uniquely American act of generosity. Even as cuts to global health funding make the news back home, our work in Côte d’Ivoire continues, making Americans safer by responding to emerging and infectious diseases around the world to stop their spread, before they reach American shores. n An estimated 7.8 million babies have been born HIV-free thanks to this uniquely American act of generosity.
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