On HIV: Winning the battles but losing the war?

Ana P. Santos

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'Condoms are for our protection. They are not evidence of a crime,' says one sex worker

NEEDS ATTENTION. Twelve countries account for more than 90% of people living with HIV and of new HIV infections in the region. Photo by Jeanne Hallacy/ICAAP11

BANGKOK, Thailand – Significant progress has been made in the fight against HIV over the last decade, but greater focus is still needed on key populations that are emerging as having a higher risk for HIV infection.

At the 11th International Congress on AIDS in Asia and the Pacific (ICAAP), a regional conference on HIV and AIDS, keynote speakers called for an end to stigma and discrimination and a more coordinated response to reach the 2015 goals of zero: zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“The Theme of ICAAP11, ‘Reaching Triple Zero’ is an opportunity for us to consider our numerous challenges and how we can engage towards a better HIV response,” said Sintavanarong Pradit, Royal Thai Government Public Health Minister.

Decline in HIV, but more than increase

In 2012, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that new incidents of HIV infections across 25 low- and middle-income countries dropped by more than 50% from 2001 to 2011. During this period, there was also a record drop in AIDS-related deaths. The report also showed that in 2011, for the first time, domestic investments in HIV response surpassed global funding

In this UNAIDS year’s report launched at the ICAAP11, numbers of new HIV infections in the region have fallen by 26% since 2001. A number of countries have reduced new HIV infections by over 50% in that time: India (57%), Myanmar (72%), Nepal (87%), Papua New Guinea (79%) and Thailand (63%).

In addition, more people than ever before have access to HIV services across the region.

However, there remains inadequate progress on addressing the specific needs of key populations at higher risk of HIV infection and a lack of focus on geographical areas with higher HIV point.

“The pace of progress needs to be redoubled to sustain past achievements, drive results and meet global AIDS targets,” said Steven Kraus, UNAIDS director of the Regional Support Team for Asia and the Pacific. “Efforts should be more focused on smart investments in the right places and on programs to reach the people in greatest need.”

Slowing of impact brings out emerging epidemic 

An estimated 4.9 million people were living with HIV in Asia and the Pacific in 2012. Twelve countries account for more than 90% of people living with HIV and of new HIV infections in the region: Cambodia, China, India, Indonesia, Malaysia, Myanmar, Nepal, Pakistan, Papua New Guinea, the Philippines, Thailand and Viet Nam.

Overall numbers of new HIV infections across the region remaining largely unchanged in the past 5 years. However, new HIV infections remain concentrated among key populations: people who buy and sell sex, people who inject drugs, men who have sex with men, and transgender people.

Emerging epidemics are becoming evident: between 2001 and 2012, new HIV infections increased 2.6 times in Indonesia; Pakistan has seen an 8-fold increase and new infections in the Philippines have more than doubled.

The fastest-growing epidemics in the region are among men who have sex with men. These epidemics are typically concentrated in large urban cities with prevalence of HIV infection among MSM estimated at 15% to almost 25% in Bangkok, Hanoi, and Jakarta.

In the Philippines, reported HIV cases spiked from one per day in 2007 to 13 by August 2013. MSM accounted for 10 of the 13 reported infections.

Male sex workers are more likely to be infected (compared to female sex workers). Among MSM in high prevalence countries, 6%-20% solicit sex from male sex workers. (READ: Alarming: 12 HIV cases a day in PH  and HIV crisis worsening in PH)

Stigma and discrimination remains to be the biggest barriers to HIV and AIDS response. Sex workers, migrant workers and people who inject drugs (PWD) called for the repeal of punitive laws that prevent those at risk for infection and PLHIV (People Living with HIV) from accessing services.

“Condoms are for our protection. They are not evidence of a crime,” said a sex worker speaking at ICAAP. She called for the decriminalization of sex workers and their clients. “Sex work is work.”

“We need to change the dogmatic morality driving the AIDS response,” said Malu Marin, regional coordinator of NGO, Seven Sisters.

Marin called for an end to the detention of people who use drugs, compulsory drug rehabilitation programs, and criminalization of same sex behavior.

ARV: Test and treat

The number of people accessing life-saving antiretroviral treatment in the region has increased to 1.25 million people at the end of 2012. Numbers of AIDS-related deaths have declined by 18% since 2005 to 270,000 in 2012, largely thanks to this increased access to treatment.

According to the World Health Organization (WHO), standard antiretroviral therapy (ART) consists of the combination of at least 3 antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease.

However, in 2012, nearly half of people in Asia and the Pacific who were eligible for treatment were not accessing it and the rate of increased access is slowing down, 13% in 2011-2012 compared to 20% in 2010-2011.

Health experts called for more acceptance of the “Test and Treat” approach in controlling the HIV epidemic. “Test and Treat” was proposed by the WHO in 2009 recommends voluntary annual or more frequent testing for HIV and immediate antiretroviral therapy for anyone found to be HIV-positive.

Despite these gains, the AIDS response in Asia and the Pacific remains underfunded. In the region, total HIV spending for 2012 was estimated at US$2.2 billion. To achieve the 2015 annual investment target in low- and middle-income countries in Asia and the Pacific, UNAIDS estimates that approximately $5.4 billion must be mobilized. – Rappler.com



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