AIDS epidemic at a critical juncture in Asia-Pacific region

Shobha Shukla (CNS) *

10th International Congress on AIDS in Asia and the Pacific (10th ICAAP) in Busan from 26th August to 30th August, 2011

Thirty years into the AIDS epidemic, and on the occasion of the 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP), being held at Busan, the Joint United Nations Program on HIV/AIDS (UNAIDS) released a new report on the HIV epidemic in the Asia-Pacific region. The report titled ‘HIV in Asia and the Pacific: Getting to Zero’, provides the latest regional and country-level data on the HIV epidemic and response, and offers perspectives on the situations, opportunities and challenges currently at play.

According to the report the AIDS epidemic in the Asia and Pacific is at a crossroad. Although there has been a 20% drop in new HIV infections since 2001 and a threefold increase in access to antiretroviral therapy (ART), the epidemic still outpaces the response - there are still almost two new HIV infections for every person who starts treatment. There is inadequate focus on most-at-risk-populations (MARPs) and insufficient funding from both domestic and international sources.

"Getting to zero new HIV infections would demand national responses based on science and the best available evidence. HIV programmes must be sufficiently resourced and solidly focussed on key populations. Investments made today will pay off many fold in the future," said UNAIDS Executive Director Michel Sidibe.

According to the report, there were an estimated 4.9 million people living with HIV (PLHIV) in this region in 2009 - which is almost the same as in 2005. A majority of these people are living in one of the 11 countries of the region - Cambodia, China, India, Indonesia, Malaysia, Myanmar, Nepal, Pakistan, Papua New Guinea, Thailand and Vietnam.

Not that there is nothing to celebrate about, with Cambodia, India, Myanmar and Thailand reducing their HIV infection rates significantly, and Cambodia being one of the just 8 countries of the world providing antiretroviral therapy to more than 80% of the people eligible for it. But still more than 60% of the people of this region who are eligible for treatment are unable to access it. Then again, although there is an estimated 15% decrease in new HIV infections among children, regional coverage of services to prevent new infections in children lags behind global averages, especially in South Asia.

Across the region, stigma and discrimination against PLHIV, and MARPs is still a way of life. Ironically while new HIV infections in the region remain concentrated among sex workers and their clients; injecting drug users, men who have sex with men; and transgender people, the punitive laws and policies retained by about 90% of the countries in the region prevent these key affected populations to access life saving HIV services.

Another point of concern is the emergence of the epidemic in countries which earlier boasted of a low prevalence of HIV. A case in point is Philippines where after a 20 year low and slow epidemic, there has been a rapid increase in the number of HIV infected cases. In the city of Cebu in Philippines, HIV prevalence amongst injecting drug users has risen by almost 900%, from 0.6% in 2009 to 53% in 2011.

Data also suggest that a significant proportion of new HIV infections within key populations are among young people under the age of 25 years. In most settings, HIV prevention programmes are failing to sufficiently reach most at risk young people.

The report indicates that the AIDS response in Asia and the Pacific is underfunded, with only about an estimated total of US$ 1.1 billion being spent across 30 countries of the region in 2009. This is almost just 33% of the actual funds needed to achieve universal access goals to HIV services.

Though China, Malaysia, Pakistan, Samoa and Thailand are funding the bulk of their HIV response from domestic resources, many countries in Asia and the Pacific depend heavily on foreign funding, particularly for the provision of antiretroviral therapy. Funding cut backs from international donors is further aggravating the problem. So, increased investment of domestic resources, especially in middle-income countries, is critical for the ongoing regional response to HIV.

India accounts for nearly half of Asia’s HIV epidemic, with 2.4 million people living with the disease, 140,000 new HIV infections and 170,000 AIDS related deaths estimated in 2009. Women account for 39% of all reported HIV cases. Prevalence remains high amongst Men who have sex with men (7.3%) and injecting drug users (9.2%). There are 320,074 people receiving antiretroviral therapy

In the words of Ban Ki Moon, United Nations General Secretary, "Today we have a chance to end this epidemic once and for all. That is our goal: Zero new HIV infections; Zero discrimination; and Zero AIDS-related deaths."

This can happen only if we work together to make high-impact HIV prevention a top priority; speed up and sustain access to antiretroviral treatment; and advance human rights and gender equality. (CNS)