Thailand

Nearly 4000 delegates from more than 80 countries gathered in Bangkok, Thailand, this week, for the 11th International Congress on AIDS in Asia and the Pacific (ICAAP11). The Congress opened officially on 19 November. Building on UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, the theme for this year’s ICAAP is Triple Zero – Investing in Innovation.

Opening the Congress on behalf of the Prime Minister of Thailand, Yingluck Shinawatra, Thailand’s Minister of Health, Dr Pradit Sintavanarong underlined the opportunities presented by the four-day event to drive progress towards the end of the AIDS epidemic in the region.

“We can only achieve this by integrating the preventive effects of antiretroviral therapy, focusing our efforts both geographically and demographically, and by normalizing HIV among the general population and, importantly, among key populations,” he said.

“Action now will pay off in the future,” he added, emphasizing the need for effective investments in areas where they will have most impact.

Addressing delegates at the opening ceremony, UNAIDS Deputy Executive Director Jan Beagle called for greater innovation and focus in region’s response to HIV. “The annual number of new infections has remained largely unchanged over the past five years, and emerging epidemics are evident in a number of countries in the region,” said Ms Beagle.

Ms Beagle spoke about the important linkages between HIV and other development goals. “Experience has shown that AIDS is an entry point to advance broader issues of human rights, redistribution of opportunity and social justice for all. The AIDS response is a pathfinder for transformative development,” said Ms Beagle.

The opening ceremony of the conference saw representatives from the communities of people living with HIV, sex workers, transgender people, people who inject drugs and men who have sex with men voice their hopes and expectations for the congress through performance art. “Through the performance we wanted to send the message that we are trying to put faces to the epidemic. We are the people behind the data, and this is where the focus should be,” said Mehrdad Pourzaki who works with Youth LEAD, the regional network for young key populations at higher risk.

Fragile gains in Asia and the Pacific

On the opening day of the Congress, UNAIDS launched the 2013 HIV in Asia and the Pacific report. The report shows that while important gains have been made in the region’s response, the pace of progress is too slow and significant challenges remain.

According to the report, an estimated 4.9 million [3.7–6.3 million] people were living with HIV in Asia and the Pacific in 2012. Regionally, numbers of new HIV infections have fallen by 26% since 2001, with a number of countries reducing infections by over 50% in that time. However, the overall number of new HIV infections across the region has remained largely unchanged in the past five years.

The number of people accessing antiretroviral treatment in the region rose to 1.25 million people by the end of 2012. But the rate of increase in access to treatment has slowed in recent years.

Get to Zero HIV: Run for a reason

Echoing the messages and themes from ICAAP11, several key events took place during the days leading up to the conference. For the Bangkok Marathon, Thailand’s largest sporting event, official sponsor Standard Chartered Bank Thailand teamed up with UNAIDS Asia and the Pacific to promote HIV awareness under the theme Run for a Reason: Get to Zero HIV.  Many of the 57,000 runners taking part in the marathon and ‘fun-walk’ events, wore Get to Zero HIV t-shirts and hats, and carried banners promoting the theme. UNAIDS Deputy-Executive Director Jan Beagle officially started a number of the race events accompanied by CEO and President of Standard Chartered Thailand Bank Ms Lyn Kok and dignitaries from the National Jogging Association of Thailand.

On 29 August at the AIDS Vaccine Efficacy Consortium (AVEC) Summit for an AIDS-Free Generation in Thailand, a Thailand-United States partnership working on the development of an HIV vaccine has announced its commitment to build on the success of previous trials, giving a renewed push to vaccine research.

In 2009, the landmark RV144 Thai vaccine study—jointly developed by the Thai health ministry and US military researchers—proved the first evidence in humans that a safe and effective preventive HIV vaccine is possible. Results of the RV144 found 31.2% efficacy at the end of the study among 16 000 Thai volunteers.

Building on this, researchers will work to improve the levels of protection found previously and conduct additional trials in Thailand over the coming years, focusing on key populations at higher risk of infection, including men who have sex with men. The aim of the on-going research is that a modified version of the vaccine would raise the protection rate to around 50%—the figure needed to obtain regulatory approval for public release.

The Thai Government will take a leadership role by supporting the future HIV vaccine efficacy study and assisting in the establishment of flexible manufacturing systems and infrastructure that could support the production of a registered HIV vaccine.

UNAIDS Goodwill Ambassador Mr Myung-Bo Hong (second from left) was accompanied on the visit to Thailand by his two sons: 12-year-old Jeongmin (left) and 14-year-old Seongmin, standing next to UNAIDS Executive Director Michel Sidibé. Credit: UNAIDS

South Korean football star Hong Myung-bo—a UNAIDS International Goodwill Ambassador—described his HIV fact-finding visit to Thailand this week as an “eye-opening experience” and a great learning opportunity.

“I’ve been able to see first-hand the tremendous work that UNAIDS and its partners are doing in Thailand and across Asia,” said Mr Hong, who played for South Korea’s national football team in four consecutive World Cups (1990-2002) and is currently Korea’s Olympic Football Team coach.

“A football match lasts 90 minutes and even if you are leading in the first half, you can still lose the match,” said Mr Hong, adding, “We cannot afford to drop the ball” in terms of HIV awareness.

During his five-day mission, Mr Hong visited community organizations and met with members of key affected populations in the national HIV epidemic, including female sex workers at the Empower Foundation—a national non-governmental organization that protects the rights of female sex workers.

Mr Hong pledged to share impressions and highlights from the visit on his return to South Korea with key stakeholders and to underline the importance of shared responsibility and continued funding for the AIDS response. While connecting with UNAIDS Executive Director Michel Sidibé in Bangkok, he shared his plan to arrange a charity football match in December to raise money for AIDS-related projects in the region.

“The power of sport is impressive and can be an agent for change, especially for young people,” said Mr Sidibé, who was in Thailand as part of a three-country official mission in South-East Asia. “Mr. Hong is a compelling voice to empower young people to protect themselves from HIV—to address stigma and discrimination against people living with and affected by HIV.”

During his visit to Thailand, Mr Hong took part in a football training session for coaches organized by Thailand’s National Olympic Committee and the Physical Education Institute.

Mr Hong was accompanied on the visit to Thailand by his two sons, 14-year-old Seongmin Hong and Jeongmin, aged 12. While meeting with Mr Sidibé, Seongmin presented the Executive Director with a US$ 3000 donation, which he had raised at an art exhibit for AIDS.

Mr Sidibé applauded the young man’s initiative: “You have made a very powerful gesture. Efforts like yours show that we can be inclusive, tolerant, open and compassionate—that we can all work together to stop HIV.”

Thailand’s Deputy Prime Minister and chair of the National AIDS Committee, H.E. General Yuttasak Sasiprapha giving an address at the launch of Thailand’s new national AIDS plan.
Credit: UNICEF Thailand / P.Kitatnaruyuth

Thailand has become the latest country in the Asia and the Pacific region to align its national AIDS strategy with the UNAIDS vision of getting to zero new HIV infections, zero discrimination and zero AIDS-related deaths.

Launching the country’s new national strategy on HIV/AIDS 2012-2016—entitled ‘AIDS Zero’—the chair of the National AIDS Committee, H.E. the Deputy Prime Minister General Yuttasak Sasiprapha noted that, “Thailand has a long tradition of close cooperation between government, non-government organizations, civil society, communities and private sector, and this working together will lead Thailand to ‘AIDS Zero’.”

Over the past 25 years, Thailand has become known as a model for its rapid and multi-sectoral HIV response. Early investments in the HIV epidemic have shown concrete results including in the elimination of new infections among children—nearly 97% of women living with HIV in Thailand are now accessing services for the prevention of mother-to-child transmission. There has also been a dramatic increase in providing access to HIV treatment which is now a reality for nearly 80% of all in need.

However, despite significant progress, the country is still experiencing concerning trends among key populations at highest risk including people who inject drugs, men who have sex with men and sex workers, particularly in urban centres. National spending data shows that investments in HIV prevention are under-resourced, particularly for programmes focused on populations most at risk of HIV.

The new national AIDS strategy addresses two critical questions: What is Thailand doing well that should continue, and what needs to change to get to zero new HIV infections, zero AIDS-related deaths, and zero discrimination? Accordingly, the plan has two main strategic directions: ‘Innovation and Change’ and ‘Optimization and Consolidation’.

The ‘Innovation and Change’ prong focuses on promoting strategies to better prevent new HIV infections—particularly among key affected populations; to better localize responses and ownership at the sub-national level; and to better address the socio-environmental factors which hinder access to HIV prevention and care services, and fuel stigma and discrimination.

Under the ‘Optimization and Consolidation’ section, strategies aim at continuation, optimization and sustainability of proven programmes already carried out in the country. Examples of strategies falling under this area are on the elimination of new infections among children and HIV prevention among young people, where Thailand has already seen significant progress.

Among the strategic goals emphasized in the new plan is the aim to reduce new HIV infections by two thirds by 2015—over and above the global goal agreed through the 2011 Political Declaration on AIDS of reducing new infections by 50%. The strategy also aims for total elimination of new HIV infections among children.

“The new approach recognizes that while impressive progress has been made in a number of areas in Thailand, there is still room to push forward on certain priorities that may have already been defined in the past but have thus far not been implemented,” said UNAIDS Country Coordinator for Thailand, Michael Hahn. “By operationalizing these new strategies—and ensuring dedicated resourcing through domestic and international sources—Thailand is taking critical steps towards making ‘getting to zero’ a reality in the country.”

Representatives from government, civil society and the international community agreed that the most important thing now is turning the strategy into action as soon as possible. It was also highlighted the need for stakeholders to mobilize adequate resources, national leadership, and effective management to ensure that the Thai national AIDS strategy moves from principle to reality. 

In Asia and the Pacific, a number of countries and regional bodies have realigned their national strategies and goals around the ‘Getting to Zero’ vision. At their 2011 Summit, the ASEAN Heads of State adopted a Declaration to ‘Get to Zero’ on HIV and reaffirmed their commitment in working towards realizing an ASEAN community with Zero HIV Infections, Zero Discrimination and Zero AIDS-related Deaths.

Sex workers share their ideas for new business ventures that will bring greater economic independence.
Credit: ILO

When San, a sex worker in Bangkok, was given the opportunity to participate in a pilot business skills training scheme, she jumped at the chance. She wanted to put her idea of setting up a bakery into practice.

“I’ve always enjoyed baking and so I was interested in starting a part-time baking business to add to my income from sex work,” she said.

Sitting in the red-light district office of Empower Foundation, a sex worker advocacy group, San chats with Au and Wii, fellow graduates of the International Labour Organisation (ILO) Community-based Enterprise Development (C-BED) training. Au is working on a business plan in partnership with another C-BED graduate to start a food delivery service supplying spicy Thai salad to apartment buildings around Bangkok. And Wii intends to open a small store specialising in traditional clothing.

C-BED is a new tool which builds the capacity of current or aspiring entrepreneurs through self-facilitated business skills modules which rely on activity-based, participant-run, social learning principles.

Sex workers face a range of challenges in their daily lives such as long working hours, employment-related violence and a lack of access to health care and social security benefits. They also have an increased vulnerability to HIV: nearly 3% of brothel-based sex workers were living with HIV in 2009 and one 2007 study showed their HIV prevalence as high as 20% in Bangkok and Chiang Rai.

Empower Foundation and other similar groups in Thailand have been calling on the government and development agencies to address the economic vulnerability of sex workers and to create access to additional forms of income generation. The C-BED training addresses this gap through a low cost, innovative methodology emphasising the value of recognising and sharing community knowledge.

“C-BED empowers vulnerable groups, including sex workers and HIV-positive people, to improve their means of income generation,” says Richard Howard, ILO Senior Specialist for HIV/AIDS in Asia Pacific. “Economic empowerment can support sex worker efforts to negotiate for better, safer working conditions free of violence and harassment with improved access to health services, including HIV prevention, treatment and care.”

The recent initial C-BED training took place over three days in Empower’s office, facilitated by a team of staff and volunteers involved with the sex worker community. The 26 female sex worker participants, aged 18-72, had varying levels of literacy so business theory was explained and demonstrated through a series of activities including drama, drawing and discussions. Key entrepreneurial topics included marketing, bookkeeping, productivity, personnel management, costing and quality control, with participants creating action plans.

“I liked that everyone had a chance to introduce their business idea without fear - it was fun and not stressful so everyone was able to learn more,” said one participant. She added, “I now think I can have my own business.”

C-BED is designed for untrained, but literate, participants from the community to facilitate group sessions, so they can share their increased knowledge and expertise.  As the facilitator does not require training or expensive materials, C-BED can be implemented at minimal cost in vulnerable or hard-to-reach communities which would traditionally be inaccessible due to social or geographical isolation.

UNAIDS Country Coordinator, Michael Hahn, welcomes the project. “This is a really good example of an activity designed and implemented with the full participation of sex workers. The business skills they gain will help widen their choices about how they best want to shape their lives and their futures.”

ILO plans to roll out C-BED in partnership with sex worker organisations in Thailand, Cambodia, Vietnam and Sri Lanka over the next two years, aiming to reach more than 2 000 sex workers by the end of 2013.

Since completing the training, San has started a bakery in Samut Sakhorn and hopes one day she can employ staff to help her expand. “C-BED gave me the confidence to start out on my own,” she says.

Many of Thailand’s more than five million migrants find themselves in situations that heighten their risk of HIV and have difficulty accessing key services such as antiretroviral therapy.
Credit: UNDP

Migration plays an integral role in Thailand’s economic development and the country hosts more than five million migrants from Cambodia, Lao People’s Democratic Republic (PDR) and Myanmar.

Many migrants however find themselves in situations that heighten their risk of HIV and have difficulty accessing key services such as antiretroviral therapy (ART). A recent regional conference, organised by the UN Development Programme (UNDP) and the Joint Initiative on Mobility and HIV/AIDS (JUNIMA) from 24-25 April explored ways of ensuring better provision of ART to this potentially vulnerable group.

Although migration is not in itself a risk factor for HIV, it can increase vulnerability, such as exploitative working conditions, which may include sexual violence; and separation from spouses/partners, families and established social and cultural norms and values.

A new study in the six provinces most affected by HIV in Thailand has shown that Cambodian migrants bear the highest burden with an HIV prevalence of 2.5%. The estimated adult prevalence in the country as a whole is 1.3%. 

The Government of Thailand has taken steps to ensure that migrants have access to ART. Speaking at the conference, Dr Petchsri Sirinirund, Director of the National AIDS Management Centre at the Ministry of Health’s Department of Disease control said, “In the new national strategy for 2012-2016, we aim to provide access to quality HIV treatment and care for any person living with HIV in Thailand, regardless of their nationality.”

There is provision of antiretrovirals (ARVs) for certain categories of low skilled migrants but there are more people in need. Those who are officially registered can pay a fee for universal health coverage which includes HIV treatment and a limited number of people with temporary papers, some 2 300, receive ART through Thailand’s Global Fund project.

Political commitment to providing high quality care, including antiretrovirals, is also evidenced by the establishment of a Memorandum of Understanding on Joint Action to Reduce HIV Vulnerability Associated with Population Movement. This was signed in December 2011 by the six members of the Greater Mekong Sub-region (Cambodia, Lao PDR, Myanmar, Thailand, Vietnam and the Yunnan Province of China). A Joint Plan of Action for the memorandum is being formulated.

In addition, Thai and Cambodian authorities have collaborated on a scheme which allowed Cambodian migrants to return to their home country to obtain a three month supply of ARVs.

However, many migrants are not in a position to access antiretrovirals. Each health scheme has a cost to individuals ranging from the equivalent of around 45 US dollars to 90 US dollars and there is also a long waiting list for treatment. A number of those who are unregistered never come to the attention of authorities and therefore receive no help.  

The challenges of cross border navigation of different regulations, health systems, and languages, as well as the often temporary nature of migration, make it particularly challenging for migrants living with HIV to access ART along the migration continuum and to adhere to drug regimens.

Furthermore, being given ART does not only involve obtaining the drugs themselves but also ensuring access to wider HIV services like voluntary and confidential counseling and testing as an entry point to treatment.

According to Promboon Panitchpakdi, Executive Director of the Raks Thai Foundation, a development NGO, “While we need to focus our discussion on availability of ARVs as a commodity, what also needs to be in place is a comprehensive system of medical and social care that is backed up by national and regional policy.”

A number of recommendations emerged from the UNDP/JUNIMA conference. These included: examining ways to use TRIPS intellectual property and free trade agreement flexibilities to lower the cost of treatment services and increase coverage for migrants; harmonize treatment and referral protocols across countries; and ensure that in addition to treatment, migrants have better HIV services available. 

Rathin Roy, Manager of UNDP Asia Pacific Regional Centre, is confident that migrants will be increasingly better served. “Thailand is a pioneer in implementing the human principle that migrants can access the same quality of HIV services and commodities that are available to citizens, and UNDP, through JUNIMA, is pleased to work in partnership with government and civil society across borders to address the challenges that will allow all migrants in need to access vital HIV treatment.”

Representatives from the community of people living with HIV and key populations most at risk urge governments in Asia and the Pacific to work with them to reach global AIDS targets and commitments.
Credit: UN ESCAP

Dressed in a striking blue and red shalwar kameez (traditional dress from South and Central Asia), Akkai, a transgender woman from Bangladesh, steps onto the stage. Turning to her audience of government officials from Ministries of health, justice, public security, drug control, social protection; United Nations officials; and fellow members of key populations most affected by HIV, she started to sing:

“I born as me/ My feelings changed… / I started behaving like a girl / I started walking like a girl / I started dressing as a girl / When my parents forced me to stop myself /  I was beaten up / I was locked up / I was tortured…./ …There was nobody to ask these things / … / This kind of torture, violence, harassment /  Is not faced only by me / Where to live?/ Where to share?/ Where to survive our life?”

Joining the scene, the coordinator of the Women’s arm of the Asia-Pacific Network of people living with HIV explained: “I have been living with HIV for 17 years. Fortunately I have had access to treatment. But now free-trade agreements are compromising access to essential medicines,” she said. “Eighty percent of generic medicines are made in this region. Without access to affordable medicines we cannot get to zero,” she added.

These personal experiences were two of many shared by people living with HIV and key affected populations at the United Nations Economic and Social Commission for Asia and the Pacific (UN ESCAP) high-level intergovernmental meeting held in Bangkok, Thailand from 6-8 February 2012. The meeting was an opportunity to review the region’s progress towards international targets on AIDS.

“For the first time in history we have the possibility to end AIDS and Asia-Pacific nations have shown we can lead the world in making an impact. But we cannot ignore the challenges our region faces and how these can jeopardize our ability to progress,” H.E. Ratu Epeli Nailatikau, President of Fiji, who underlined his long-term commitment and leadership on HIV as Chair of the high-level talks.

Representatives from the most-affected communities urged government delegations from Asia-Pacific nations to recognize the existing challenges in accessing HIV services posed by punitive laws and practices, threats to continued availability of HIV treatment and widespread stigma and discrimination. They also called upon governments to work increasingly with communities to ramp-up action to reach HIV goals.

The call to action was heard. By the end of the three-day talks, co-convened by UNAIDS and other UN partners, the nations present endorsed a framework to fast-track regional action on AIDS towards the achievement of global targets and commitments by 2015. Countries agreed to create ‘spaces’ for key affected communities—including people who use drugs, men who have sex with men, people who buy and sell sex, and transgender people—to be involved in the development of practical solutions to legal impediments and HIV service scale-up at the policy and programmatic level.

“It was recognized here that we have to find new ways to reach the maximum amount of people in the short time we have before 2015,” said UNAIDS Director of the Asia-Pacific Regional Support Team, Steven Kraus. “And there is no question; this must be done hand-in-hand with the community.”

Akkai, a transgender woman from Bangladesh, sings about the stigma and discrimination she faces.
Credit: UN ESCAP

In recent years, Asia and the Pacific has experienced significant progress in reduction of new HIV infections, increase on numbers of people receiving antiretroviral treatment and expansion of programmes to reach key populations most at risk.

Examples given by a number of countries at the Bangkok talks illustrated that scaled up HIV services coupled with intensive engagement of key affected populations, have led to declining epidemics. In Thailand for example, the transgender people-led initiative “Sisters”, which provides social services and support to transgender people in the Pattaya area reports that HIV incidence fell from 12 to 8% among people using its services in the last 5 years.

With such examples of progress, the importance of developing the next generation of community leaders is a central regional priority. The new Asia-Pacific framework for accelerated action underlines that young people from key affected populations must be heard, heeded, and have space at the policy and programme tables.

Emphasizing the readiness of young people most affected by HIV to take on a leadership role in the region’s future HIV response, Coordinator of Youth LEAD, the regional network for young HIV key affected populations, Thaw Zin Aye said: “Young people are taking ownership of the AIDS response and we are committed to carrying on the legacy. We urge governments to continue taking action with us.”

The endorsed regional framework emphasizes the need to share good practices and lessons learned in implementing the measures and commitments related to HIV. Asia-Pacific countries also requested UN ESCAP, UNAIDS and other cosponsors to support implementation of the road map.

24-year old Ayu Oktariani from Indonesia who is living with HIV is part of the Youth LEAD network for key affected populations.
Credit: UNAIDS

When Palitha Wijebandara from Sri Lanka found out he had tested positive for HIV, he was shocked and confused. He had been tested as part of a company policy at his work, without his specific consent or proper counseling, and he did not understand the implications of his test result.

Palitha is one of many thousands of people in Asia and the Pacific who have faced the challenge of discovering their HIV status in their youth. At only 23 years old, he was alone. He did not know how to face his family. He feared discovery of his status and of the fact that he had been having relations with other men.

In Asia and the Pacific, evidence indicates that 95% of all new HIV infections in young people in the region are among young people from key affected populations—young people who buy and sell sex, young men who have sex with men, young transgender persons and adolescent drug users.

Specific data on young people at higher risk of HIV in the region is sparse. But estimates that do exist give cause for concern. In some Asian countries, three out of five female sex workers, and almost half of all men who have sex with men, are younger than 25 years. In the Lao People’s Democratic Republic, 82% of sex workers are in that age group. In Nepal, half of all people who inject drugs start injecting in their late adolescence, when they are between 15 and 21 years old. By the time someone has been injecting for a year, there is a 33% chance that they will have acquired HIV.

Multiple challenges

Despite high vulnerability to HIV infection, young people at higher risk find it difficult to obtain information on HIV, sterile injecting equipment, or other services such as HIV testing and support. Across Asia-Pacific, programmes focusing specifically on young people most at risk are often scarce.

“Prevention campaigns don’t reach out to young female sex workers as often we do not come out to access the information, and if we do, it doesn’t speak to us,” said Ms Fulmaya*, a young sex worker from Nepal.

“As a young gay man, some things are hard to say openly and you worry that if you say those things, people will discriminate against you. The first time I wanted to get an HIV test, I had no idea where to get it and I was too scared to go to the hospital,” said Xiao Chen*, 21, from China.

Stigma, the criminalization of certain behaviours and other legal hindrances mean that young people from key populations at higher risk are often difficult to reach. In many countries, taking an HIV test, going on HIV treatment, or using reproductive health or harm-reduction services requires the consent of a parent or guardian.

“I can’t get the free HIV test because I don’t want my mother to know what I’m doing and so I cannot provide the clinic with parental consent. All I want is to know my HIV status,” said Bugoi a transgender sex worker from the Philippines.

Many adolescents find sexually transmitted infection clinics and HIV clinics intimidating, and feel uncomfortable talking about personal issues with clinical staff who are much older than them, and who can be judgmental. Harm-reduction programmes for drug users generally focus on male adults, despite statistics that show some young drug users start injecting as early as 12 years old and the fact that young women also need services.

“I have heard of organizations that give out needles but many are far and they only target the boys,” explained Payal, an 18 year old woman from Nepawho uses drugs.

An often-expressed frustration of young people from key populations at higher risk in Asia is that they often feel they are robbed of the voice to describe, discuss and alter their realities.

“Young people have plenty to say, but their voices aren’t heard. I think if people paid more attention to HIV and strengthened the voice of the community a bit, more people would learn about HIV and understand the issues and what we need,” Xiao Chen* said.

Time to lead

Some significant action is being taken to bring the voice of young key affected populations to the foreground –organizations and networks of young people from key populations at higher risk are gradually becoming strengthened.

Sri Lankan Palitha Wijebandara, who discovered his status through an unauthorized HIV test, drew strength from his involvement in peer support and, recently, from his efforts to promote the rights of young people from key populations at risk through Youth LEAD. This Asia Pacific regional network set up in 2010 is helping develop youth leadership in key populations at higher risk to strengthen their involvement in community, national and regional programmes. Representatives from Youth LEAD and other youth at risk organizations are increasingly being able to take their place at the table in regional policy arenas and debates.

From 6-8 February in Bangkok, Thailand, the need for increased focus on and involvement of young people from key affected populations in the Asia-Pacific AIDS response is one of the central areas of discussion at a high-level United Nations meeting. Young people from key affected populations are joining government leaders and senior officials from across Ministries of health, justice, law enforcement, social development and drug control agencies as well as their older civil society counterparts from key affected populations and people living with HIV to address legal and policy barriers that impede access to HIV services in the region.

According to UNAIDS Director of the Regional Support Team for Asia and the Pacific, Steve Kraus, the regional UN gathering on AIDS provides the ideal opportunity for young people from key communities to “Be loud, be heard and be honest about the critical things you need to make Getting to Zero a reality in this region.”

For 24-year old Ayu Oktariani from Indonesia who is living with HIV, and participating in the Bangkok meeting with Youth LEAD, the message is simple: “We need to be empowered and supported so that we can take ownership of AIDS. We are here to say please include us, listen to us, work with us and together we can achieve great things.”

 A longer version of this feature first appeared in the UNAIDS publication: HIV in Asia and the Pacific - Getting to Zero, August 2011.

* Some names have been changed on request to protect the identities of the interviewees

Resolution 67/9 on HIV was endorsed at the 67th UN ESCAP Commission held in Bangkok, Thailand from 19-25 May 2011. Credit: UN ESCAP

In the lead-up to the 2011 General Assembly High Level Meeting on AIDS to take place in New York from 8-10 June, the 62 Members and Associate Members of the United Nations (UN) Economic and Social Commission in Asia and the Pacific (ESCAP) have unanimously adopted a new Resolution on HIV. The resolution reconfirms commitment of countries in the region to reach universal access to HIV prevention, treatment, care and support and to address critical barriers hampering responses to AIDS.

Cosponsored by the Governments of Indonesia, Australia, Fiji, Thailand and Myanmar, the 67^th Commission Session, held at the ESCAP headquarters in Bangkok, Thailand, passed the Resolution on Wednesday 25 May 2011.

The HIV Resolution was developed following the Asia Pacific Regional Consultation on Universal Access held at the end of March, at which over 250 representatives from governments, international organizations, donors and civil society from nearly 30 countries agreed upon necessary actions from the region towards the vision of zero new HIV infections, zero discrimination, zero AIDS-related deaths.

“Thirty years since AIDS was first discovered, many countries have made progress in their HIV responses, but the agenda is unfinished. To ‘get to zero’ we need to unite as a region and redouble our efforts, making sure they are focused to reach those who need them most,” said Dr Nafsiah Mboi, Secretary of the Indonesian National AIDS Commission.

Recalling previously adopted Resolutions and commitments on HIV made by the Commission, ESCAP Resolution 67/9 calls upon members and associate members to further intensify actions to reach the unmet goals and targets of the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS.

The Resolution emphasizes members’ agreements to support the achievement of 80% coverage for populations at higher risk including people who use drugs, people who buy and sell sex, men who have sex with men and transgender people, with a view to achieving targets on universal access to HIV services.

“We welcome this strong endorsement by Members of ESCAP. With less than one month to go before the High Level Meeting on AIDS, this Resolution is timely and shows the commitment of the region to respond to HIV and particularly to removing barriers which can hamper progress,” said UNAIDS Regional Director, Steven Kraus.

The new declaration calls on governments in the region to ensure the commitment of a greater proportion of national resources to improve the programmatic effectiveness of the HIV responses. Resolution 67/9 also urges a review of national laws, policies and practices to enable the full achievement of universal access targets with a view to eliminating all forms of discrimination against people affected and infected with HIV. Finally, it underlines that to better address HIV, countries must continue to develop their national strategies to address all forms of gender-based violence, including sexual violence, particularly against women and girls.

UN ESCAP’s Social Development Director, Nanda Krairiksh underlined the significance of the Resolution endorsement for the region: "Governments in the Asia-Pacific region are moving forward to ensure greater effectiveness in national HIV responses. They are calling for greater financial sustainability, resource allocation and scaling-up of the full range of actions to ensure universal access to HIV prevention, treatment, care and support," she said.  

Steve Kraus, Director, UNAIDS Regional Support Team for Aisa and the Pacific, gives an overview on the epidemic and response in the region. Credit: UNAIDS / V. Dithajohn

Nearly 30 countries from Asia and the Pacific have unanimously committed to driving forward the region’s efforts to reach universal access to HIV services by 2015.

This commitment came as more than 250 representatives from government, civil society, people living with HIV, UN agencies and development partners from across the region met in Bangkok, Thailand from 30-31 March, to review progress made and to develop key actions to achieve universal access to HIV prevention, treatment, care an support.

Through a Resolution, unanimously adopted at the end of the review, participants underlined the need for an HIV prevention revolution focusing on key populations at higher risk. Also, the need to sustain gains made in the provision of HIV treatment and to take urgent action to address legal barriers, stigma and discrimination and funding gaps that block progress in the region’s response to AIDS. The Resolution will now be presented to the 67^th Commission of the UN Economic and Social Commission in Asia and the Pacific where it will be considered for official adoption by the entire Commission comprising 62 Member governments.

“This is a region showing it is serious about an effective Asia Pacific response to AIDS, and is willing to stand up for sex workers, people who use drugs, men who have sex with men, transgender persons and policies that uphold the human rights of people living with HIV,” said Mr Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific. “Commitment and energy have produced a strong and clear agreement on how to achieve universal access in Asia Pacific, giving a strong regional voice in the lead up to the UN High Level Meeting in New York in June,” he added.

Over the two-day meeting, hosted by UNAIDS in collaboration with the UN Economic and Social Commission in Asia and the Pacific, participants noted important progress in the region to date, including that HIV epidemics have significantly slowed or stabilized across the region and that a number of the countries are reaching high levels of coverage for antiretroviral treatment.

However, critical challenges were raised as no country in the region is reaching universal access to HIV prevention, treatment, care and support. One in three people in the region do not have access to HIV treatment; 60% of people living with HIV in the region do not know their HIV status; and key affected communities continue to be subjected to stigma and discrimination, punitive laws, policies and practices which obstruct access to HIV services. Many countries in the region—including those with or approaching middle-income status—rely heavily on international funding for their AIDS responses.

Speaking at the opening, Dr Siriwat Tiptaradol, Deputy Permanent Secretary from the Ministry of Health in Thailand urged countries to make health is a policy priority and to ensure a partnership response: “Progress on universal access can only be possible when different arms of the same government, together with civil society, join together with common goals.We must find ways to support each other, particularly at the regional level, to make AIDS funding a collective responsibility.”

Igor Mocorro, a member of ‘Youth Lead’, addresses the plenary at the Asia Pacific Regional Consultation on Universal Access. Credit: UNAIDS / V. Dithajohn

In times of fiscal austerity and competing development priorities, the need to sustain momentum on HIV was echoed throughout the Consultation. “The world’s most populous region cannot afford complacency on AIDS. Political leadership with civil society and the key affected communities as the cornerstone of the response requires fresh perspectives from the ground,” said ESCAP Social Development Division Director, Nanda Krairiksh.

Strongly emphasized was the critical importance of continued engagement and motivation of the region’s youth—particularly those from key populations at higher risk. Young leaders underlined the importance of the full involvement of young people in the HIV response and urged national leaders and partners to ensure their voices are equally heard and heeded.

“We have the passion for change and it’s time for leaders to take young people seriously as equal partners and key actors in society,” said Igor Mocorro, a member of ‘Youth Lead’, a programme to develop youth AIDS leaders from key affected populations. “We know the realities; we can make a difference.”