Fiji's President Ratu Epeli Nailitikau reads the report Secret lives, other voices at the launch.
Credit: UNAIDS/Kim

At the 10th International Congress on AIDS in Asia and the Pacific a new study called Secret lives, other voices was launched. It explores sexuality, gender identity and HIV transmission risk in Fiji, and represents the first research of its kind to be conducted since 1998 among men who have sex with men and transgender people in the country.

The launch was attended by Fiji's President Ratu Epeli Nailitikau.

With more than 200 respondents, the research project engaged staff members and volunteers from the AIDS Task Force of Fiji's Amithi Project and the AIDS Council of New South Wales.

Conceived with the aim to inform the HIV response and the development of community-based activities, the research was conducted by members of the community.  Research staff included men who have sex with men and transgender people, from a variety of social and ethic background, who were involved in each stage of the process including planning, data collection, analysis and reporting.

The report found that men who have sex with men are at high risk of HIV in Fiji. Only 21.6% of respondents consistently used condoms during anal sex with a male or transgender partner in the previous six months. More than one in five reported never using them.

Although there are high levels of knowledge about HIV, with over 66% of respondents answering questions correctly about transmission, the knowledge is not translating to behaviour.

The study also explored transactional sex and found that two thirds of the respondents reported giving or receiving money, gifts or favours in return for sex, making this a common experience.

Of the respondents only 10% had taken an HIV test in the preceding 12 months and knew the results. Barriers to testing included confidentiality and privacy issues as well as respondents reporting judgmental attitudes by clinic staff.

Many of the study participants had experienced some form of stigma and discrimination. About two thirds felt unsafe and uncomfortable expressing their sexuality or gender. About 57% reported experiencing verbal abuse and a third had been physically hurt in the previous six months.

The report recommends that HIV prevention and health interventions should be culturally appropriate and focused on reaching different groups within the men who have sex with men and transgender community, many of whom self identify in different ways. Access to HIV testing that is friendly should be scaled up and health care workers need training to best support the needs of men who have sex with men and transgender people, according to the authors.

In addition, the report recommends a concerted effort to challenge stigma and discrimination and increase psychosocial and support services. Men who have sex with men and transgender people are also encouraged to develop mobilizing skills to make sure their voices are heard.

"With technical support from UNDP and ACON we were able to show that civil society has the capacity to complete in-depth research projects to a recognizably high standard," said Niraj Singh, Project Manager with the AIDS Task force of Fiji and co-author of the report.

"The AIDS Task Force of Fiji has a very clear vision of the priorities leading from research to action. We now have a baseline which will help us to design and implement effective programmes to reach a diverse range of men who have sex with men and transgender people in Fiji. This study represents a valuable contribution to ongoing national and regional efforts to ensure that these communities are better served and better protected," he concluded.

The Secret lives, other voices project was funded by the United Nations Development Programme (UNDP).

While the number of people living with HIV receiving antiretroviral therapy (ART) in Asia and Pacific almost tripled from 280 000 in 2006 to 739 000 in 2009, coverage remains low and only one in three people living with HIV had access to treatment in the region that year.

Early and equitable access to treatment in is hampered by stigma, discrimination and inaccessible service delivery. Limited use of rapid diagnostic and poor linkages between HIV testing and counseling and treatment results to delayed initiation of treatment. Funding constraints also hamper scale up and sustained access to ART.

With 4.9 million people living with HIV in the region, six courtiers account for over 90% of people eligible for treatment: China, India, Indonesia, Myanmar, Thailand and Viet Nam.

Treatment 2.0: the next phase of ART

Against this backdrop, the World Health Organization and UNAIDS Regional Support Team in Asia and Pacific, together with the Asia and Pacific Network of People Living with HIV Working Group (ANP +) organized a session to explore the critical components Treatment 2.0, an innovative approach to treatment on the second day of the 10^th International Congress on AIDS in Asia and the Pacific.

Treatment 2.0 is an initiative coordinated by UNAIDS and WHO to catalyze the next phase of HIV treatment scale-up, grounded in public health and human rights. The approach aims at universal and sustained access to antiretroviral treatment through radical simplification and innovation of treatment regimens, renewed commitment and resources, with a focus on decentralized delivery systems and greater involvement of communities. 

“Substantial gains can be achieved through appropriate task-shifting and community-based delivery systems,” said Dr Iyanthi Abeyewickreme, HIV/STI Regional Advisor at WHO Regional Office for South-East Asia. “Decentralized services will help to leverage scarce resources to maximize their effect.”

Human and economic benefits

With 60% of people eligible for treatment in the region still not yet able to access it, need for scale up is urgent. There is ample evidence of the human and economic benefits of antiretroviral therapy for people living with HIV. In China, for example, it is estimated that the provision of free antiretroviral therapy has lead to a 64% drop in AIDS related mortality.  A resent study has also shown that the risk of transmitting HIV to an uninfected sexual partner can be reduced by as much as 96%, when people living with HIV receive timely and effective antiretroviral therapy.

John Rock, of APN +, stated that enhanced understanding of the life-saving benefits of treatment is needed: “In our region some people living with HIV do not even know that HIV can be treated,” he said. He also warned that treatment access needs to be safeguarded against terms of free trade agreements that could affect affordability and availability. Treatment scale up in the region necessitates increased and sustained financing. But experts at the Treatment 2.0 session underlined that investment now will ensure savings in the future.

What is needed to scale up treatment?

Dr Bob Verbruggen, of the UNAIDS Regional Support Team in Asia and Pacific said, “Funding is critical to take advantage of the multiple new opportunities and developments within the treatment arena. Implementing Treatment 2.0 will require important short-term funding from both international and domestic sources, but will yield huge savings in the medium and long term if we simultaneously invest in high-impact HIV prevention programmes.”

The session highlighted country experience and key steps to roll-out Treatment 2.0 in the Asia and Pacific region, and preliminary results from pilot countries such as Viet Nam. Some of the recommendations made included combined action of optimizing drug regimens, advancing point-of-care and other simplified platforms for diagnosis and monitoring, reducing costs, adapting delivery systems, and mobilizing communities and protecting human rights.

Dr Nafis Sadik, United Nations Secretary-General Special Envoy for HIV/AIDS, Dr Kent Buse, Senior Advisor at UNAIDS and Dr Werasit Sittitrai, Thai Red Cross on the panel of “Thinking Politically.”
Credit: UNAIDS/Kim

Activists, academics and HIV programme implementers met in Busan, South Korea at the 10th International Congress on AIDS in Asia and the Pacific (ICAAP 10) to explore and debate the political complexities of HIV responses. The event, entitled ‘Political Sciences and the Politics of HIV in Asia and the Pacific,’ shed light on the often highly contested nature of responses to the epidemic.

This satellite was part of a global initiative spearheaded by UNAIDS and the International AIDS Society, ‘Thinking Politically about HIV.’ The initiative seeks to strengthen the capacity of people engaged in the response to understand and influence politics in a more systematic way in order to foster an enabling environment for effective AIDS responses.

Panellists shared experiences of effective political analysis which have been used to identify strategic opportunities to move the agenda on HIV in a positive direction in countries across the region.

“When I began my work in reproductive health, I found enormous suspicion and ignorance, even among highly educated people. A great deal of that negativity has disappeared,” said Dr Nafis Sadik, United Nations Secretary-General Special Envoy for HIV/AIDS. “Political leaders came to understand that they had more to gain than to lose by responding to the enormous latent demand for reproductive health services, especially among women — and the same holds true for HIV.”

A number of countries in the Asia-Pacific region have shown impressive political responses over the last ten years. Thailand is one of the heralded ‘success stories’ in the 1990s resulting in dramatic declines if new HIV infections from 143,000 new infections in 1991 to 29,000 in 2000. Speaking at the session, Dr Werasit Sittitrai of the Thai Red Cross explained how that these results were achieved through a transformation of the political landscape, driven by evidence-based advocacy and civil society pressure. “One of the most successful strategies was advocating the potential economic consequences of inaction to political leaders,” he said.

While the region has much to progress to celebrate, the HIV response is at a crossroads. Programmes are buffeted by donor fatigue and many countries retain laws and policies that effectively prevent people living with HIV and key populations at higher risk from access to life saving services. In this context, a better appreciation of the politics of the challenges is critical to continued success — particularly by the next generation of leadership.

According to Dr Kent Buse, chair of the session and Senior Advisor at UNAIDS, “the AIDS response is particularly political because some of the behaviours that put people at risk of HIV — sex, sex work, and drug use — are taboo in many societies. People living with and affected by HIV have therefore continuously challenged the values and ideologies of leaders and the international community.”

Additional speakers at the event included Professor Dennis Altman, of La Trobe University, co-chair of the Advisory Group for Thinking Politically and Dr David Stephens of RTI International.

Discussion at the session will feed into broader debates and events for the 2012 International AIDS Conference (Washington DC, United States). A special issue of Contemporary Politics, featuring case studies on successful political responses to HIV in a number of countries, is being prepared for publication ahead of the 2012 Conference.

Ngan is living with HIV. She gave birth to her son, who was born free of HIV, because Ngan had access to PMTCT services.
Credit: UNAIDS/ Mott

One of the key goals of the global AIDS response is the elimination of new HIV infections among children by 2015 and keeping their mothers alive. In Asia and the Pacific, both Thailand and Cambodia are on track to reach this goal. However, overall, coverage of prevention of mother-to-child transmission is well below global averages, with very wide variations across the region.

During a symposium held on August 27 during The 10th International Congress on AIDS in Asia and the Pacific, experts explored how the 2015 elimination goal could be best achieved in Asia and the Pacific and what immediate concrete steps need to be taken. Organised by the United Nations Children’s Fund (UNICEF), the World Health Organisation (WHO) and UNAIDS, the session also reviewed progress on prevention of mother-to-child transmission of HIV and discussed opportunities and challenges.

The event was intended to build on both the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive,  launched in June 2011, and a regional UN Task Force framework on the issue developed in November last year.

Participants heard that improved coverage of prevention of mother to child HIV and congenital syphilis services, better monitoring of mothers living with HIV and their children and greater coordination among health services in the region are critical to eliminating new infections in children.

“To reach the goal of zero new infections among children by 2015, national health services and communities need to work together,” said Steven Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific in conjunction with the session. “By coordinating efforts, not only will lives be saved and HIV transmission to children be halted, but national health systems will be strengthened as well.”

Anupama Rao Singh, UNICEF Regional Director for East Asia and the Pacific, maintained that while countries in the region are working to scale up the elimination of new HIV infections among children, there was a need  increase monitoring. “A lack of critical monitoring means they do not know how many children born to HIV-positive mothers are free of HIV and how many are infected,” she added, “Improved monitoring, especially through strong data management and follow-up, will go a long way towards our ultimate goal of having zero new infections among the region’s children.”

Without proper follow up systems, many of the children infected with HIV at birth or through breastfeeding will not be treated and about half will die before their second birthday.

The need to scale up antiretroviral (ARV) therapy was also highlighted. 

"Technologies like the WHO 2010 recommendations for ARV drugs for treating pregnant women and preventing HIV infections in infants exist and we know what needs to be done. Now we have a new strategy to do it more efficiently and effectively in ways that also contribute to stronger health services,” said WHO South East Asia Regional Director, Dr Samlee Pliangbanchang. “The vision for a new generation free from HIV is within our reach."

By providing high-quality, coordinated, antenatal care and family planning services, identifying and treating pregnant women living with HIV and syphilis, and providing follow-up treatment for children, countries in the region can achieve the goal of zero new infections among their children and keeping their mothers alive, the participants concluded. 

UNAIDS Executive Director Michel Sidibé and President Ratu Epeli Nailitikau engage in discussion during ICAAP 10.
Credit: UNAIDS/Kim

In a meeting with the President of Fiji on 27 August, UNAIDS Executive Director Michel Sidibé commended the Fijian leader and his Government for recent amendments to the country’s 2011 HIV/AIDS Decree. Officially endorsed on 25 August, the amendments remove HIV-related travel restrictions and ensure greater protection for the rights of people living with HIV.

“Mr President, the United Nations salutes the bold and clear decision of your Government earlier this week to lift all travel restrictions for people living with HIV,” said Mr Sidibé. “People around the world need a voice like yours. I want to sincerely thank and recognize your efforts in the global response to AIDS.”

Calling AIDS “a great humanitarian challenge,” President Ratu Epeli Nailitikau said he was committed to not only preventing new HIV infections but also to working with people living with HIV and their families.

“I don’t see any nobler cause than AIDS,” said President Nailitikau. “In the history of Fiji, we lost a third of our population due to measles; whole generations of the community perished. The flu had the same devastating effect. With a population of just 800 000, we cannot afford to lose any more of our population. That, for me, is the driving force of my engagement.”

The UNAIDS office in the Pacific is currently working with the Government of Fiji to translate the recommendations from the June 2011 UN General Assembly High Level Meeting on AIDS into action. Key areas of focus include eliminating new HIV infections among children, ensuring HIV services for key affected populations are available, and implementing the newly-amended Fijian HIV/AIDS Decree.

According to government figures, coverage of services to prevent new HIV infections in children in Fiji is low. Though there has been progress in expanding HIV services for populations at higher risk of HIV infection, stigma and discrimination remain major barriers to access.

While at ICAAP 10, the President of Fiji chaired a session focused on the AIDS response in the Pacific region. Participants addressed the role of faith-based organizations and young people in the HIV response, as well as the importance of providing an enabling legal environment to protect the rights of people living with and affected by HIV.

Migrant worker Sarath shares his experiences with the panel.
Credit: UNAIDS/Kim

There are still about 50 countries, territories and areas around the world that impose some form of restriction on the entry, stay and residence of people living with HIV. Such restrictions remain a key form of discrimination, affecting the rights and freedom of movement of many migrants living with HIV and would-be migrants.

A symposium held at the 10^th International Congress on AIDS in Asia and the Pacific on 27 August brought together expert panellists from various countries with and without HIV-related travel restrictions to discuss the experiences faced by migrant workers and by public health systems. Their aim was to put forward recommendations and concrete policy actions needed to eliminate travel restrictions for migrants living with HIV.

Organized by the Joint United Nations Initiative on Mobility and HIV/AIDS in South East Asia (JUNIMA) and sponsored by UNAIDS, UNDP and ILO, the panel was chaired by Clifton Cortez, the UNDP Practice Team Leader on HIV, Health and Development for Asia and the Pacific.

“HIV is not a condition that should determine whether you are allowed to work or not; however, some 15 countries in Asia and the Pacific impose some form of restriction on the entry, stay and residence of people living with HIV. We surely can be better than that,” said Mr Cortez.

Mr Cortez was joined by Dr Chanvit Tharathep, Thailand’s Ministry of Public Health, Ms Maria Lourdes Marin, Executive Director, Action for Health Initiatives (ACHIEVE), Inc. Philippines, and Dr Lee Hang-Sun from the Ministry of Public Health in South Korea.

Sarath, as a migrant worker, shared experience of the limitations imposed by travel restrictions with the panel: “Testing for HIV and deportation of people who test positive makes no sense neither from a public health perspective nor from a financial point of view. We generate a lot of economic benefits to both sending and host countries and usually fall between the cracks in accessing social services, especially when we are abroad.”

Reintegration of migrants

Ms Marin talked about the reintegration process when migrants deported for their HIV status return home. This is a real issue for the Philippines which sends large numbers of migrants overseas.  

“The reintegration process must be needs-based and responsive to specific contexts of migrants. It needs to be holistic, and address all the dimensions of HIV such as economic, political and psychosocial,” said Ms Marin. “To do that you need to have discussions taking into account all phases of the migration cycle, including pre-departure and post-arrival.”

Some countries hold that HIV-related travel restrictions are imposed to protect their nationals from ‘foreign’ diseases and to avoid increased healthcare costs.  This rationale was refuted by Dr Chanvit from Thailand, a country which does not impose HIV-related travel restrictions:

“By providing universal access to health care for all, including migrants, we have not experienced an overflow of the health care system by migrants. What we have seen however is that we are better able to control infectious diseases and give treatment and care to those that need it.”

Dr Lee shared the South Korea experience: “Some people in South Korea still believe that HIV is a virus that comes from abroad. I hope ICAAP will give us the opportunity to join hands with civil society and work together on addressing the misconceptions regarding HIV.”

The way forward

The panel explored a series of recommendations to eliminate HIV-related travel restrictions and to promote universal access for migrant workers living with HIV. These included:

• Harmonize national policies on HIV and migration, promote collaboration between relevant ministries and civil society groups and support sustained bilateral and multi-country dialogues between sending and receiving countries;
• Establish minimum labour standards and health rights for migrant workers, and ensure that there are protection and support systems for migrants in destination countries;
• Build the capacity of Asian source countries to effectively reintegrate returning migrant workers living with HIV.

JUNIMA brings together governments (including ASEAN Secretariat), leading NGO networks, and the United Nations family, to promote universal access to HIV prevention, treatment, care and support for migrant workers in South East Asia and southern China.

Michel Sidibé, Executive Director of UNAIDS and Vince Crisostomo, Executive Director of the Coalition of Asia and the Pacific Networks on HIV and AIDS.
Credit: UNAIDS/Kim

A wide range of representatives from key affected communities in the AIDS response joined UNAIDS Executive Director Michel Sidibé on 27 August for an interactive dialogue to share their concerns and reflections. The hour-long “Common Ground” session, organized on the second day of the 10^th International Congress on AIDS in Asia and the Pacific (ICAAP 10), was held in memory of Dr Robert Carr, a well known AIDS activist and human rights defender who passed away in May 2011.

“My hope is that this will live up to Robert Carr’s vision of all people coming together, regardless of who we are, what we are and where we are—that we will be able to create spaces that empower our communities to move forward in the AIDS response,” said Vince Crisostomo, Executive Director of the Coalition of Asia Pacific Regional Networks on HIV/AIDS (7 Sisters) and Chair of the “Common Ground” session.

According to a new report from UNAIDS launched ahead of ICAAP 10, HIV infections in the Asia and the Pacific remain concentrated among key populations: people who buy and sell sex, people who inject drugs, men who have sex with men, and transgender people. Most programmes to protect key populations and their intimate partners from HIV infection are inadequate in size and scale. Across the region, stigma and discrimination against people living with HIV and key populations remain rife, the report found.

In his opening remarks, Mr Sidibé recalled his recent visit to the city of Chengdu, China, where he saw first-hand the critical role that civil society organizations play in ensuring access to HIV services for people who inject drugs and men who have sex with men. “Civil society is the engine in the response to AIDS—particularly in Asia and the Pacific,” said Mr Sidibé. “Policy reforms are needed to give these organizations the space to fully engage,” he added.

Participants in the dialogue raised a number of issues with the UNAIDS Executive Director, including the need for increased access to antiretroviral treatment across the region, as well as for drugs that are simpler, more robust and more resistant. As of end-2009, more than 60% of people eligible for treatment in Asia and the Pacific were not able to access it, according to the new UNAIDS report.

Representatives from organizations of sex workers underscored that the criminalization of sex work remains a major issue across the region. “Despite all the talk about decriminalizing sex work year after year at conferences, only one country in this region has actually done so: New Zealand,” said Janelle Fawkes, a sex worker and Chief Executive Officer of the Scarlet Alliance, an organization based in Australia.

Across the region, punitive laws and policies continue to hamper the AIDS response. Ninety per cent of countries in Asia and the Pacific have laws and policies that prevent people living with HIV, and key populations at higher risk, from accessing life-saving HIV services.

Among the other issues raised at the forum were the need for increased funding for civil society organizations and the importance of human rights protections for key affected populations.

Michel Sidibé UNAIDS Executive Director and young mentees engage in discussion during the launch of the NewGen Aisa initiative.
Credit: UNAIDS/Kim

Across the Asia and Pacific region an estimated half a million young people aged 15-24 are living with HIV. A significant number of all new infections in the region are among young key populations including sex workers, men who have sex with men, transgender people and young people who inject drugs.

To ensure that people who need HIV services are reached, young people require a strong voice and increased representation in the AIDS response. An initiative called New Generation (NewGen) Asia aims to develop the capacity of the next generation of young leaders from key populations to make their voices heard.

Launched on 27 August at the 10th International Congress on AIDS in Asia and the Pacific in Busan, Republic of Korea, the NewGen programme, spearheaded by the Asia-Pacific Inter-Agency Task Team for Young Key Affected Populations, stepped up a gear with an event which showcased the NewGen Mentoring Young Leaders Programme and the official launch of a new leadership course.

“You are not just the leaders of tomorrow, you are the leaders of today,” said UNAIDS Executive Director, Michel Sidibé at the launch. “Leadership is about commitment, courage and confronting what is wrong. With your energy we can build a better world.”

The NewGen Asia event involved a long table lunch which brought together 30 high-level mentors and the new young leaders, predominantly from key populations, whom the mentors will encourage and support.  The mentors are drawn from a diverse range of backgrounds, such as civil society, the United Nations, government and young people who already have strong leadership experience. They include among others Ursula Schaefer-Preuss, Vice President of the Asian Development Bank, Khartini Slamah, Chair of the Asia-Pacific Transgender Network and Jimmy Dorabjee of the Asian Network of People who Use Drugs.

A two-way learning and sharing exercise

“I believe NewGen mentoring component is a very important initiative to help stimulate dialogue between young leaders from key populations, who are often stigmatized or in difficult circumstances, and mentors who can help provide vision and leadership,” said mentor Ursula Schaeffer-Preuss, Vice President of the Asian Development Bank.

Gerard Ompad, a young mentee with experience in HIV prevention, thinks the NewGen Asia initiative will help him become a more effective champion of the needs and concerns of his community. “I’m very pleased to be part of this initiative. The training will empower us as young people from key affected communities to become real leaders and develop our advocacy skills. Youth ownership and leadership of the AIDS response is critical and this is a significant step forward for the region,” he said.

During the lively lunch, mentors and mentees discussed their expectations and planned various activities over the coming year. It was generally agreed that it would be a two-way learning and sharing exercise.

Five day leadership course

The event also provided an opportunity for the launch of a five day leadership course for young people from key affected populations and those working with them. The programme has been developed and delivered by a team of technical experts from Youth LEAD, a regional network of groups committed to advancing HIV prevention. Youth LEAD members are also heavily involved in the mentoring programme in collaboration with academic experts and UN partners. 

The course will include information on HIV and key affected populations and will have a special focus on skills-based training, including advocacy, communication and leadership.

In a further commitment to championing youth engagement in the AIDS response, Youth LEAD, in collaboration with the HIV Young Leaders Fund also launched a request for youth lead initiatives working to address the needs of those most affected by HIV in Southeast Asia and the Pacific for its 2011-2012 funding round.

It is hoped that the multi-pronged NewGen Asia initiative will reap clear benefits in increasing the effective engagement of key communities which are bearing the brunt of the AIDS epidemic in the region.

Anupama Rao Singh, UNICEF's Director of East Asia and the Pacific Region commented on the importance of the NewGen initiative:

“Young people most affected by the AIDS epidemic are at the heart of prevention revolution in Asia and the Pacific. The NewGen Asia initiative, with support from the regional inter-agency task team, will build young people's leadership to advocate policies and programmes that concern them and prepare a new generation of change agents for the region's AIDS response.”

Impressive gains across the region, but most countries need greater and sustained efforts to ‘get to zero’

BUSAN, South Korea, 26 August 2011—The AIDS epidemic in Asia and the Pacific is at a crossroads, according to a new report from the Joint United Nations Programme on HIV/AIDS (UNAIDS). While the region has seen impressive gains—including a 20% drop in new HIV infections since 2001 and a three-fold increase in access to antiretroviral therapy since 2006—progress is threatened by an inadequate focus on key populations at higher risk of HIV infection and insufficient funding from both domestic and international sources.

Launched at the 2011 International Congress on AIDS in Asia and the Pacific (ICAAP), the report, titled HIV in Asia and the Pacific: Getting to Zero, found that more people than ever before have access to HIV services across the region. However, most countries in the region are a long way from achieving universal access goals for HIV prevention, treatment, care and support.

“Getting to zero new HIV infections in Asia and the Pacific will demand national responses based on science and the best available evidence,” said UNAIDS Executive Director Michel Sidibé. “HIV programmes must be sufficiently resourced and solidly focused on key populations. Investments made today will pay off many-fold in the future.”

Gains in the regional HIV response, but progress is fragile

According to the report, an estimated 4.9 million [4.5 million–5.5 million] people were living with HIV in Asia and the Pacific in 2009, a figure that has remained relatively stable since 2005. The majority of people living with HIV in the region are in 11 countries: Cambodia, China, India, Indonesia, Malaysia, Myanmar, Nepal, Pakistan, Papua New Guinea, Thailand and Viet Nam.

Across Asia and the Pacific, there was a 20% decline in new HIV infections between 2001 and 2009—from 450 000 [410 000–510 000] to 360 000 [300 000–440 000]. Cambodia, India, Myanmar and Thailand have reduced their HIV infection rates significantly with intensive, wide reaching HIV prevention programmes for people who buy and sell sex.

The number of people accessing life-saving antiretroviral treatment in the region has tripled since 2006, reaching some 740 000 people at the end of 2009. Cambodia is one of only eight countries in the world to provide antiretroviral therapy to more than 80% of the people eligible for it. However, as of end-2009, more than 60% of people in Asia and the Pacific who were eligible for treatment still could not access it.

The report found an estimated 15% decrease in new HIV infections among children since 2006. But regional coverage of HIV services to prevent new HIV infections in children continues to lag behind global averages, particularly in South Asia.

According to the report, HIV epidemics can emerge even in countries where HIV prevalence was previously low. After a more than 20-year ‘low and slow’ HIV epidemic in the Philippines, for example, the country now has a rapidly expanding epidemic among key populations. In the city of Cebu, HIV prevalence among people who inject drugs increased from 0.6% to 53% between 2009 and 2011. In Manila and Cebu, HIV prevalence among men who have sex with men is estimated at 5%.

Key populations at higher risk of HIV infection

According to the report, new HIV infections in the region remain concentrated among key populations: people who buy and sell sex, people who inject drugs, men who have sex with men, and transgender people. Most programmes to protect key populations and their intimate partners from HIV infection are inadequate in size and scale.

Across the region, stigma and discrimination against people living with HIV and populations at higher risk of infection remain rife. About 90% of the countries in the region retain punitive laws and policies that effectively prevent people living with HIV and key populations from accessing life-saving HIV services.

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

More AIDS resources urgently needed

The AIDS response in Asia and the Pacific is underfunded, the report found. In 2009, an estimated US$ 1.1 billion was spent on the AIDS response in 30 countries across the region—approximately one third of the funding 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. Increased investment of domestic resources, especially in middle-income countries, is critical for the ongoing regional response to HIV.

Funding cutbacks from international donors also threaten progress in the regional AIDS response. In 2009, international assistance for the global AIDS response leveled off for the first time in a decade, and in 2010 it declined.

According to the report, investments to protect key populations from HIV remain insufficient. Among countries reporting detailed expenditure data in 2010, only 8% of total AIDS spending in South Asia and 20% in Southeast Asia focused on HIV prevention among key populations at higher risk of HIV infection.

(Left to Right): Michel Sidibe, Excutive Director, UNAIDS, Ratu Epeli Nailatikau, President, Republic of Fiji, with Jong Sam Park, CEO, World Vision Korea. AIDS Champions meeting,
August 26, 2011.
Credit: Bertha Shoko/Nyanga, Zimbabwe

An AIDS champions meeting, held just before the opening ceremony of the 10th International Congress on AIDS in Asia and the Pacific (ICAAP10), brought together some of the most vocal leaders and activists across Asia and the Pacific to call on states, donor organizations and partners to implement the 2011 Political Declaration on HIV/AIDS: Intensifying our efforts to Eliminate HIV/AIDS, adopted by all UN Members States at a High Level Meeting on AIDS in June.

Participants at the event included the President of the Republic of Fiji, Ratu Epeli Nailatikau, Australia’s Ambassador for HIV, Murray Proctor, the Special Envoy for AIDS in Asia and in the Pacific, Dr Nafis Sadik, and UNAIDS Executive Director Michel Sidibé, among others.

“The High Level Meeting gave us ‘words’. Now we need action,” said President Ratu Epeli Nailatikau. “We need to up the ante and learn from countries that have faced serious HIV epidemics, so we can better focus our responses in our communities,” he added.

With ICAAP considered the second largest HIV forum in the world, the AIDS champions meeting was an important opportunity for participants to align advocacy strategies, as well as for debate and discussion.

“This Champions meeting not only impacts the Asia Pacific region, but the world. To meet the commitments made at the High Level Meeting—towards zero new HIV infections, zero discrimination and zero AIDS-related deaths—we need to reform our way of doing business,” said Mr Sidibé, in his remarks at the gathering. “To do this, we need AIDS champions from government, civil society and partners. But let us not forget the people outside the room whose voices we also need to listen to,” he said.

Many representatives from national parliaments, civil society and the private sector participated in the meeting. HIV ambassadors and champions committed to support regional and country advocacy efforts to ensure key affected populations have access to HIV prevention, treatment, care and support services.

“Despite current financial challenges this is an opportunity for the Asia Pacific community to closely examine global commitments and see how these best fit our regional contexts, to ensure responses and programmes are clearly focused on key populations at highest risk,” said Murray Proctor, Australia’s Ambassador for HIV.

The meeting also shone a light on the crucial role of existing and emerging leaders in the AIDS response across the region in “getting to zero” and in engaging young leaders from key populations at higher risk. Young people from marginalized populations such as men who have sex with men, transgender people and sex workers are among the most vulnerable to HIV infection in the in the Asia Pacific region.

Speaking from the perspective of young people in the ICAAP 10 host country, a young leader from the Republic of Korea said: “This is our first time participating in such a regional platform. We are ready. We need advice and support to help us develop innovative vision and ensure young Koreans at risk are able to access HIV information, education and services.”

Within the context of this year’s theme “Diverse Voices, United Action”, the AIDS champions endorsed a joint statement, to be read at the official opening ceremony of ICAAP10.