Cities

Mayors and other city leaders from the 17 cities that make up the National Capital Region in the Philippines pledged to make the HIV epidemic a public health emergency requiring multisectoral strategies and a full provision of resources. The city representatives recently signed a city HIV resolution during a dinner meeting in Manila hosted by the Secretary of the Department of Health, Paulyn Jean Rosell-Ubial.

A recent UNAIDS report, Ending AIDS: progress towards the 90–90–90 targets, has helped to galvanize this action. The report found that the number of new HIV infections in the Philippines has risen by 140% in the past six years and the country has the fastest growing HIV epidemic in the Asia and the Pacific region. Health authorities say that the 17 cities in the National Capital Region accounted for more than 40% of reported HIV cases in the country.

Ms Rosell-Ubial stated that she had raised this alarm as early as last year, when she took office, calling the situation a national emergency. She appealed to the mayors and city officials of Metro Manila for their help in delivering crucial services to community groups and key populations. The Mayor of Taquig City and Chair of the League of Cities, Laarni “Lani” Cayetano, expressed her support for the initiative and underlined the efforts of Taguig City in providing HIV services.

The Secretary of Health expressed appreciation for the personal support of Eamonn Murphy, UNAIDS Director of the Regional Support Team for Asia and the Pacific, and for the long-term contribution from the UNAIDS country office.

Mr Murphy praised the strong leadership of the Secretary of Health and the commitment by cities in the Manila region and pledged to help mobilize technical support, and is in discussion with development partners regarding these efforts.

The city HIV resolution recognized that the 2030 Agenda for Sustainable Development committed countries to ensuring healthy lives and the well-being of all citizens, as well as ending AIDS by 2030. It commits cities to increasing financial investments and accelerating the implementation of high-impact programmes, including ensuring quick diagnosis and entry into treatment, HIV services tailored to the needs of gay men and other men who have sex with men and innovative prevention programmes, including targeted outreach and pre-exposure prophylaxis. The resolution also promised to eliminate HIV-related stigma and discrimination and other human rights violations that prevent key populations and people living with HIV from accessing services.

The village of Jiele is where China’s first HIV cases were reported in 1989. Located in Dehong prefecture in Yunnan province, the village experienced an AIDS epidemic that resulted in almost 200 deaths. However, a quarter of a century later, the village is now brimming with hope and renewed energy.

“In the past, everyone was so scared of HIV, but now we are getting great health services and we are living normal healthy lives. We are not afraid of HIV anymore,” said a resident of Jiele.

The more than 100 people currently living with HIV in the village are receiving regular check-ups and almost all are on HIV treatment. The village’s success is echoed across Dehong prefecture, which was at the heart of China’s early AIDS epidemic.

Located near the opium producing areas of the Golden Triangle and the major drug trafficking routes, Dehong’s initial HIV cases were among people who inject drugs, as well as sex workers and their clients. In the past 15 years the prefecture has worked with community organizations, the central government and international organizations and has implemented a wide range of innovative measures, leading to a remarkable turnaround in the AIDS epidemic.

During a week-long mission to China, UNAIDS Executive Director Michel Sidibé witnessed the achievements made in Dehong. He met with officials and community groups and visited a range of sites, including Ruili Hospital on 7 September. He saw how the city hospital provides one-stop-shop HIV prevention and treatment services, including health education, HIV testing, methadone for people who inject drugs and prevention of mother-to-child transmission of HIV services.

In 2009, Dehong started to decentralize antiretroviral therapy management down to the community level for people living with HIV who had been accessing treatment for more than a year. Ruili Hospital provides assistance and technical support to the community-level antiretroviral therapy sites, which in 2014 were providing treatment to more than 600 people living with HIV.

“Ruili Hospital is a model of how one-stop-shop HIV services save lives and money,” said Mr Sidibé. “It’s remarkable how the hospital is spreading its know-how down to the community level and ensuring that quality health care is available in even the most remote corners of China.”

“The fourth round of the People’s War against AIDS has just been launched in Yunnan,” said Gao Feng, Vice-Governor of Yunnan. “We are confident we will achieve the 90–90–90 targets by 2020 in Yunnan.”

Dehong’s HIV response has evolved to meet the new challenge of providing quality health care to cross-border migrants. While in most parts of China access to key HIV services, such as treatment and methadone, require a Chinese identification card, in Dehong, HIV treatment is available to non-Chinese people who can present residence and employment permits and health certificates.

Mr Sidibé visited Jiegao, which is a district of Ruili where around 50 000 Burmese people are estimated to live. The Needle Exchange and Methadone Maintenance Treatment Extension (MMT) sites provide services to mainly migrants who inject drugs. Truck drivers crossing the China and Myanmar borders are provided with comprehensive services at a government-funded truck driver action spot. The services include health education, HIV counselling and testing, condom distribution, and referral to HIV treatment.

The local government in Dehong has a strong partnership with community-based organizations, which have played a key role in reaching migrants and people who use drugs, engage in sex work or are living with HIV.

Owing to these effective strategies, Dehong is the only prefecture in Yunnan province to receive public recognition for having reversed its AIDS epidemic. Health authorities report that HIV treatment coverage is around 60% of all people living with HIV, while prevention of mother-to-child transmission of HIV programme coverage is 100%. In Ruili, among people living with HIV eligible for antiretroviral therapy, the mortality rate has decreased by 95% compared to 2005. There were zero new HIV infections reported among people who use drugs attending MMT clinics from 2008 to 2014 and no babies born to pregnant women living with HIV have been reported to be HIV-positive since 2008. Dehong’s success is all the more remarkable as neighbouring prefectures in Yunnan province continue to experience expanding epidemics.

“Political leadership and engagement with communities and programmes based on scientific evidence can inspire other communities in China to end the AIDS epidemic,” said Mr Sidibé.

On the eve of the United Nations General Assembly High-Level Meeting on Ending AIDS, mayors from global cities joined government representatives, the private sector and other stakeholders at the United Nations Headquarters in New York, United States of America, to discuss and showcase innovations in technology and financing for ending the AIDS epidemic by 2030. 

The participants explored key challenges in city responses and offered innovative examples in information technology, mobile and data applications, pharmaceuticals, diagnostics and other scientific advancements for reaching “hard-to-reach” people with HIV prevention and treatment services. More than 20 innovators in the public, private and non-profit sectors presented their innovations in a hands-on marketplace for mayors, ministers, policy-makers and implementers. Innovations that were showcased included new cervical cancer diagnostics, smartphone applications, web-based dashboards and commodity delivery systems by drone.