Ranjita Biswas reports on the proceedings of the Ninth International Congress on AIDS in Asia and the Pacific, which heard strong calls for increased access to treatment to women and children who were left out of the loop
The just concluded Ninth International Congress on AIDS in Asia and the Pacific (ICAAP) in Bali had the theme ‘Empowering People, Strengthening Networks’. As empowerment was discussed at multi-disciplinary sessions and fora, universal access to antiretroviral drugs (ARV) for those infected with HIV was repeatedly mentioned. In fact, the conference began with the call for a strengthened commitment to achieving universal access and providing prevention, care, support and treatment for those who need it most.
AIDS ambassadors from different countries, led by Indonesia, also urged nations to work towards implementing the Declaration of Commitment adopted at the UN General Assembly Special Session on AIDS in 2001 and the Political Declaration of 2006, despite the pressures of the global economic crisis.
At the plenary discussion on the first day (‘An overview of AIDS epidemic in Asia Pacific Region’) JVR Prasada Rao, director, UNAIDS Regional Support Team for Asia and the Pacific, while speaking on ‘Universal Access –Progress and challenges in South East Asia’, set the target for the Asia Pacific region:
- Provide treatment access to all those who need it: reach 1 million by 2011.
- Increase coverage levels of the prevention of mother to child transmission (PMTCT) programme to stop all transmission from mothers to children by 2015.
- Scale up high-impact prevention coverage to match Universal Access commitments.
About the figure of one million, Rao clarified at a press briefing later: “There are about 5 million people living with HIV (PLHIV) at the moment in the Asia-Pacific region of whom 20% need ARV, that is, 1 million people.”
However, though there have been good progress in countries like Cambodia, Laos, Thailand and also India, he admitted that “there have been gaps in our response to youth, migrant, and partner transmission”, which have affected prevention efforts in the region.
In a message to the congress, UNAIDS Executive Director Michel Sidibé said some countries in the Asia Pacific were beginning to see success in their efforts to reverse the spread of HIV, but not enough to break the trajectory of the epidemic.
According to UNAIDS, in Asia, the number of new infections and people who died from AIDS-related illnesses were, comparatively speaking, equal in 2007 – 380,000 new infections (range 200,000–650,000) and 380,000 deaths (270,000–490,000).
National HIV infection levels are the highest in South-East Asia. New HIV infections are also increasing steadily, although at a much slower pace, in populous countries such as Bangladesh and China.
Almost 90% of the people needing treatment in Asia are in China, India, Myanmar and Thailand (946,000 out of 1,067,000 in 2007).
Governmental expenditure on ARV is primarily in first-line treatment, though second-line treatment is also being provided in some countries, including India. However, the cost of second-line treatment is much higher and its reach is still minimal.
According to Rao, since the last ICAAP meet in Colombo in 2007 there has been an improved understanding of the HIV/AIDS scenario and the drivers of the epidemic, specifically in the Asia Pacific region after the release of the report by the Independent Commission on AIDS in Asia -2008 (see box). He was emphatic that universal access is feasible in Asia but more focused attention is needed.
Some countries like Cambodia, Laos and Thailand are showing much better performance than others. But that is only one side of the coin, as Rao pointed out. A cluster of problems remain, hindering universal access to those in need.
Reaching commercial sex workers and men who have sex with men, both considered to belong to high-risk groups, is still “more difficult” in this region, he said. In this context he hailed the recent verdict by the Delhi High Court decriminalising homosexual acts between consenting adults as a positive step and an example worth emulating by countries still stigmatising them.
“For gay men, we need to reach out. But if their behaviour is criminalised, they are not going to come forward and say ‘Hey, I need help.’ This is a classic case of a clash between public health and public security,” said Loretta Wong, head of the Hong Kong based group AIDS Concern.
According to experts working to assist people living with HIV, everywhere around the world, criminalisation of behaviour involving illicit drug use, sex work and sex between men is seriously hampering effective prevention and support programmes.
The conference also heard strong calls for increased access to treatment to women and children who were left out of the loop. David Cooper, director of Sydney’s National Centre in HIV Epidemiology and Clinical Research, emphasised: “There is incontrovertible new evidence that treating women with antiretroviral therapy in pregnancy and during their breast-feeding period will almost eliminate HIV infection in their infants. But we are not getting access to these women and we are not treating them with proper antiretroviral therapy. We are just giving them single-dose drugs.”
Cooper also warned, “We are supposed to be achieving universal access by 2010, but we are not going to meet these goals.” Although about 3 million people worldwide were receiving ARV by the end of 2007 – nearly 950,000 more than at the end of 2006 – only 31% of people in need of drugs were receiving them, he said.
Rao also said that though China and India are the fastest growing economies, the reach of the PMTCT programme is not enough which is “not acceptable” and shows lack of commitment to reach the zero vertical transmission target by 2015. Further, compared to China, figures show that India’s performance is far worse in this area.
Cooper felt strongly that there are “two standards” of care for high and low to middle income countries. The latter must:
- Implement testing and treatment for all HIV-infected infants;
- Implement HAART for all HIV-positive women to prevent MTCT;
- Improve uptake ART by HIV infected pregnant woman and children, and
- Increase research into biomedical prevention, especially vaccines, microbicides and pre-exposure prophylaxis. (Pre-exposure prophylaxis is an experimental HIV prevention strategy that would use ARV to protect HIV-negative people from HIV infection).
The global meltdown is also bad news for the campaign against AIDS. Michel Kazatchkine, executive director of the Global Fund for AIDS, Tuberculosis and Malaria, said that the ongoing global financial crisis was shifting countries’ attention from the need to maintain invested in public health, subsequently leading to reduced health spending. “The Global Fund will be facing major challenges in the coming years in terms of funding,” he said.
Rao agreed that the economic downturn and subsequent crunch on funding due to competing claims on funding will affect prevention programmes more than treatment, but cautioned that commitment to the AIDS campaign must be sustained by activism; otherwise “it will fall off the agenda”.
(Ranjita Biswas is a journalist based in Kolkata writing mainly on women and gender issues, HIV/AIDS and environment. She is also Editor of Trans World Features)
InfoChange News & Features, August 2009
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