Meltdown undercuts Asia-Pacific's gains in HIV treatment

Bali: This was the assessment of a mix of experts on Monday at the International AIDS Conference on Asia and the Pacific (ICAAP), the region’s biggest conference on the pandemic that is being attended by more than 4,000 people.

Attended by public health experts, researchers, community organisers, advocates and development agencies, ICAAP held its first full day on Monday and will run until August 13.

The recognition that the Asia-Pacific has made major strides toward the goal of giving universal access to treatment for whose living with HIV and AIDS has been a common thread through the simultaneous sessions here.

The number of patients getting anti-retroviral therapy (ART) has risen to 565,000 people today. This is a three-fold increase from the figure in 2003, according to the Joint United Nations Programme on AIDS (UNAIDS).

Universal treatment not a 'utopia'

Given this progress in the last two years, “meeting this (universal access to treatment) is not an aspirational goal,” remarked J.V.R. Prasada Rao, director for UNAIDS Regional Support Team-Asia Pacific.

“The progress shows that universal access is possible, not a utopian deal in this region,” added Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said at a discussion Monday.

In 2006, the world’s governments committed themselves to the cause of achieving universal access in HIV prevention, treatment, care and support by 2010.

Countries like Thailand, Cambodia and Laos account for a good part of this progress in access to treatment, because they are able to provide 80% of those who need ART the drugs they need.

But while headway in access to treatment may be a reason for optimism, experts also said the Asia-Pacific could do much better in access to prevention, care and support – the other components of the goal toward universal access.

Across the region, prevention and care and support in HIV and AIDS are undercut by stigma and discrimination, lack of legal protection that put groups such as drug users, sex workers and men who have sex with men at more risk – and as well as resource constraints that governments face at a time of recession.

“We need to reach men who have sex with men, intravenous drug users and sex workers and have the right legal environments to achieve universal access for them,” Kazatchkine said.

But this cannot happen if drug use is still subject to the death penalty in many Asian countries, even as sharing of needles is a major mode of HIV transmission, he added. In 2007, Indonesia had the highest figure in Asia of drug users having HIV at 60%, followed by Burma at nearly 50%. Afghanistan has one million drug users, of which 120,000 are injectors.

Likewise, 12 countries in the region have laws that criminalise on the basis of sexual orientation, same-sex relations and sodomy.

'Good news'

There has been some good news though, such as the decision by the New Delhi High Court to strike down a section of the Indian Penal Code on male to male sex. Taiwan has a new law granting sex workers the same rights as their clients. Nepal recognised constitutional rights of sexual and gender minorities.

“Out-of-school youth, street children, young sex workers, including youth men who have sex with men have different needs. But they have the same rights,” said youth campaign coordinator Liping Mian. She added that her research in 2007 showed that sex workers are getting younger at the age of 15 or 16.

Women, including pregnant ones, and young people also need to be reached better by prevention and treatment efforts in Asia. Fifty million women, comprising 34% of all infections in the region, are put at risk by their male partners, UNAIDS says.

But a respected medical professor, David Cooper of the National Centre in HIV Epidemiology and Clinical Research, University of South Wales, tempered some of the optimism stated here by official development institutions.

He pointed out worrisome gaps, such as the fact that those with lesser financial resources getting less of the benefits of medicine and care that have been extending the life spans of those living with HIV and AIDS by 12 to 20 years.

“We now have all the drugs available but we’re not treating HIV-positive infants and those that belong to middle and lower income brackets,” Cooper said. “We’ve to do better and right now, we’re not doing well with pregnant women and children. The prevention strategy should be increased.”

“We’re nowhere near universal access in this region,” he added.

Discussions on how to improve responses to HIV and AIDS nearly 30 years into the pandemic – and on the eve of achieving the goal of universal access to treatment in HIV and AIDS – are occurring against the backdrop of concerns about how the financial crunch puts additional pressure on developing countries’ already tight resources.

The meltdown effect

The response to AIDS is “in competition with the global financial crisis” and the fact that more countries are being affected by conflict and displacement, Rao added. Still, he said, UNAIDS expects “much larger funding” from the Global Fund that can help more people get access to treatment in Asia.

But those like Samsuridjal Djauzi, an Indonesian doctor who is ICAAP co-chair, says “we should (already) discuss how to mobilise other resources in order to continue our programmes” and reach the universal access goals that countries like Indonesia expect to meet in 2010.

HIV prevalence in Indonesia remains low at 0.2% and the death rate from AIDS has decreased from 46% in 2006 to 17% in 2008 due to anti-retroviral treatment.

“The financial crisis cannot be an excuse to spend less on health. It’s important that we do not lose the gains we made,” Kazatchkine pointed out.

At the formal opening of ICAAP Sunday night, Indonesian President Susilo Bambang Yudhoyono said that leadership is key to preventing and coping with HIV and AIDS. “The best way to strike a blow against AIDS is through leadership. Without leadership, the fight against AIDS becomes sporadic, reactive, without focus, lacking resources, and will eventually lose steam,” he said.