BANGKOK – The 11th International Congress on AIDS in Asia and the Pacific (ICAAP11) today conducted the first of three plenary discussions focussing on the first of the UNAIDS Getting to Zero goals. The theme for today was ‘Getting to Zero New HIV Infections in Asia and Pacific: Possible or Impossible Dream?’
The discussion was moderated by James Chau, United Nations Goodwill Ambassador and CCTV Anchor in China, and keynote speeches were delivered by Timothy Mastro, Group Director for Global Health, Population and Nutrition of FHI 360 and Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific. Commentators were Professor Tjandra Yoga Aditama, Director General of the Ministry of Health in Indonesia representing Dr Nafsiah Mboi, Health Minister and Chair of the Global Fund, Anan Boupha from Purple Sky Network Foundation, Baby Rivona from the Indonesian Positive Women Network, and Aradhana Johri from the National AIDS Control Organisation in India.
Mr Kraus stated that as at 2012 there were 4.9 million people living with HIV in the Asia-Pacific region, of which 1.7 million (34%) were female. There were 350,000 new infections in the area and 270,000 AIDS related deaths in 2012. Between 2001 and 2008 there had been a 26% decline in the annual HIV infection rate, but since 2008 there had been no further progress in the fight against the disease. Progress was unevenly distributed across the region. Countries such as Cambodia, Myanmar, Nepal, India and Thailand experienced large falls in HIV infections. However, the infection rate is rising in other countries including Indonesia, Pakistan, The Philippines and Malaysia.
While Mr Kraus showed that progress has recently stagnated, Mr Mastro was more optimistic. “We have the tools, we just need to learn how to use them,” he said. Mr Mastro was confident that achieving zero new HIV infections is possible, but would require more work. In summarising the challenges faced by the region, he said “we know a lot, but we do not do a lot.”
The commentators each had varying opinions on whether or not a zero new infection rate is possible. Aradhana Johri was optimistic, but cautioned that the implementation of HIV policies must account for the specific features of the epidemic in each country. She said, “What works in one country may not work in toto in another.”
Anan Boupha emphasised the need for partnership between key at-risk populations and policy makers in order to ensure that the policies were realistic and would make a difference. Baby Rivona stated that without specific policies on women affected by the epidemic, the goal would remain a dream and she would have to “keep dreaming”. She called specifically for the collection of epidemiological data on women within each key at-risk population group and policies to tackle issues such as violence against women.
Professor Aditama stated his view that progress was being made and this goal was certainly achievable. He described recent progress in Indonesia, including the implementation of treatment as prevention, a policy for HIV prevention that is backed by strong evidence. In particular, sero-discordant couples would now be eligible for anti-retroviral therapy (ARV) regardless of their CD4 levels. Coverage of testing has also been expanded in Indonesia, with particular focus on men who have sex with men (MSM).
The session was generally optimistic, but there was clear consensus that if the goal of zero new infections is to be achieved, it will require a redoubling of efforts throughout the region and massive scale-up of evidence-based approaches to prevention. HIV is too serious a problem to go out of fashion, and with the pending expiry of the Millennium Development Goals (MDGs) it is imperative that HIV is not lost amongst competing health priorities and strained national budgets. Zero new HIV infections may have been a dream yesterday but it is a hope today, and it will hopefully be a reality tomorrow.
By Dr Timothy West, Pacific Friends of the Global Fund Representative at ICAAP11
BANGKOK - Day one of the 11th International Congress on AIDS in Asia and the Pacific (ICAAP11) featured keynote addresses from senior government officials and NGO representatives from some 80 countries, including Mr Pradit Sintavanarong, Public Health Minister of Thailand representing Ms Yingluck Shinawatra, Prime Minister of Thailand, Mr Ratu Epeli Nailatikau, President of Fiji, Ms Jan Beagle, Deputy Executive Director of UNAIDS, Mr Mechai Viravaidya, Chairman of the Population and Community Development Association (PDA) and also known as “Mr Condom” in Thailand, and Professor N.M. Samuel, President of the AIDS Society of Asia and the Pacific (ASAP). Video messages from Aung San Suu Kyi, UNAIDS Global Advocate for Zero Discrimination and Michel Sidibe, UNAIDS Executive Director were also screened.
There were strong recurring themes in presentations which set the tone and agenda for the remainder of the conference, which runs until Friday 22 November.
Most importantly, there was recognition that the United Nations Millennium Development Goals (MDGs) expire in 2015 and that post-2015, HIV may receive less attention than it has over the last thirteen years. In his video message, Mr Sidibe argued that in light of this, there were three critical questions that the conference should address. Firstly, it should determine how to meet the specific aims of MDG 6, which sets specific goals for HIV treatment and prevention, before the MDGs expire. Second, it should re-kindle HIV/AIDS activism in the community to prepare for advocacy in the post-2015 world. Third, it should start the process of defining what goals should be set in the post-2015 world. These issues should be discussed with the understanding that neither a cure nor vaccine for HIV/AIDS are on the horizon and that therefore long-term plans must be based on currently implementable policies such as treatment as prevention.
The need to focus on key at-risk groups, as well as the generalised epidemic, was also a common theme of the first day. These groups are well-recognised and in the Asia-Pacific context consist of men who have sex with men (MSM), intravenous drug users (IVDU), those who buy and sell sex, transgendered people and migrant workers. The focus should consist both of engaging and empowering these communities to represent themselves, and societal and legal change to remove discriminatory law and customs. Furthermore, discrimination against people living with HIV/AIDS (PLWHA) must also be addressed. Daw Suu Kyi said, “You and I can make a difference by reaching out and letting people lead a life of dignity regardless of their HIV status or sexual orientation. We need an Asia-Pacific community of compassion to end discrimination.”
There was a strong emphasis on the need for rational, evidence based policy. In particular, there is a need to provide anti-retroviral (ARV) therapy to all people with HIV, regardless of their CD4 cell count. Known as “early test/treat”, this policy is backed by strong scientific evidence but within the Asia-Pacific region only Cambodia has made significant headway in its implementation. Barriers to its implementation include uncertainty of long-term funding for ARV therapy. Ms Beagle pointed out that at present 62% of funding for ARV therapy within the Asia-Pacific region was from government sources, and that the maintenance of this level of domestic funding is critical to continuing and extending the delivery of ARV therapy across the region. Presently, only half of those eligible for ARV therapy receive it.
Finally, there was recognition that young people are critical to the fight against HIV/AIDS. There is a need to engage and educate young people throughout the Asia-Pacific region, and to ensure that they are able to access HIV testing and ARV therapy. For example, Thailand is presently planning law reform to allow minors to access these critical services without parental consent. In describing previous successful campaigns of youth engagement, Mr Viravaidya gave a humorous and highly informative presentation in which he described Thailand’s successful education program. This program began in the late 1980s and involved sex education across all of society, in schools at all levels, and broad distribution of condoms in such places as shopping centres, bars, toll booths, gas stations and McDonalds. Police also distributed condoms in a program Mr Viravaidya described as the “cops and rubbers” programme.
The remainder of the conference will examine these issues in detail. As Mr Sintavanarong said in the closing address for the day, ”We have the capacity, and now we need to demonstrate how the Asia-Pacific region can lead the world to zero HIV, zero discrimination and zero AIDS related deaths”.
By Dr Timothy West, Pacific Friends of the Global Fund representative at ICAAP11
BANGKOK - The 11th International Congress on AIDS in Asia and the Pacific (ICAAP11) opened today at the Queen Sirikit National Convention Centre. With a theme of “Reaching Triple Zero: Investing in Innovation”, the conference will examine the particular challenges of the Asia-Pacific context in reaching the UNAIDS vision of zero new infections, zero AIDS-related deaths and zero discrimination. While these specific challenges vary greatly from country to country, common issues include the impending expiry of the UN Millennium Development Goals in 2015, the need to better engage with communities at increased risk of HIV/AIDS, the importance of evidence-based policy such as early test/treat, the need for legal reform, and ethnic and sexual discrimination.
High-level presenters at the conference include Yingluck Shinawatra, Prime Minister of Thailand, Ratu Epeli Nailatikau, President of Fiji and Nafsia Mboi, the Indonesian Health Minister and Chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria. There is a diverse Australian delegation, including representatives of the Australian government and executives and staff members from organisations including ACON, AFAO and the Burnet Institute amongst others. Pacific Friends of the Global Fund is represented by Chris Puplick, advisor to the NSW Health Minister and former federal senator, Shawn Clackett, communications and administrative officer, Dr Timothy West and Dr Jeremy Law.
ICAAP occurs biennially in odd-numbered years, alternating with the International AIDS Conference, the worldwide top-level HIV/AIDS symposium. The Australian Government is a Platinum Sponsor of ICAAP11. With Melbourne hosting the AIDS 2014 conference in July 2014, the upcoming Global Fund replenishment round and the impending visit to Australia by Aung San Suu Kyi for World AIDS Day 2013, ICAAP11 is a valuable opportunity to raise the profile of Australia’s response to HIV/AIDS and to set the agenda for AIDS 2014.
GENEVA – In partnership with Zambia, the Global Fund to Fight AIDS, Tuberculosis and Malaria signed a US$156 million grant agreement that aims to ensure a secure supply of antiretroviral medicine to all those receiving HIV treatment. The new funding will also support work that gets 225,000 more people to start treatment over the next three years.
At present, 480,000 people in Zambia are enrolled on antiretroviral (ARV) treatment with Global Fund support.
“Continued support from the Global Fund allows us to increase HIV testing and start thousands more people on treatment,” said Dr. Joseph Kasonde, Minister of Health, Republic of Zambia. “It will also allow us to pursue the elimination of mother-to-child transmission of HIV and to increase coverage of male circumcision.”
Zambia is one of the first countries in sub-Saharan Africa to achieve universal access to ARV treatment, defined as 80 percent coverage of those eligible. More than 90 percent of adults requiring treatment were on ARV therapy in June 2013. Zambia has been working with the Global Fund, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and other partners, all of whom made important contributions to these achievements.
Zambia has adopted new WHO guidelines encouraging countries to automatically provide all HIV-positive pregnant or breastfeeding women antiretroviral therapy for life – a change that aims to both prevent transmission to infants and keep mothers healthy. Zambia has also adopted the WHO-recommended approach to couples where one person is HIV positive by providing treatment to these people regardless of the strength of their immune system – a factor that had previously determined whether treatment should commence.
The new grant, signed with the United Nations Development Programme, will also help strengthen the national supply chain and systems for assessing impact, as well as increasing the Ministry of Health’s capacity for managing health programs.
“Zambia’s strong political support and the growing level of domestic financing have helped establish interventions for attaining universal access in prevention, treatment, care and support,” said Linden Morrison, Head of the Global Fund’s High Impact Africa II Department. “Robust partnerships and investments will continue to yield impact.”
The 2012 UNAIDS report estimates HIV prevalence at 12.5 percent. More females (16.1 percent) than males (12.3 percent) are HIV-positive. Among 15 to 24 years, the estimated prevalence is 7 percent and 3.1 percent for females and males, respectively. HIV is the leading cause of death for all ages in Zambia.
COTONOU, Benin – The Global Fund to Fight AIDS, Tuberculosis and Malaria has signed US$68.8 million in new HIV grants for Benin to help stop the disease’s spread, notably by targeting those most vulnerable to infection, such as sex workers, men who have sex with men and truck drivers.
The new funding will also help support continued expansion of HIV treatment and of programs to prevent HIV positive mothers from infecting their babies with the virus, with the aim of providing treatment for 90 percent of those who need it by 2015.
Three HIV grants were signed at a ceremony last week in Cotonou attended by Benin’s Health Minister, Dorothée Kinde Gazard, and the Global Fund’s Director for Africa and the Middle East, Lelio Marmora.
“The Global Fund is in a dynamic partnership with Benin which is expressed in political will and a sense of shared responsibility with a view to reaching the Millennium Development Goals in the area of health,” said Minister Kinde Gazard. “On a more global level we have a holistic vision of the entire health system envisaging strengthened governance and efficient management of grants.”
Benin has stabilized a generalized HIV epidemic, which now affects 1.2 percent of the adult population, and prevalence has also declined sharply among young people, from 1.8 percent in 2008 to 0.4 percent in 2012, while the total number of people receiving antiretroviral treatment now stands at 23,000.
In order to bring the epidemic entirely under control more attention needs to be focused on especially vulnerable groups which have made slower progress. Prevalence among sex workers, for example, was still high at 20.9 percent in 2012 despite falling from 26.5 percent in 2008.
New funding is therefore being redirected to target prevention activities at those most exposed to infection, also including, among others, workers in the transport, construction and tourism industries and young people who are not receiving any schooling.
The grants will be managed by 3 Principal Recipients: the ‘Programme National de Lutte contre le SIDA’ (PNLS), which is Benin’s National AIDS Program, the ‘Société d’Electricité Industriel et du Batiment’ (SEIB), a private enterprise, and Plan Benin, an international NGO.
“This is a major step forward in the Global Fund’s partnership with Benin to defeat HIV/AIDS,” said Marmora. “We also commend the government for matching the increased funding from the Global Fund with a significant rise in domestic health spending.”
The funding will also help provide care and support for orphans and vulnerable children; people living with HIV/AIDS; prevention activities such as strategic and targeted behavioral change communication; HIV counseling and testing; and condom promotion and distribution.
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Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.