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20 November 2013
Shawn Clackett

Zero New Infections in the Asia-Pacific: Possible or Impossible Dream?


icaap-plenary-day-two

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.

20 November 2013
Guest Contributor

ICAAP11 Day One: Setting The Agenda

By Dr Timothy West, Pacific Friends of the Global Fund Representative at ICAAP11

ICAAP11-opening-cultural-performance

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”.

20 November 2013
Guest Contributor

ICAAP11 Opens in Bangkok

By Dr Timothy West, Pacific Friends of the Global Fund representative at ICAAP11

ICAAP11-PFGF-representatives

Representatives of Pacific Friends of the Global Fund check-in to ICAAP11 in Bangkok

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.

21 June 2013
Shawn Clackett

Myanmar Funding gets Early Approval

Myanmar

On 15 June, 2013, the Global Fund announced approval for the first concept notes submitted by three early applicants: Myanmar, El Salvador and Zimbabwe. A concept note is the Global Fund’s mechanism for countries to request financing. The three countries have been approved for funding up to $449.8 million. Because the approved amounts are ceilings, the final level of funding determined during grant negotiations could be less.

“Countries have been able to act quickly to get this new funding model started, and that’s great news,” said Simon Bland, Chair of the Global Fund Board. “These first grants show how, by working with partners, we can reach more people facing these diseases and really move forward progress toward defeating them and removing them as threats to public health.”

In contrast to El Salvador and Zimbabwe, Myanmar will receive $111.8 million to fight all three diseases; HIV ($39.5 million), tuberculosis ($26.3 million), and malaria ($26.0 million).  HIV, tuberculosis, and malaria afflict Myanmar. There are an estimated 220,000 people living with HIV; ie. 0.6% of the country’s population. There are believed to be some 125,000 people in need of HIV anti-retroviral treatment. HIV-prevention program in Myanmar will support a strong push in that country to meet an urgent need for anti-retroviral coverage. The grant will support Myanmar’s goal of achieving universal access to anti-retroviral treatment by 2016, up from 43 percent in 2012. Tuberculosis afflicts some 300,000 people, and it is estimated that over 30% of tuberculosis cases remain undetected. Malaria is also a serious problem, with transmission rates high in nearly half of the country, putting 1 in 1,000 people at risk of infection.

Between 18-19 June 2013, the executive board of the Global Fund to Fight AIDS, Tuberculosis and Malaria held its twenty-ninth in Colombo, Sri Lanka. At this meeting, the executive board favourably considered progress on the implementation of the new funding model approved at the twenty-eighth meeting of the board held in late 2012.   The new funding model greatly streamlined the way applicants apply for funding, obtain approval of their proposals, and then manage their grants.

“The new funding model is dynamic and exciting,” said Prof. C. O. Onyebuchi Chukwu, Minister of Health in Nigeria, who participated in the Board meeting. “It is welcome in the sense that it is flexible and makes for sustainability of programs based on country leadership and priorities.”

Essentially, the new funding model makes it easier for countries to receive funding while ensuring funds are being spent as described in the application. Under the new funding model, country eligibility was reviewed and an ‘allocation formula’ created to ensure countries received appropriate amounts necessary to fight the three diseases. The approval of these substantial grants to Myanmar, El Salvador and Zimbabwe indicates that the new funding model is robust and effective, and is working to allocate financial resources in a more timely and efficient manner.

Shawn Clackett

25 April 2013
Shawn Clackett

World Malaria Day

April 25, 2013

By the time you finish reading this article, malaria will have killed five children. Malaria kills an estimated 660,000 people every year of which some 85% are children under five years of age. That is roughly one death every minute of every day. Neatly 3.3 billion people, half of the world’s population, are at risk of acquiring malaria. In 2010, there were over 219 million cases of malaria. Eighty percent of all cases occurred in just 17 countries with forty percent occuring in only three countries- the Democratic Republic of the Congo, India, and Nigeria.

Although malaria is most common in Africa, it is endemic in many Asia-Pacific countries including Papua New Guinea. Eighteen percent of all deaths at PNG hospitals are malaria-related. With 90% of the country at risk, approximately 800 Papua New Guineans die from malaria each year.

Malaria is a preventable and curable disease. However, many countries do not have the funding or access to the prevention services, early diagnosis, or treatments that could save thousands of lives. On World Malaria Day, April 25, we reflect on the severity and cruelty of this disease but also recognize the progress we have made towards defeating one of the world’s greatest killer diseases.

Malaria Map

Mosquito

Malaria is caused by parasites that are transmitted to people through the bite of an infected mosquito (specifically the Anopheles genus). Effective prevention involves the use of insecticide-treated bed nets (ITNs) which act as a barrier between an uninfected person and a malarial mosquito. ITNs have been shown to reduce all-cause mortality in children under 5 by about 20 percent and malarial illnesses among children under 5 and pregnant women by up to 50 percent. An additional preventive measure is the use of indoor residual spraying, which repels and kills mosquitoes. The Global Fund to Fight AIDS, Tuberculosis, and Malaria has provided malaria-endemic countries with some 310 million insecticide-treated bed nets and provided indoor residual spraying units to 44 million buildings.

Malaria is curable and there have been recent advances in treatment. Artemisinin-based combination therapies (ACTs), the most effective antimalarial drugs, have been increasingly available worldwide. The number of ACT treatment courses acquired by public health authorities increased from 11.2 million in 2005 to 76 million in 2006, and 181 million in 2010. The Global Fund has played a critical role in the introduction and expansion of coverage of ACTs in many countries where resistance to older malaria drugs has increased. In addition to financing treatment for 260 million cases (cumulatively) of malaria by mid-2012, the Global Fund has been piloting a pioneering financing mechanism to improve access to ACTs by making them more affordable.

With the Global Fund’s new US$15 billion replenishment target for 2014-16, announced in Brussels earlier this month, we have every hope that malaria will soon be a problem of our past. We have come a far way in treatment and prevention of malaria, but with a child dying every minute, we clearly still have a long way to go.

Shawn Clackett

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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.

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