HIV/AIDS fight: Asia-Pacific gains ‘fragile’

Francoise Barre-Sinoussi

Wed, 06/08/2011
Francoise Barre-Sinoussi, Paris
The Jakarta Post

Thirty years ago, US scientists identified the first case of an immune system failure that we (Luc Montagnier, myself and colleagues) found two years later to be caused by HIV.

Twenty years later at a landmark UN General Assembly Special Session, world leaders declared that AIDS was a “global emergency” and called for an “urgent, coordinated and sustained response” to the epidemic.

Now, three decades into the epidemic, what is the global scorecard for the AIDS response?

From June 8-10, world leaders will convene in New York City at the UN General Assembly High Level Meeting on AIDS.

The gathering of heads of state and other leaders from government, the scientific community, civil society and the private sector offers a unique opportunity to chart the future course of the global AIDS response.

The meeting comes at a critical time.

According to a recent report of the UN Secretary-General, more than six million people were accessing lifesaving antiretroviral treatments in low- and middle-income countries at the end of 2010 — up from just 400,000 in 2003. In the past 10 years, the number of people newly infected with HIV declined by nearly 20 percent.

And in 2009, more than 50 percent of HIV-positive women were able to unsure their babies were born HIV-free.

In the Asia-Pacific region, there have been significant gains.

The number of people living with HIV appears to have remained stable for the past five years and estimated new infections are 20 percent lower than in 2001.

Thailand, Cambodia and India have turned their epidemics around by providing services to their most at-risk populations.

Cambodia is one of only eight countries worldwide to have reached universal access to antiretroviral therapy and Thailand has reported 80 percent coverage of prevention of parent-to-child transmission services.

But Asia-Pacific’s great strides are fragile, as they are in the rest of the world.

Despite incredible efforts, the HIV epidemic continues to outpace the response, with an estimated two new HIV infections for every individual starting treatment. AIDS resources have flat-lined, and critical sources of leadership and accountability remain untapped.

In Asia-Pacific, communities most vulnerable to HIV — sex workers, drug users, men who have sex with men, transgender people —are not being well enough reached for HIV prevention and treatment.

And 90 percent of the countries in the region have laws or practices that hamper access to HIV services for people living with HIV and/or people from key affected populations.

I recently had the opportunity to visit Cambodia to discuss the national progress on HIV. Here, the dichotomy of success and challenges are clear.

Although Cambodia has seen some of the most significant achievements in the region for halting and reversing the spread of HIV — the country was presented with a MDG award to that effect at the United Nations Millennium Development Goal Summit earlier this year — the success of Cambodia, continues to be challenged by high infection rates amongst most-at-risk populations including injecting drug users, sex workers and men who have sex with men.

HIV prevalence among injecting drug users, for example, is 24.4 percent, a stark and sobering figure when compared to Cambodia’s HIV prevalence of 0.7 percent among the general population.

Clearly, tailored, focused efforts are needed — and those that address not just the communities themselves, but the external legal and social pressures that make accessing services even more difficult.

In Cambodia, I saw some key examples of how such efforts are being rolled out — for example, programs partnering law enforcement officials, the health sector, local authorities and community members to ensure key affected populations can access health services and put into practice effective HIV prevention measures, without fear and harassment.

Size and scale are critical factors. Cambodia’s Methadone Maintenance Therapy Program in Phnom Penh is showing that methadone patients appear to be committing less crime after they enter the program and are more likely to protect themselves from HIV.

But such programs are small and need to be hugely expanded to ensure universal access to HIV services, to turn the tide on HIV once and for all.

Expansion cannot come without resources and in the Asia Pacific region a rapid increase of domestic funding for HIV is needed. Estimates suggest international funding accounts for more than 50 percent of AIDS spending in the majority of the region’s countries — including Cambodia where 90 percent is from outside funds.

“Game-changing” findings released recently prove that HIV transmission can be prevented when people living with HIV are taking antiretroviral early, consistently and correctly. The implications of this alone underline the dramatic importance of ensuring treatment sustainability and the resources to make this a reality.

A sustained “prevention revolution” is also a necessity.

Can Asia-Pacific do what it takes to move towards the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths outlined by the United Nations Joint Program on HIV/AIDS (UNAIDS)?

The evidence is clear — reversing and stopping HIV is possible in this region, but leadership is the deciding factor.

At this “pivot point” in its AIDS response, and as leaders prepare to gather in New York, Asia-Pacific countries need to reaffirm their commitment and redouble efforts within the new global direction for AIDS.

Thirty years of AIDS is thirty years too many. Let us reshape the response make AIDS a thing of the past.

Prof. Françoise Barré-Sinoussi is a Nobel laureate (Physiology/Medicine 2008) and cochairperson of the UNAIDS High Level Commission on HIV Prevention. She recently visited Cambodia to discuss progress in the national response to HIV with political leaders, policy makers, programmers and researchers.