Better access to testing urgently needed to fight HIV in Asia-Pacific

HIV-positive children play at a health centre in Baty, in Cambodia's Takeo province, in 2006. Fewer than 10 percent of the Asia-Pacific region's estimated 8.5 million people infected with HIV are aware of their status, the United Nations said at the end of a conference calling for better access to testing. Photo: Tang Chhin Sothy/AFP

Wed Jun 6, 2007

PHNOM PENH (AFP) - Fewer than 10 percent of the Asia-Pacific region's estimated 8.5 million people infected with HIV are aware of their status, the United Nations said Wednesday at the end of a conference calling for better access to testing.

"We all agree that HIV testing and counselling needs to be improved and scaled-up in the region in order to achieve universal access," said Shiba Phurailatpam, regional coordinator for the Asia Pacific Network of People Living with HIV/AIDS.

He was speaking at a meeting here jointly sponsored by the World Health Organisation, the UN Children's Fund and the UN's coordinating body against the disease, UNAIDS, to identify ways of slowing the spread of HIV and improving services for people who already have it.

"With so few people aware of their status, efforts to prevent new infections and treat those who are positive are becoming more difficult," the agencies said in a statement.

Although voluntary counselling and testing sites have been established in all of the region's countries, poor infrastructure and limited resources often prevent these services from reaching the people who most need them.

Persistent social stigma and discrimination also keep many people from actively seeking help until they are too ill for treatment.

Anti-discrimination policies must be implemented to make testing and counselling initiatives successful, said J.V.R. Prasada Rao, regional director for UNAIDS.

"That's very essential if we want to take the testing policies forward," he said.

Priority also needs to be given to children, in whom the disease progresses faster.

Of the 64,000 children living with HIV in the region who are in need of treatment, only one in five is receiving anti-retroviral care, the UN said.

Nearly all of these children live in Cambodia, India and Thailand, the agencies said.

"Children are unnecessarily becoming infected, dying, in our region ... because of a lack of HIV access testing and counselling," said Ian McLeod of the UN Children's Fund, adding that the prevention of mother-to-child transmission of HIV also needed to be scaled-up.

In 2006 alone, a million additional people were infected with HIV and more than 500,000 people died of AIDS-related illnesses, according to UN figures.

UN agencies call for concerted effort to rapidly scale up access to HIV testing and counselling services in Asia and the Pacific

UNICEF Press Centre

PHNOM PENH/CAMBODIA, 4 June 2007– Fewer than 10 per cent of people infected with HIV in HIV in Asia and the Pacific are aware of their status. This is a major obstacle in the campaign to prevent the spread of HIV and to provide AIDS treatment, say United Nations agencies, which today called on governments in Asia and the Pacific to rapidly expand access to HIV testing and counselling.

Representatives from the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) will meet 4-6 June in Phnom Penh, Cambodia, with experts and civil society delegates to identify strategies for dramatically increasing the availability of these services.

As of 2006, an estimated 8.5 million people are living with HIV in the Asia Pacific region. In 2006 alone, a million additional people were infected and more than 500 000 people died. With so few people aware of their status, efforts to prevent new infections and treat those who are positive are becoming more difficult.

“Knowing his or her HIV status is a public health and human rights imperative, as it leads to life-extending HIV treatment, care and support services, as well as to evidence-based prevention interventions," said Dr Shigeru Omi, WHO Regional Director for the Western Pacific.

More than 20 years after the first reported case of HIV in the Region, access to testing and counselling is limited. Although voluntary counselling and testing sites have been established in all countries, poor infrastructure and limited human resources hinder the capacity of health services to introduce and deliver the needed testing and counselling.

Persistent stigma and discrimination also prevent many individuals from actively seeking help. Those infected tend to wait till they are too ill, thus jeopardizing the success of treatment. And often, those already at risk of HIV infection, such as partners of injecting drug users or men visiting sex workers, do not perceive themselves at risk of being infected.

In an effort to overcome these obstacles, United Nations agencies are calling for an increase in client- and provider-initiated testing and counselling, as well as a strengthening of prevention, treatment and care services.

The Phnom Penh consultation involves some 70 experts and scientists, representatives of nongovernmental organizations, civil society and affected communities, along with human rights experts from Asia and the Pacific. They will be looking at existing testing and counselling policies and practices, discussing global guidelines, and identifying ways to scale up HIV testing and counselling as part of prevention, treatment, care and support services in the Region.

An important component of this deliberation is the recently released WHO and UNAIDS guidance on provider-initiated HIV testing and counselling services. Provider-initiated HIV testing and counselling (PITC) is an approach in which health care providers specifically recommend an HIV test, when it fits the local epidemiological and social context. This requires that health facilities have the capacity to ensure that patients receive and understand basic information on HIV and have given informed consent prior to the testing. Provision of individual post-test counselling and referral to specialized services are steps that follow the HIV test, ideally done at laboratories linked to quality assurance and control schemes.

“Expanding access to quality HIV testing and counselling will require strengthening of existing infrastructure, quality assurance systems and human resource capacity, as well as monitoring and supervision systems, at all levels of the health system," said Dr Samlee Plianbangchang, WHO Regional Director for South-East Asia.

According to the new guidelines, HIV testing continues to be voluntary and in compliance with the "3 C's" – informed consent, counselling and confidentiality. This requires that laws and policies against discrimination on the basis of HIV status are in place. Where such laws exist, a more concerted effort is needed to ensure they are enforced.

“As we work to scale up testing and counselling suitable to the regional context we must safeguard the rights of those who test positive while securing resources for training in the health care system to further reduce stigma and discrimination,” says Prasada Rao, UNAIDS Asia Pacific Regional Director. “We need a greater commitment to change attitudes about the virus and strengthen political will to make anti-discrimination policies a reality.”

Priority also needs to be given to children, who have faster disease progression than adults and for whom there are specific HIV testing issues around consent and confidentiality. Of the 64 000 children living with HIV in the Region who are estimated to be in need of treatment, only one in five are receiving antiretroviral treatment, and nearly all of these children are in three countries - Cambodia, India and Thailand.

“By increasing access to early diagnosis of HIV in infants and children, we are in a better position to improve the quality of life for children who test positive by providing better care, support and treatment,” said Anupama Rao Singh, Regional Director of UNICEF East Asia and Pacific Regional Office. “However, we need to ensure that when it comes to testing children, we adhere to the Convention on the Rights of the Child, especially that the best interest of the child is respected.”