UNAIDS leadership forum at ICAAP – achieving zero new infections, zero AIDS deaths and zero discrimination in Asia and the Pacific

Panel at the UNAIDS Leadership Forum.

In the lead up to the 11th International Congress on AIDS in Asia and the Pacific (ICAAP11) -  the largest HIV conference in the region - The World Health Organization (WHO) and UNAIDS are hosting a two-day Leadership Forum entitled "Asia Pacific Getting to Three Zeros"  to discuss achieving zero new infections, zero AIDS deaths, and zero discrimination in the region.

The two day forum, held 18-19 November in Bangkok, is one of many events happening during the ICAAP conference that is putting the international spotlight on responses to HIV in Asia and the Pacific. Around one hundred senior government officials, policy makers and civil society leaders were in attendance on the first day of the forum.


The first day focused on the leadership role that Asia and the Pacific is playing in ending HIV/AIDS, and presenters addressed the question: "Can Asia and the Pacific achieve zero AIDS deaths?"

The forum was opened by Steve Kraus, Regional Director of UNAIDS, who stated that despite scientific advances and innovations in programmatic responses to HIV over recent years, the number of new HIV infections in Asia and the Pacific has remained constant - at around 350,000 new infections every year since 2008. He also stressed that despite a decline in deaths from AIDS in the region, over 50% of people who need HIV treatment still cannot access it.

Mr Kraus said that too many countries in our region have travel restrictions for HIV positive people, criminalise same sex behaviour and sex work, and impose the death penalty for using drugs. "We still have a long way to go to get to zero discrimination," he said.

Dr Gottfried Himschall, Director of the HIV department at WHO, discussed treatment numbers. He said that although many countries have had great success in scaling-up the number of people accessing treatment in recent years -  such as India, Myanmar and Vietnam which have more than doubled the number of people receiving ARV treatment between 2009 and 2012 - many other countries are falling behind.

He said that the Leadership Forum aimed to highlight concrete action points and community-based approaches from the region that could be used to address rates of HIV in key affected populations: men who have sex with men, transgender people (particularly transgender women), sex workers, and people who inject drugs.

Jan Beagle, Deputy Director of UNAIDS, and Ratu Epeli Nailatikau, President of Fiji, discussed global development and leadership issues for ending AIDS.

Jan Beagle gave a passionate speech declaring that failure is not an option because failure costs lives, while his Excellency, Ratu Epeli Nailatikau, said that by strengthening health promotion strategies, addressing stigma and selecting appropriate interventions he believed that we can succeed in getting to zero.

These opening addresses were followed by a panel of speakers who presented a series of case studies from across the region. The four panellists presented data on their respective countries, examining the following questions:

• What are barriers in scaling up access to treatment?
• How can new WHO Treatment Guidelines and the UNAIDS Treatment Framework assist the process?
• What are key actions for strategic use of antiretroviral (ARV) medications in the 800 days until the current millennium development goals expire?; and
• What can be learnt from responses throughout the region regarding 'game changers' and priority actions that other countries can scale-up and adopt?

Case studies

Indonesia

Presented by Kernal N. Singer (Secretary National AIDS Commission, Indonesia)

Kernal N. Singer talked about the importance of scaling-up access to ARVs to achieve zero AIDS deaths in Indonesia.

He said that Indonesia has strong political leadership on HIV and a strong focus on key populations and geographic hotspots; however, the country is still facing difficulties responding to HIV.  Despite a declining epidemic among people who inject drugs (PWID), HIV infections were still growing among men who have sex with men, and overall rates of HIV infections in the country were increasing.

Game changers include: a focus on key populations and geographic locations in a system that is highly decentralised.

Challenges include: In 2012, only In 40,000 people were receiving ARVs out of 350,000 people living with HIV. This makes the scale up of ARVs a major priority, and more effective district level coordination to scale up prevention and treatment services is needed.

Mr Singer says that the multi island geography of Indonesia presents challenges because: "…in a decentralised country … the commitment of local government is varied." He said that new infections are still increasing; he would like to address this by sharing good practices and learning from other countries in the region.

Myanmar

Presented by Myint Shwe (Programme Manager, National AIDS Program, Myanmar Ministry of Health)

Myint Shwe talked about the impressive scale-up of ARVs in Myanmar over the last few years. He said that new infections are declining since a peak in 2000 and the country is now providing treatment to 54,000 people -- almost double the number from 2010. This figure is anticipated to double again by 2016.

Game changers include: scale-up of treatment; increased government commitment on health and HIV (from 0.9% of GDP to 5% by 2015); expanded ART centres and decentralisation of testing and antiretroviral therapy (ART) resulting in more people being aware of their HIV status; prevention as a mainstay of the response, including treatment as prevention; and a review of legal frameworks.

Challenges include: limited resources, punitive laws, stigma and discrimination, and a lack of data for key populations by geographic area.

He concluded: "With prevention efforts … [and] the process of addressing barriers to treatment and care services, I hope that we can reach close to zero by 2016".

Cambodia

Presented by Mean Chi Vun, Director National Centre for HIV/AIDS, Dermatology and STD, Cambodia

Mean Chi Vun  said that Cambodia has had one of the fastest growing epidemics since the mid-90s,  but new infections have dropped tenfold over the past five years due to achieving over 80%  ART coverage among affected populations.

Game changers: Cambodia's HIV strategy to eliminate new HIV infections by 2020 and many elements of innovation such as new ways of testing  involving the streamlining and the decentralisation of services and the integration with other services such as TB and STIs. Good coverage has been achieved among many affected populations, with over 80% retention rates.

Challenges include: a costly AIDS response, fragmented community networks, and a legal and policy environment that hampers service access for key populations. Despite a threefold reduction in mortality rates, there has been a slight rise in mortality over recent years due to drug resistance.

He concluded by saying: "We have a clear roadmap to get to zero infections and death," but said he was not sure about achieving an end to stigma and discrimination by 2020.

Concluding remarks

Shiba Phurailatpam, regional coordinator of APN+, representing civil society, concluded the discussions with a passionate speech about the importance of peer-based approaches to counselling and community-led testing.

He said that people are getting tested too late and stressed the importance of testing early. He cited his former experiences as a person who had used injecting drugs and talked about his involvement with peer-based and community-led approaches to HIV testing and counselling among PWID.

He said that he believes that community testing and care is important for many reasons, one of which is that it increases retention rates. He also said that involving community in the process of testing and support can reduce the loss-to follow up. He also discussed the need to address legal barriers, saying that drug use doesn't make a person a criminal.

He discussed the primary importance of investing in the scale-up of HIV treatment and questioned the value spending huge amounts of money attending international AIDS events every year, saying that this money count be more effectively spent.

Another issue he talked about (and one not raised by the other presenters) was the issue of trade and intellectual property agreements and the price of ARVs.

In conclusion, some of the overarching themes that emerged from the forum discussions were:

• the importance of testing
• the need for community-led approaches in responses to HIV
• more focus on retention; and
• the decentralisation of services to bring them closer to the people that need them

Forum participants