As per the last update from UNAIDS, globally, compared with adults in the general population (aged 15-49 years), HIV prevalence was 11 times higher among gay men and other men who have sex with men, four times higher among sex workers, seven times higher among people who inject drugs, and 14 times higher among transgender people in 2022.
UNAIDS 2023 update further states that “The most successful HIV responses are following principles very similar to those that anchor the United Nations Common Agenda and that serve as compass points for the SDGs. They put people first, confront inequalities, uphold human rights, and forge trust between public authorities and affected communities. There are huge opportunities to advance on all these fronts. Seizing them now will take the world to within reach of ending the AIDS pandemic, and it will add fresh momentum towards achieving a range of SDGs.”
“The path to ending AIDS is clear. HIV responses succeed when they are anchored in strong political leadership, have adequate resources, follow the evidence, use inclusive and rights-based approaches, and pursue equity. Countries that are putting people first in their policies and programmes are already leading the world on the journey to ending AIDS by 2030” further added UNAIDS update last year.
But not only we are not focussing on key populations enough in Asia Pacific region or doing what UNAIDS has stated above, but even the funding gap is so mountainous!
“In order to reach the 2025 target, set within the 2021 Political Declaration on AIDS, the funding gap is enormous: of US$ 29 billion! Asia and the Pacific region need 32% of it. Where will the US$ 9.28 billion come from for the HIV response in the region?” asks Midnight Poonkasetwattana, Executive Director APCOM. He was addressing a pre-conference at the AIDS 2024 (25th International AIDS Conference in Munich, Germany).
There is a whooping 64% resource gap to meet the 2025 HIV-related targets (in Asia Pacific region), said Midnight.
“As a gay man from the Asia Pacific region, I ask why we are continually being left behind - and we demand equal and safe access to comprehensive HIV services, and end all forms of stigma, discrimination, criminalisation and punitive laws against gay men and other men who have sex with men,” said Midnight.
Asia and the Pacific region have 6.7 million people living with HIV – which is the second-largest number in any region worldwide after Sub-Saharan Africa (together both regions of Sub-Saharan Africa and Asia Pacific are home to 82% of people living with HIV globally). Over 300,000 people got newly diagnosed with HIV (almost a quarter of new HIV infections globally took place in Asia Pacific in 2022) and 150,000 people died of AIDS in 2022.
UNAIDS 2023 update further states that “The most successful HIV responses are following principles very similar to those that anchor the United Nations Common Agenda and that serve as compass points for the SDGs. They put people first, confront inequalities, uphold human rights, and forge trust between public authorities and affected communities. There are huge opportunities to advance on all these fronts. Seizing them now will take the world to within reach of ending the AIDS pandemic, and it will add fresh momentum towards achieving a range of SDGs.”
“The path to ending AIDS is clear. HIV responses succeed when they are anchored in strong political leadership, have adequate resources, follow the evidence, use inclusive and rights-based approaches, and pursue equity. Countries that are putting people first in their policies and programmes are already leading the world on the journey to ending AIDS by 2030” further added UNAIDS update last year.
But not only we are not focussing on key populations enough in Asia Pacific region or doing what UNAIDS has stated above, but even the funding gap is so mountainous!
“In order to reach the 2025 target, set within the 2021 Political Declaration on AIDS, the funding gap is enormous: of US$ 29 billion! Asia and the Pacific region need 32% of it. Where will the US$ 9.28 billion come from for the HIV response in the region?” asks Midnight Poonkasetwattana, Executive Director APCOM. He was addressing a pre-conference at the AIDS 2024 (25th International AIDS Conference in Munich, Germany).
There is a whooping 64% resource gap to meet the 2025 HIV-related targets (in Asia Pacific region), said Midnight.
“As a gay man from the Asia Pacific region, I ask why we are continually being left behind - and we demand equal and safe access to comprehensive HIV services, and end all forms of stigma, discrimination, criminalisation and punitive laws against gay men and other men who have sex with men,” said Midnight.
Asia and the Pacific region have 6.7 million people living with HIV – which is the second-largest number in any region worldwide after Sub-Saharan Africa (together both regions of Sub-Saharan Africa and Asia Pacific are home to 82% of people living with HIV globally). Over 300,000 people got newly diagnosed with HIV (almost a quarter of new HIV infections globally took place in Asia Pacific in 2022) and 150,000 people died of AIDS in 2022.
Every new HIV infection is a grim reminder that we could have done better in making the full cascade of combination prevention options available to everyone, everywhere – especially focussing on the key populations and ensuring they are not left behind.
Likewise, every AIDS-related death is a collective failure because we could have done better to save a life - we have the science and tools (including community-led science and evidence) that shows people with HIV can live normal healthy lives if they receive lifesaving antiretroviral therapy and remain virally suppressed. The World Health Organization (WHO) says that there is zero risk of HIV transmission from a person whose HIV viral load is undetectable.
That is why all governments in Asia Pacific have promised to achieve 95-95-95 by 2025. These targets mean that at least 95% of people living with HIV should know their HIV status, 95% of those who know the status should be receiving antiretroviral therapy, and 95% of those on the therapy should be virally suppressed.
“AIDS epidemic is generally on a decline in the region but in a few countries like Afghanistan, Bangladesh, Fiji, Laos, Papua New Guinea and the Philippines, it is on a rise. Not only this, but coverage of antiretroviral therapy is also below 50% in Afghanistan, Bangladesh, Fiji, Indonesia, Iran, Mongolia, Pakistan and the Philippines,” said Midnight.
“New HIV infections have increased by 32% among gay men and other men who have sex with men since 2010 in Asia Pacific. 38 countries criminalise some aspect of sex work and 17 countries criminalise same-sex relations in Asia Pacific region. 28 countries’ law does not allow for possession of a certain limited amount of drugs for personal use and 20 countries criminalise the transmission of, non-disclosure of or exposure to HIV transmission in Asia Pacific region,” said Midnight. “14 countries restrict the entry, stay and residence of people living with HIV.”
He added: “We must not leave out communities in Afghanistan and Myanmar due to the political situations. The Pacific Islands are often left behind in the response, and the civil society in the Pacific also calls for attention as Fiji and Papua New Guinea are seeing a rise of HIV infections. Progress towards 2030 targets for ending HIV transmission in Asia and the Pacific has slowed.”
Rollout of new HIV prevention options like PrEP remains disappointing
Expanding the range of HIV prevention options is important so that people in different contexts and settings can choose what works for them to protect them against HIV acquisition.
Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention option and is initiated before a potential exposure to HIV. It was approved by US FDA in 2012.
Should not we question if after 14 years of the FDA approval to PrEP, why has it not been introduced and translated into reduction in new HIV infections worldwide?
Agrees Midnight: “Across the Asia-Pacific region, access to and uptake of oral PrEP has been slow and there are multiple barriers to PrEP uptake. New PrEP products like long-acting Cabotegravir could address some of the challenges of oral PrEP and WHO has recommended long acting injectable cabotegravir as an additional PrEP option. Understanding, awareness of and preferences for different PrEP products will help countries and programmes better plan to provide the appropriate mix of options.”
Just few weeks ago, results of a phase-3 PURPOSE-1 HIV prevention study done among adolescent girls and young women in South Africa and Uganda show that there were no HIV infections in HIV-negative women who received 6 monthly (twice yearly) injectable investigational drug Lenacapavir - an injectable form of PrEP.
One wonders how long the delay is going to be in taking Lenacapavir to introduction in public programmes and seeing the impact in terms of reduction in new HIV cases among adolescent girls and women.
“Inequalities in HIV service provision and access leave many key populations underserved. In Asia Pacific, we are only reaching an abysmal 2% PrEP users in 2022, the target for 2025 being 8.2 million PrEP users, and we are only reaching 150,000 users. Where is the scale up? And to top it all, we need to programme long-acting injectable PrEP in our region as well,” rightly points out Midnight.
(Citizen News Service)
21 July 2024
(Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Global AMR Media Alliance (GAMA). Follow her on Twitter @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)
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