HIV Epidemic in the Western Pacific Region
Just as it is possible to prevent becoming infected by HIV, it is possible, through concerted and sustained efforts, to prevent the growth of an HIV epidemic, to stabilize it, and to reverse it.
Through the provision of evidence-based technical support, WHO takes the lead within the United Nations system in the global health sector response to HIV/AIDS and assists countries to scale up towards the internationally endorsed goal of universal access to HIV prevention, treatment, care and support services by 2010.
Key health sector interventions focus on HIV testing and counselling, prevention of HIV among most-at-risk populations, and treatment and care of HIV and AIDS through the provision of antiretroviral medications.
Universal access means that everyone who may need HIV prevention and treatment services has access to them. The target for universal access therefore is 100%.
Evidence has shown, however, that in order to reverse the HIV epidemic in a country, a target of 80% for prevention is sufficient to impact on and reverse the HIV epidemic. The only target acceptable for treatment is 100%, as everyone who is infected with HIV should be treated.
In the Region
In the Western Pacific Region, intensified political commitment has led to a significant increase in available resources and the establishment of broad national programmes in response to HIV/AIDS over the past five years. However, these improvements are still not sufficient to halt or reverse the spread of the HIV epidemic and most countries in the Region will not meet the universal access goal by 2010.
HIV testing and counselling
The provision of HIV testing and counselling services has increased overall in the Region, and more people are accessing them. Coverage levels are still insufficient, however, particularly for most-at-risk populations. The majority of people living with HIV/AIDS are still unaware of their status.
Prevention for most-at-risk populations
Prevention of HIV among most-at-risk populations varies greatly among countries in the Western Region. Overall, limited availability of information, uncertainty about population sizes and large size of “invisible sub-groups” are some of the challenges faced in evaluating prevention among these populations. Current evidence shows that condom use among sex workers is high in many countries, especially in sex work establishments. Prevention coverage among men who have sex with men and people who inject drugs is on the rise, but the coverage is largely insufficient given the fast spread of HIV documented in many countries.
Treatment and care
Between 2004 and 2008, antiretroviral therapy (ART) coverage increased eight fold and scale-up has continued since then, with a 37% increase in 2008 over the previous year. In spite of this progress, however, coverage only stands at 31% in the Region and is still far from the 100% target of universal access to treatment and care by 2010. Moreover, coverage may decrease as new WHO guidelines recommend earlier initiation of ART.
Interventions for women and children
Appropriate services to prevent mother-to-child transmission of HIV are still inadequate in the Region, even though availability of services and higher uptake of testing among women have been documented in the Region. As a consequence, there are many new cases of paediatric HIV. Despite the late start of paediatric treatment in the Region, evidence has shown good coverage of ART among children living with HIV.
Future incidence of HIV/AIDS will be influenced directly by the level at which HIV prevention and treatment are sustained and strengthened. In the Region, more efforts are needed:
- to track and monitor both epidemics and responses, with a particular focus on the main drivers of the epidemic;
- to ensure the quality and sustainability of established services;
- to expand health sector interventions to the recommended coverage level (universal access) in order to impact on the epidemic; and
- to scale up HIV services for women and children.