Bold action needed to end AIDS in the Western Pacific Region
Advances in HIV prevention and treatment could end AIDS as a public health threat in the Western Pacific Region, but for this to happen, people living with HIV need to know their status, access life-saving antiretroviral therapy (ART) and continue with lifelong treatment. These challenges were recognized by the United Nations General Assembly in September 2015 when it resolved to end the AIDS epidemic by 2030. The theme for World AIDS day this year, "Getting to zero", highlights the need to act more boldly and innovatively to reach this target.
The Western Pacific Region has made steady progress over the past 15 years. The annual number of new HIV infections has decreased from 120 000 in 2000 to 95 000 in 2014, and national adult HIV prevalence has remained below 1% in all countries in the Region in recent years. Half a million people are now on ART, a 44-fold increase since 2000.
Yet nearly two-thirds of people living with HIV are not receiving ART. Annual HIV-related deaths have increased from 43 000 in 2000 to 50 000 in 2014. In terms of HIV incidence, 97% of new infections occur in low- and middle-income countries. Vulnerable communities are disproportionately affected such as men who have sex with men, sex workers and people who inject drugs.
Chris Lagman, a volunteer for Love Yourself, a nongovernmental organization in the Philippines, has been working relentlessly to ensure equal access to HIV testing. Chris sees the barriers that prevent people from testing and the impact a late diagnosis can have: "A lot of people are basically scared to know their HIV status. We would like to change this, so the image of HIV testing should transition from scare to care. Instead of a fear-laden event, HIV testing should be considered as part of routine self-care”.
In Viet Nam rapid HIV testing is removing some barriers: “With simple techniques like finger prick to draw blood and rapid test diagnostics, we were able to train people who inject drugs to deliver HIV testing services to their peers in their communities. The convenience and comfortable environment have increased testing among those hesitant to visit such health care facilities", comments Dr Truong Binh Minh, Vice Director of Thai Nguyen Provincial AIDS Centre in Viet Nam.
A new method to reduce HIV transmission between sexual partners, pre-exposure prophylaxis (PrEP), is also welcomed by affected communities. PrEP involves the HIV negative partner taking continuous antiretroviral drugs to prevent transmission from their HIV positive partner. A range of studies have confirmed the effectiveness of PrEP and countries are now identifying the best way to integrate it into national HIV programmes. As Chris Lagman remarks, “PrEP is an empowering new addition to ways people can be accountable for their well-being, to protect and care for themselves. We are very excited to introduce it in the Philippines in 2016".
At the same time, new approaches must not overshadow traditional strategies such as consistent condom use, needle and syringe distribution and opiate substitution therapy. Dr Zunyou Wu, Director of the National Center for AIDS Control and Prevention, Chinese Center for Disease Control and Prevention notes, “Methadone programmes have had a tremendous impact on reducing new HIV infections among people who inject drugs”. In China there has been a 90% reduction of new HIV infections among the 184 000 drug users in the methadone programme since 2004.
While there is clear progress in testing and treatment for people living with HIV, more needs to be done to reach the goal of elimination by 2030. This includes combatting stigma and discrimination against vulnerable people across the Region. World AIDS Day 2015 seeks to raise awareness of these issues and highlight the actions we need to take to achieve a future free from HIV.