Sunday, 01 August 2010

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Experts gather in Bali to discuss AIDS fight

Only a quarter of those in need of HIV treatment in the Asia-Pacific region are getting it. Around 4,000 experts have gathered in Bali to discuss and strategise on how to take the fight against AIDS further

Experts from 65 nations gathered in Indonesia from August 9-13, 2009, to assess progress in the battle against HIV/AIDS in Asia and the Pacific, amid concern that only a quarter of those in need in the region were getting treatment.  

The ninth International Congress on AIDS in Asia and the Pacific (ICAAP), on the resort island of Bali, will look at how to ensure “universal access” to antiretroviral treatment, congress chairman Zubairi Djoerban said.

He added that only 25% of the 1.7 million people with HIV/AIDS in the Asia-Pacific region who needed the treatment were receiving it, which is far below the target.  

UNAIDS regional director Prasada Rao said that countries such as Thailand, Cambodia and Laos have been able to treat 80% of HIV-positive people, but about 10 countries managed to cover only 10-15% due to geographical limitations and lack of funding.  

While there are some bright spots in the region, such as Cambodia, where HIV prevalence has declined through condom use, new infections are growing in populous countries such as Bangladesh and China according to a UN report released in 2008.

In Indonesia and South Asia, Djoerban said, the biggest threat was the lethal combination of dirty needles and unprotected sex.  

“We’re concerned about India, Indonesia and Pakistan where there is overlapping of drug injecting and unprotected sex... this includes sex workers taking drugs and drug users not using condoms,” he said. “New infections are offsetting positive results from preventive actions.” 

An estimated 5 million Asians are living with HIV, especially in southeastern countries such as Thailand, Cambodia, the Philippines and Indonesia, according to the UN report.  

Across the region, prevention, and care and support in HIV and AIDS are undercut by stigma and discrimination and lack of legal protection that puts groups such as drug users, sex workers and men who have sex with men at more risk. Also, resource constraints that governments face at a time of recession.  

“We need to reach men who have sex with men, intravenous drug users and sex workers and have the right legal environment to achieve universal access for them,” Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said at a discussion on August 10. But, he added, this cannot happen if drug use is still subject to the death penalty, as in many Asian countries, even as the sharing of needles is a major mode of HIV transmission.  

In 2007, Indonesia had the highest figure in Asia of drug users having HIV, at 60%, followed by Myanmar at nearly 50%. Afghanistan has 1 million drug users, of whom 120,000 are injectors. Likewise, 12 countries in the region have laws that criminalise on the basis of sexual orientation, same-sex relations and sodomy.  

The Delhi High Court’s decision to strike down a section of the Indian Penal Code on male-to-male sex was widely discussed and welcomed at the congress. Anand Grover, director of the Lawyers Collective HIV/AIDS Unit and UN Special Rapporteur on the Right to Health, said that criminalisation poses great challenges in addressing public health issues and presents a direct barrier in providing relevant HIV services.  

Other countries too have seen positive changes in legislation. Taiwan has a new law granting sex workers the same rights as their clients. Nepal recognised the constitutional rights of sexual and gender minorities. “Out-of-school youth, street children, young sex workers, including young men who have sex with men, have different needs. But they have the same rights,” said youth campaign coordinator Liping Mian. She added that her research in 2007 showed that sex workers are getting younger.  

Women, including pregnant women, and young people also need to be reached better by prevention and treatment efforts in Asia. Fifty million women, comprising 34% of all infections in the region, are put at risk by their male partners, says the Joint United Nations Programme on AIDS (UNAIDS). 

The number of patients getting antiretroviral therapy (ART) in the region has risen to 565,000 people today, a three-fold increase from the figure in 2003, according to UNAIDS. While this is a major achievement, respected medical professor David Cooper of the National Centre in HIV Epidemiology and Clinical Research, University of South Wales, pointed to worrisome gaps.   

“We now have all the drugs available but we’re not treating HIV-positive infants and those that belong to middle and lower income brackets,” Cooper said. “We have to do better, and right now we’re not doing well with pregnant women and children. The prevention strategy should be increased.”  

“We’re nowhere near universal access in this region,” he pointed out.  

Source: AFP via AIDS-INDIA, AIDS-INDIA eFORUM, August 10, 2009
           Johanna Son and Lynette Lee Corporal, TerraViva, August 10, 2009