Universal Access – Challenges in the Asia Pacific Region

JVR Prasada Rao, Director of the UNAIDS Regional Support Team of the Asia and Pacific region, reiterated that “Universal Access is an achievable goal, and not just an aspirational goal”, all people should be able to access the services to live with health and dignity. Chairing the session on ‘Universal Access: What it takes to deliver in the Asia-Pacific Region’, Mr Rao stressed that countries in Asia need to think big and with confidence. Referring to the findings of the report ‘Redefining AIDS in Asia -- Crafting an Effective Response ‘, published by the Commission on AIDS in Asia, he stated that by pragmatically focusing prevention programmes on key populations – commercial sex workers and their clients, intravenous drug users (IDUs) and men having sex with other men (MSM), a considerable impact could be made by governments in halting and reversing the number of new infections across the Asia Pacific region.

At the UN high level meeting on AIDS in June 2006, the world committed itself to Universal Access to HIV prevention, treatment, care and support for all people in need by 2010. Following this, most countries organized consultations with key stakeholders, including civil society organizations, networks of people living with HIV, to agree on national universal access targets and on ways for overcoming the obstacles in achieving them. Since then, the commitment to universal access has galvanized AIDS responses around the world and reinforced the engagement to stand by those infected and affected by HIV. Specifically in the Asia-Pacific region, it is critical to make a breakthrough in prevention coverage among most at risk populations. In order to achieve this, countries will need to tackle legislative barriers and actively work with civil society organizations and people living with HIV to create an enabling environment and reach marginalized groups.

Michel Kazatchkine, Executive Director of the Global Fund for AIDS, TB and Malaria (GFATM), discussed the challenges to achieve Universal Access in the Asia Pacific. In the current scenario of global economic recession, resources are constrained even in the Asia Pacific region. But it is crucial that investment in the fight against HIV/AIDS continues. There is no excuse to decrease health spending, it is critical that gains made in the last eight years especially the progress made in scaling up prevention and treatment are not lost. Advocacy efforts are required at the national and global levels to continue the momentum and resource allocations for health. The Global Fund is currently providing support to 75 percent of those being treated for HIV in Asia. Asian economies even in this period of crisis are showing growth, and there is need for co-investment from multilateral organizations and the private sector.

Interventions have to be prioritized to reach high target groups, also protecting their human rights. More proposals that are dealing with vulnerable communities, IDU’s, MSM, Sex-workers needed to achieve Universal Access targets. Legal reforms are necessary in the region that truly protect PLHIV and work towards removing legislations that blocks universal access by criminalizing the lifestyles of vulnerable groups. Civil society partnerships are essential; communities need to be at the core of policy making, planning and programme delivery. It is vital that civil society organizations have support and funds.

HIV and TB co-infection and drug-resistant forms of tuberculosis present the greatest health challenges in the Asia Pacific. TB kills more people with HIV than any other disease. There is a growing emergence of Multidrug-resistance TB (MDR-TB) in this region; 10 of the 22 highest burden countries are in this region, and only a few cases are getting appropriate treatment. Need for urgent and aggressive scale up for effective interventions for the prevention, treatment and care of TB and MDR-TB in the Asia Pacific. Failure of Asian nations to combat MDR is a threat to global health.

One of the most significant barriers to achieving universal access to HIV-AIDS treatment and prevention is the lack of health infrastructure. In order to achieve universal access to comprehensive HIV prevention, treatment, care and support services; drastically cut maternal and child mortality; and achieve the other health-related Millennium Development Goals by 2010, strong health systems are essential. To strengthen and build sustainable health systems, long term commitments are required from all stakeholders in the Asia Pacific region. Ratu Joni Madraiwiwi, member of the Solomon Island Truth and Reconciliation Commission, believes that “to achieve universal access we must be rid of prejudice, engage civil society more, be culturally sensitive and have political commitment”.

Purnima Mane, Deputy Executive Director of the United Nations Populations Fund (UNFPA) stressed that the report of the independent Commission on AIDS in Asia published earlier this year found that it is vital that national responses are evidence-based and bring services to where it is most needed. Interventions are needed in marginalized groups – these include men who have sex with men, people who inject drugs, sex workers and their clients. Access to Sexual and Reproductive health services and information needs to be provided to youth and women living with HIV. Stating the slogan ‘Nothing About Us Without Us’, it is imperative that civil society be involved at each and every process in policy making and delivery on national programmes.

Ishdeep Kohli-CNS

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