HIV - Still A Significant Burden in Asia

HIV related epidemiological trends in Asia are no less alarming than those in Africa. With increasing number of new HIV cases among the men who have sex with men (MSM) and transgender populations in the region; the critical need to sustain responses, programmes and mobilize optimal resources to address needs of sex workers and injecting drug users (IDUs), and growing requirement to provide life-long treatment, care and support for all people living with HIV (PLHIV) in the region, the XIX International AIDS Conference (AIDS 2012) cannot afford to ignore HIV in the Asian region.

Addressing the needs of IDUs where interventions are getting limited or losing funding is acute. This is coupled with the proliferating use of illicit drugs that further compounds the public health challenge.

According to a "2012 Report of a Joint Strategic Assessment in 10 Countries" presented at the AIDS 2012 by Peter Godwin, this situation presents a huge public health challenge. The need to scale out and scale up prevention initiatives calls for an urgent action to prevent new HIV infections. There is a significant and continuing increase in  HIV prevalence rates. The public health sector is continually underfunded. While countries are pushed to engage in health systems strengthening, they aren't yet capable to deliver HIV services such as provider-initiated counselling and opt out/ in testing particularly to key populations like sex workers, MSM and IDUs. In most of the Asian countries, HIV programming had been developed vertically and is not well aligned to the health systems strengthening strategy.

Donor money and support are shifting to a “value for money” approach to spending, with a potential shift of focus to non-communicable diseases (NCDs) and integrate HIV chronic care services. Increases in the domestic funding which may result in sustainable financing solutions is a huge challenge for local public service delivery  provision, and may not be happening.

For more than 10 years, donors have poured 95% of HIV funding to low and middle income countries in the region where substantial volumes of money are utilized for general programmes and activities  targeted at low risk populations and at times domestic funding covers for treatment costs. 

The region is achieving numbers to meet the targets set at the United Nations High Level Meeting (HLM) which will be difficult to sustain unless countries develop the appropriate long term sustainable funding strategies with high levels of coverage and proven interventions.

According to Godwin, the following impediments have to be addressed by countries in region: 

* sound policy creating an enabling environment for investment that are better focused, with clear targets, and built on models that have worked;  

* efficient management structures and architecture, resource allocations according to strategy; 

* develop a national strategy where development priorities are aligned and harmonized so as to maximize resources, programs integrated; 

* comprehensive and transparent information on aid flows; 

* develop national plans that are self-improving; 

* strategic information systems program and resource guide; 

* investments on health systems strengthening and HIV programming and clear in operationalizing integration of HIV program into health systems strengthening (HSS); 

* evidence on efficacy if integrated care is improving quality of services, and more clarity about what outcomes are important to guide future integration investment; 

* critical programming challenges to scale up treatment; 

* address treatment gap and "take off" treatment as prevention; country’s national strategic plans with harmonization and alignment with common agreed strategies and results at the regional level; 

* civil society greater role to achieve UN HLM targets with sufficient human and funding resources and management capacity.

Over all major changes must happen at country level around HIV and health related policy and programming. Each country should be flexible and should adjust to the current and new agenda in order to respond to the new HIV situation. Policy and programing frameworks are essential, otherwise it will be difficult for countries to manage effectively.

As part of the strategic options, Godwin proposed that countries must determine what investment is needed and where do they intend to use the investment. It would also be technically sound if countries within the region think and work together working on a common vision, where they can invest together and the potential for partnership expansion in particular working with India and China along for ensuring access to high quality antiretroviral (ARV) medicines for those who need them most.

Nenet L Ortega - CNS (Philippines)