We have all the scientifically proven tools to end AIDS. It is about ensuring that these tools reach people who need them the most, through a sustainable HIV response, so said Dr Adeeba Kamarulzaman, the well known infectious diseases expert form Malaysia and a former President of International AIDS Society (IAS). She was speaking at the plenary of the 10th Asia Pacific AIDS and Co-infections Conference (APACC 2025) in Tokyo, Japan.
The world is indeed at the crossroads, in terms of the global response to HIV today. The Asia Pacific region has 3/4 of the world’s population and 6.7 million people living with HIV. The region accounts for almost a quarter of the annual new HIV infections globally (23%), making it the world's second-largest HIV epidemic after Eastern and Southern Africa.
The recent funding cuts by the US have further exacerbated the problems. UNAIDS projects that there would be an additional 6.6 million new HIV infections and 4.2 million deaths by 2029 just because of the shortfall created by US funding cuts. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries is so unacceptable if we take into account the promise of SDGs by all governments worldwide.
“So, will the world rise to the challenge, to make the future response affordable, or will we stumble, throwing away the progress of the last two decades and creating a drain on future resources of countries?” wondered Eamonn Murphy, Regional Director, UNAIDS for the Asia Pacific and Eastern Europe and Central Asia.
Speaking at APACC 2025, Murphy called for prioritising four other dimensions of sustainability- political leadership, enabling laws and policies, element of services and solutions and having proper systems in place, apart from financial stability.
UNAIDS leader Eamonn Murphy also stressed upon making prevention as the cornerstone of a sustainable HIV response.
"To end AIDS as a public health emergency we need a far stronger focus on prevention, and not just on keeping people living with HIV alive and well. New infections are like a leaking tap - "every drop in the bucket" is another individual requiring a life on treatment. The only way to ensure a sustainable response is to stop this flow."
As per latest UNAIDS data, globally between 2010 and 2023, there was a 39% decline in new HIV infections. However the rate of decline in Asia Pacific was three times slower than this by 13% during the same period. There were 300,000 new infections - one every two minutes -in 2023 in this region. Also, since 2010, the new HIV infections amongst gay men and other men who have sex with men across the region, have increased by 33%.
Eamonn laments that countries are investing too little in scaling up HIV prevention. “While there is a high political commitment to fund treatment, there is limited will to invest in prevention."
"Four out of every five new HIV infections occur among key populations. However only one third of these communities have access to HIV prevention services. Key population led HIV prevention services are severely underfunded with less than 15% of HIV resources going into interventions for key populations," he said.
The recent funding cuts by the US have further exacerbated the problems. UNAIDS projects that there would be an additional 6.6 million new HIV infections and 4.2 million deaths by 2029 just because of the shortfall created by US funding cuts. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries is so unacceptable if we take into account the promise of SDGs by all governments worldwide.
“So, will the world rise to the challenge, to make the future response affordable, or will we stumble, throwing away the progress of the last two decades and creating a drain on future resources of countries?” wondered Eamonn Murphy, Regional Director, UNAIDS for the Asia Pacific and Eastern Europe and Central Asia.
Speaking at APACC 2025, Murphy called for prioritising four other dimensions of sustainability- political leadership, enabling laws and policies, element of services and solutions and having proper systems in place, apart from financial stability.
HIV prevention as cornerstone of sustainable HIV response
UNAIDS leader Eamonn Murphy also stressed upon making prevention as the cornerstone of a sustainable HIV response.
"To end AIDS as a public health emergency we need a far stronger focus on prevention, and not just on keeping people living with HIV alive and well. New infections are like a leaking tap - "every drop in the bucket" is another individual requiring a life on treatment. The only way to ensure a sustainable response is to stop this flow."
As per latest UNAIDS data, globally between 2010 and 2023, there was a 39% decline in new HIV infections. However the rate of decline in Asia Pacific was three times slower than this by 13% during the same period. There were 300,000 new infections - one every two minutes -in 2023 in this region. Also, since 2010, the new HIV infections amongst gay men and other men who have sex with men across the region, have increased by 33%.
Build more effective and efficient HIV programmes
Eamonn laments that countries are investing too little in scaling up HIV prevention. “While there is a high political commitment to fund treatment, there is limited will to invest in prevention."
"Four out of every five new HIV infections occur among key populations. However only one third of these communities have access to HIV prevention services. Key population led HIV prevention services are severely underfunded with less than 15% of HIV resources going into interventions for key populations," he said.
This is despite the proven evidence that key population led HIV service delivery model has been critical to bridge the gap between the public health services and those unreached. For example, 80% of PrEP (Pre-Exposure Prophylaxis for HIV prevention) is delivered by clinics run by key populations in Thailand. Thai PrEP rollout is the largest rollout in Asia Pacific region. Key populations or communities remain the largest provider and carer for those on PrEP even today in the land of smiles.
Eamonn Murphy of UNAIDS added: "PrEP related HIV prevention services largely remain donor dependent. PrEP, social contracting and other differentiated or innovative services mostly remain as pilot projects, and not continued at a scale to have impact on national or regional epidemics. For example, there is a 98% gap to the region’s PrEP target of reaching 8.2 million people by 2025."
PrEP - Pre-Exposure Prophylaxis for HIV, refers to medicines used to reduce the risk of HIV acquisition for HIV-negative people. They were first approved by US FDA in 2012.
Long walk to integrated health responses
Even though financial sustainability is important there is need for improvements in the system integration, in legal and social environments, and in community engagement and leaderships, says Dr Adeeba. "Addressing the legal and social environment, which the key populations find themselves in terms of coming forward for prevention, as well as treatment, is one area that requires much attention."
With legal barriers to HIV response existing in 39 countries of Asia Pacific, key populations are criminalised in many countries. These barriers include criminalising sex work or same-sex relations, or criminalising drug use, criminalising transmission of, or non-disclosure of HIV transmission, and restricting entry and stay of people living with HIV in the country. All these legal and social impediments have resulted in poor outcomes of HIV response in those countries.
Dr Adeeba also advocates for community engagement and leadership by involving communities not only in the designing of programmes, but also community based monitoring through peer led interventions- like in Thailand, which has great examples of key population led clinics and anti retroviral treatment.
Role of academia
As researchers and scientists, we must continue to advocate and stand firm in terms of the importance of science. Otherwise how else are we going to get the breakthroughs, like the importance of lifesaving antiretroviral therapies for treatment as prevention. HIV treatment works as prevention because science has proven that there is zero risk of any further HIV transmission from those people with HIV who are receiving the treatment, remain virally suppressed and have undetectable equals untransmittable to be true in their lives.
But the role of researchers does not end here. We then need to scale it up and the best way is through implementation research, says Adeeba.
PopART
The name PopART, stands for Population Effects of Antiretroviral Therapy to reduce HIV Transmission, because the study focused on evaluating the impact of a combination HIV prevention package, including universal test and treat, on community-level HIV incidence. The study aimed to determine how a community-wide approach to HIV prevention, including the use of antiretroviral therapy, could reduce the spread of the virus at a population level.
This PopART intervention with lifesaving antiretroviral therapy reduced HIV incidence by 30%, achieved 90% testing coverage, and increased viral suppression at population level even in remote parts of Africa. It demonstrated feasibility of scaling community based universal test and treat and influenced WHO guidelines on test and treat.
Dr Adeeba rightly insists that "Another very important role of researchers and academicians is to not just advocate with political leaders but also with pharmaceutical companies in making all the new advances accessible to countries that need them most. For example the price of Human Papilloma Virus (HPV) vaccine, which has been around for a long time, is still extremely high, and inaccessible to many parts of the world. So this is another important role that we as scientists and researchers must play- advocate to ensure sustainability of the HIV response, particularly in this day and age where financial resources are limited”. Women with HIV are at upto 6 times higher risk of HPV related cervical cancer.
With a decline in international donor support, it becomes all the more necessary for countries to transition to more sustainable domestic driven HIV financing.
UNAIDS leader Eamonn cites some good practice examples from the Asia Pacific region to see what sustainable responses could look like.
“Thailand has shown the model of integrating HIV services, introducing universal health coverage, and scaling up social contracting to reach the community organisations. and we need to pick up on that to share with other countries. Thailand already covers 90% funding of their responses and is developing a sustainability roadmap for the remainder. India is another example of progressive public policy to uphold the human rights of people in the HIV key populations, and they fund over 95% of their funding. In Malaysia, we find an example of diversified domestic resource mobilisation that targets the private sector. We can learn from these and other examples that make the right mix in different countries. We know what to do, the time of cherry picking in sustainability strategies is over. We must act now to enforce all relevant best practices and to keep the hope of ending AIDS alive."
This PopART intervention with lifesaving antiretroviral therapy reduced HIV incidence by 30%, achieved 90% testing coverage, and increased viral suppression at population level even in remote parts of Africa. It demonstrated feasibility of scaling community based universal test and treat and influenced WHO guidelines on test and treat.
Dr Adeeba rightly insists that "Another very important role of researchers and academicians is to not just advocate with political leaders but also with pharmaceutical companies in making all the new advances accessible to countries that need them most. For example the price of Human Papilloma Virus (HPV) vaccine, which has been around for a long time, is still extremely high, and inaccessible to many parts of the world. So this is another important role that we as scientists and researchers must play- advocate to ensure sustainability of the HIV response, particularly in this day and age where financial resources are limited”. Women with HIV are at upto 6 times higher risk of HPV related cervical cancer.
What next?
With a decline in international donor support, it becomes all the more necessary for countries to transition to more sustainable domestic driven HIV financing.
UNAIDS leader Eamonn cites some good practice examples from the Asia Pacific region to see what sustainable responses could look like.
“Thailand has shown the model of integrating HIV services, introducing universal health coverage, and scaling up social contracting to reach the community organisations. and we need to pick up on that to share with other countries. Thailand already covers 90% funding of their responses and is developing a sustainability roadmap for the remainder. India is another example of progressive public policy to uphold the human rights of people in the HIV key populations, and they fund over 95% of their funding. In Malaysia, we find an example of diversified domestic resource mobilisation that targets the private sector. We can learn from these and other examples that make the right mix in different countries. We know what to do, the time of cherry picking in sustainability strategies is over. We must act now to enforce all relevant best practices and to keep the hope of ending AIDS alive."
(Citizen News Service)
12 June 2025
(Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)
published in:
- CNS
- Modern Ghana
- Relief Web, UN OCHA
- Eurasia Review, Spain
- Op-Ed News, USA
- Bihar and Jharkhand News, India
