Closing the gap in the Asia–Pacific response to HIV: putting key populations at the heart of the solution

Dr Poonam Khetrapal Singh and Dr Shin Young-soo

Joint WPRO-SEARO op-ed for World AIDS Day

New Delhi / Manila,

The vast majority of new HIV infections in the Asia–Pacific Region are occurring among populations most vulnerable to HIV: men who have sex with men, transgender people, people who inject drugs, sex workers people in prisons and other closed settings. Nearly five million people were living with HIV in the Asia–Pacific Region in 2013–about one sixth of the global burden. There were an estimated 350 000 new HIV infections in the Region in 2013–the second-highest regional HIV burden after Sub-Saharan Africa.

Partnerships between health systems and communities in the Region have improved access to life-saving treatment, increased domestic resources for HIV/AIDS programmes and reduced stigmatization and discrimination. For example:

• Community organizations have helped formulate, implement and scale up the evidence-based recommendations contained in WHO’s “Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations”.
• In India, the Avahan HIV programme helped strengthen community-based organizations, leading to a sharp decline in the epidemic in several high-prevalence states. The lessons learnt are being incorporated in the national response, helping to ensure sustainability.
• In China, the Government is increasingly engaging with civil society organizations. Nongovernmental organizations such as AIDS Care China are providing a key bridge between government HIV programmes and key populations.
• The governments of the Philippines and Thailand, two of many countries where the MSM HIV epidemic is surging alarmingly, are working actively with MSM organizations that connect communities with HIV services.

All of these examples fit the theme of World AIDS Day 2014: Closing the Gap. This theme is about empowering all people to access the services they need.

Less than half of all HIV-positive people across the Asia-Pacific Region are aware of their status. An estimated 1.5 million people in the Region are receiving antiretroviral treatment–about one third of the Region’s HIV-positive population. This is a significant improvement compared with a few years ago, but the journey is less than half complete. WHO Member States can do better. It is only by closing testing and treatment gaps and reaching all in need that we can achieve our goal of ending AIDS in Asia by 2030.

We need to overcome challenges. Key populations continue to face stigmatization and discrimination, including punitive legislation. This must change. WHO consolidated guidelines are guided by human rights principles and call for governments to enforce protective laws to eliminate discrimination and violence faced by key populations.

Evidence is adding to a dynamic response. Today, WHO has released a new update to recommend antiretrovirals as an emergency prevention intervention following possible HIV exposure for HIV-negative individuals, and to prevent and manage common opportunistic infections that affect many people living with HIV.

We need more resources and wiser investments to address the HIV crisis in key populations. A renewed focus on HIV response needs to be articulated in the post-2015 health and development agenda.

WHO works to improve the continuum of HIV prevention, treatment and care. We work hand in hand with key populations–with a range of civil society organizations to help safeguard the health and well-being of millions of people.

Ultimately, health is a human right. Creating an enabling environment ensures equity and respect for human rights, ensuring greater access to essential health services for all people.

Dr Poonam Khetrapal Singh and Dr Shin Young-soo are the WHO Regional Directors for the South-East Asia Region and Western Pacific Region respectively.

Access the WHO consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations at http://www.who.int/hiv/pub/guidelines/keypopulations/en/

WHO Regional Office for South-East Asia website: www.searo.who.int

WHO Regional Office for the Western Pacific website: www.wpro.who.int