Everybody counts: End complacency, remove barriers to slow ongoing HIV spread

World Aids Day on December 1st every year is an opportunity to remind ourselves of the urgent and definitive steps that we still need to take in our efforts to end Aids as a public health threat by 2030 as a part of the Sustainable Development Goal 3.3. This day also reminds us of the enormous success we have had in our fight against HIV/Aids but also cautions us not to be complacent. On this day we renew our commitment to the cause of HIV prevention and treatment in a manner that is accessible to all, including key populations, under the overarching umbrella of universal health coverage.
Globally, the coverage of antiretroviral therapy (ART) has increased to nearly 20 million, or about 70 per cent of the estimated 36 million people living with HIV (PLHIV). As a fast-track approach to ending Aids, the World Health Organisation (WHO) in Southeast Asia Region is focusing on the 90:90:90 targets by 2020. In this regard reaching out to the first 90 per cent is the most challenging. There is a need to expand HIV testing services in a manner that will enable us to reach the unreached through a variety of testing approaches, including community-based testing and self-testing. We also need to increase detection of HIV among key populations by removing various structural and programmatic barriers for people at increased risk so that no one is left behind in our mission. Also linking all those found positive with HIV to [medical] care needs to be ensured so that no one is missed during the linkage and in the continuum of care.

The Southeast Asia Region of WHO has the [world’s] second highest number of people living with HIV with an estimated 3.5 million, out of which nearly 1.6 million are on ART. So far SEA Region countries have been able to avoid an explosive increase in HIV infections or deaths and are all showing declining trends. All countries in the Southeast Asia Region have adopted the “WHO treats all” recommendations and this is likely to lead to a significant increase in the number of people receiving free antiretroviral therapy in the Region.
An increase in coverage of antiretroviral therapy will have significant prevention benefits also in terms of reducing new infections in addition to reduction in HIV-related deaths. However, the challenge remains in early detection of treatment failure as the viral load testing facilities for monitoring response to ART are not available in many countries in the region and they still rely on CD4 testing. In terms of drug resistance, the regional office supported the country programmes in Nepal, Myanmar and Sri Lanka last year for drug resistance studies, and we are committed to support other countries in the region for similar studies.
The Regional Office has developed the Regional Action Plan for HIV in Southeast Asia (2017– 2021) for a clear vision of “zero new infections, zero HIV-related deaths, and zero discrimination”, and a goal of ending the Aids epidemic as a public health threat by 2030. The Regional Action Plan (RAP) has targets of reducing new infections by 68 per cent and Aids deaths by 67 per cent and increasing the number of PLHIV on ART to 2.9 million by 2020. It promotes a people-centred approach and is grounded in principles of human rights and health equity.
The Regional Office has also partnered with the Western Pacific Regional Office to finalise the regional framework for the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis in Asia and the Pacific 2018–2030.
Another issue that needs to be tackled effectively is preventing mortality and morbidity associated with co-infections like TB and hepatitis. There are effective medicines for treatment of hepatitis C, while hepatitis B can be treated with the same antiviral medicines used for HIV. The treatment of co-infections continues to be challenging due to the vertical nature of the HIV programme. Hence it becomes critical for programmes to improve the integration with other related programmes under the umbrella of universal health coverage.
Globally, there are challenges with respect to financing related to HIV and there is a need for countries to increase their domestic funding. The focus should be on strengthening the health system as such and bringing in efficiency in the existing system.
This year the theme for World Aids Day is “Everybody Counts”. We need to keep the momentum and push for a stronger programme that is more integrated and accessible to all. Let us all strive together for high-quality HIV care that is accessible for all including those who are marginalised and left behind under the universal health coverage umbrella. We need to keep the focus on the key populations by grounding the HIV response in human rights values, repealing punitive laws and policies, and investing in high-quality and stigma-free interventions to win this fight. I am sure that the SEA Region can win the fight against Aids and be an example for the world.