Bangkok, Thailand, 21 November 2013—United Nations entities, civil society networks and development partners in Asia and the Pacific are joining to urge for a rapid increase of voluntary confidential community-based HIV testing and counseling for key populations at higher risk—including men who have sex with men, transgender people, sex workers and people who use drugs— in the region, to help ensure more people in need are able to access life-saving antiretroviral treatment.
Low levels of access to HIV testing and counselling for key populations at higher risk remains a serious cause for concern in Asia and the Pacific. Across the region, less than half of the key populations know their HIV status, which can lead to late diagnosis, late initiation to care and treatment services, and can result in unnecessarily high morbidity and mortality for people living with HIV. This also means the benefits of the prevention impact of antiretroviral treatment are not being fully maximized in the region.
Although countries in Asia and the Pacific have made significant strides to expand coverage of antiretroviral therapy in recent years, in 2012 only 51% (43%-63%)[1] of people eligible for antiretroviral treatment were receiving it.
If access to antiretroviral treatment is to be increased (to levels committed by nations through the 2011 United Nations General Assembly Political Declaration on HIV/AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS), there is an urgent need to change current approaches to HIV testing and counselling in the region.
Ensuring key populations at higher risk have access to testing, prevention, care and treatment services is fundamental to progress on HIV in Asia and the Pacific. Current facility-based HIV testing needs to be augmented by and respectful of community approaches to reach key populations who are currently under-served. This can only be achieved by ministries of health partnering with community organizations who are trusted by their peers to provide life-saving HIV prevention, care and support, and who understand how to deliver services that are ethical, convenient, acceptable and effective.
Voluntary and confidential HIV testing and counseling using rapid testing should be provided in both facility-based and community venues at times and locations that support greater access and uptake. For community organizations to offer HIV testing and counseling, ministries of health must acknowledge, legitimize and actively support their role in providing these services and offer training on the use of rapid test devices safely and accurately. Sufficient allocation of funds for these services and adequate test kit supply must be ensured as part of national programmes. Where necessary, national HIV testing policies and protocols need to be modified to include community-based testing and counseling.
Across Asia and the Pacific, evidence shows that many people do not undergo HIV testing for fear of stigma and discrimination, and disclosure that can affect their livelihoods. In some settings in the region, testing practices such as coerced or mandatory testing of key populations, including sex workers and migrants continue to be reported. Through a number of community-based testing and counseling programmes already conducted in the region, evidence shows that community-based testing helps reduce stigma and discrimination, encourages greater up-take of services and ensures greater protection of human rights. In the drive to increase community-based testing, ministers of health and community groups need to work together to monitor the quality of services, ensure that the conform to ethical standards, including confidentiality and consent and safeguard the human rights of communities and key populations against all forms of coercive testing.
We (United Nations entities, civil society networks and development partners in Asia and the Pacific) are committed to work with countries and communities to support community-based confidential and voluntary testing and counseling through:
- Review of existing national testing strategies and approaches, and revise where needed to expedite progress
- Strengthening of partnership between ministries of health and communities
- Support of community-led efforts to promote, and increase demand for HIV testing
- Advocate for communities as equal partners in delivery of HIV testing services at national level
Supporting as many people living with HIV to be aware of their HIV status as early in their infection as possible, and linking them successfully to HIV prevention, care and treatment services will enable more people to access antiretroviral treatment and to maximize the preventative benefits of treatment.
Such decisive action can lead Asia and the Pacific towards realisation of the bold targets from the 2011 UN Political Declaration as well as the ultimate vision of an Asia and the Pacific with zero new HIV infections, zero discrimination and zero AIDS-related deaths.
[1] Under the 2010 WHO guidelines
