The failure to acknowledge the HIV epidemic in key affected populations will only make the situation worse and therefore universal promises on ending HIV/AIDS in 2030 can certainly be broken in Asia and the Pacific.
On June 10, the High Level Meeting on HIV and AIDS at the United Nations in New York was closed with the adoption of a shockingly weak Political Declaration by the member States. Nowhere in the last 27 paragraphs, which contain various global targets and commitments, was there any mention of the key affected populations such as men who have sex with men (MSM), transgender people, sex workers and their clients, people who use drugs and other sexual and gender identity minorities. There is an overwhelming evidence on how countries have not adequately invested in preventing new infections among these groups and how a large proportion among them are still denied access to antiretroviral treatment (ARV) due to stigma and discrimination against them, accompanied by the absence of enabling legal environment.
Asia Pacific has the largest HIV epidemic outside of Sub-Saharan Africa, but the region was scarcely mentioned in the Political Declaration. Asia has been experiencing a rapidly escalating epidemic among gay and other MSM, with nearly 50% of new HIV transmissions in 2020 forecasted to be among them, particularly their young cohort, the provided HIV responses remain the same. HIV prevalence among MSM is more than 5% in China, Indonesia, Malaysia, Myanmar, Thailand and Vietnam. Big cities such as Bangkok, Hanoi and Jakarta have a much higher local prevalence of 15% to 31%. Access to condoms for low income MSM is 31% and just less than 50% for that of with high income. In addition, ninety per cent of MSM in Asia and the Pacific do not have access to HIV services due to the presence of discriminatory laws in their country. Eighteen out of 38 countries in the region criminalise same-sex sexual activities and spending for HIV prevention for men who have sex with in the region is less than 7% of the total HIV budget.
Two prominent HIV advocates, the UN Secretary-General’s Special Envoy for AIDS in Asia and the Pacific JVR Prasada Rao and APCOM Executive Director Midnight Poonkasetwattana, have expressed their strong concerns on what the adopted Political Declaration will mean for the promise to end AIDS epidemic by 2030 in Asia and the Pacific.
“Any response to HIV/AIDS which does not keep prevention and treatment of the key affected populations as the central theme, will not take us to the goal of ending the AIDS epidemic by 2030. This is true even for the hyper epidemic countries of sub-Saharan Africa.”
JVR Prasada Rao made a very strong personal statement in the “The UNAIDS declaration on eradication is a half-done job” article in Hindustan Times. “Any response to HIV/AIDS which does not keep prevention and treatment of the key affected populations as the central theme, will not take us to the goal of ending the AIDS epidemic by 2030. This is true even for the hyper epidemic countries of sub-Saharan Africa,” said Prasada Rao in the article. Prasada Rao, however, does not overlook the positive points in the Declaration. The Declaration has successfully set quantitative targets the member States has pledged to fulfil by 2020 and by 2030. These remarks relate to committing financial resources for treatment programmes to fulfil the 90-90-90 targets (by the year 2020, 90% of HIV-infected people will get to know about the disease; 90% of them will receive antiretroviral cure; and 90% of those receiving antiretroviral cure will have viral suppression), international development assistance to reach the agreed 0.7% of GDP for developed countries, and spending a quarter of the AIDS budgets on prevention.
APCOM Executive Director Midnight Poonkasetwattana addressed the closing plenary of the High Level Meeting with a statement that leaves no room for misinterpretations: HIV and AIDS will not be an epidemic of the past by 2030 in Asia and the Pacific if the escalating epidemic in key affected populations is not acknowledged and no investments are made in prevention, care and treatment for these populations. Not mentioning the most affected communities is turning a blind eye on the realities in the world and the reality of HIV and AIDS, according to his closing statement.
“If we want to achieve fast-track to 90-90-90 by the year 2020, the time is now for urgent and increased investments in innovative regional and national approaches and programmes for and led by key populations to break down structural barriers that affect and make them vulnerable to HIV, especially of young gay men and other men who have sex with men, and transgender people in our region.”
“If we want to achieve fast-track to 90-90-90 by the year 2020, the time is now for urgent and increased investments in innovative regional and national approaches and programmes for and led by key populations to break down structural barriers that affect and make them vulnerable to HIV, especially of young gay men and other men who have sex with men, and transgender people in our region,” emphasized Midnight on the opening of his statement.
The closing statement entailed with a plea for more progressive action and commitments on the ground to ensure equitable access to quality and non-discriminatory prevention, treatment and care and support services, specifically to:
- commit to naming of key populations and young key populations, including gay men and other men who sex with men, sex worker, transgender people and injecting drug users;
- commit to a roadmap towards removing policies on HIV-related travel restrictions and deportation, and decriminalisation of key populations and LGBTI community;
- commit to removing age restrictions, parental and marital consent requirements for adolescents and young people;
- ensure universal access to comprehensive harm reduction, sexual and reproductive health and rights, HIV information services and comprehensive sexuality education for all;
- strengthened language on commitments to sustainable funding for civil society and meaningful community engagement;
- commit to fully optimise the use of existing flexibilities under the TRIPS Agreement specifically geared to promoting access to and trade in medicines;
- commit to the use of innovation and bring new technology to bridge and link prevention to treatment and care and support services – in particular on the use of Pre-Exposure Prophylaxes for men who have sex with men, community based and led HIV testing, and HIV self-testing for example, and using social media and on-line technology for service delivery; and
- explore, develop and maintain effective partnerships with key populations-led and -serving community organisations.
Both Prasada Rao and Midnight Poonkasetwattana indicated that the situation will be made worse because of the predicted shortage of funding HIV and AIDS programmes. It’s expected that there will be significant reduction of external assistance from sources such as the Global Fund for AIDS, TB and Malaria (GFATM) and other international HIV-oriented aid for middle-income countries. In the meantime, domestic funding in these countries is doubted to make up for the funding gap left by the withdrawal of this external support.
The required and desired funding transition from international to domestic sources comes too abrupt and without proper planning. The result of this equates an action of dismantling the longstanding knitted HIV-infrastructure, or in other words, squandering the gains made in the last decade in combatting the epidemic. There is also a notion that relying solely on domestic financing may result in the governments overlooking and under-resourcing HIV responses for key population, which are currently mostly funded through international sources.
Outrage and anxiety among key affected populations regarding the weak Political Declaration and the threat of inadequate funding from both external and domestic sources HIV services targeting them is understandable and justified. The list of progressive actions and commitments as mentioned above should have been a regional road map for ending the epidemic in Asia and the Pacific, but it is exactly there where the political will and/or the financial means in the region are lacking.
It is therefore inevitable that Asia-Pacific region will fall short in taking the immediate necessary steps to fast-track HIV responses by 2020 and to end the epidemic by 2030. Five years is not a long period in the global fight against HIV and AIDS, but the next five will determine whether ‘Ending AIDS by 2030’ is an achievable goal or will remain a distant dream for the region.