Ten years ago, the idea of elimination of HIV would have sounded like a pipe dream. However, this is now considered a realistic goal due to substantial progress made through years of commitment, investment and collective action. New HIV infections now show a declining trend globally. All 11 countries in the World Health Organisation’s (WHO) South-East Asia Region showed a decline by 34 per cent in the past decade.
The overall decline in the region is cause for increased optimism. However, complacency now could become our greatest enemy. Those most “at risk” of HIV are disproportionately affected by the disease and are also among the least empowered. They include youth, those who inject drugs, female sex workers, men who have sex with men (MSM), transgender people and migrants. Zero new HIV infections and zero AIDS-related deaths by 2015 can be achieved through greater efforts directed towards “at risk” populations to encourage increased testing. HIV prevention services for these people need to be expanded to battle the concentrated epidemic found in this region.
In India, the estimated number of new HIV infections has declined by 56 per cent over the past decade and the total number of people living with HIV is estimated at 24 lakh (the range is 19.3-30.4 lakh). This is good news but it remains essential to continue with public awareness programmes on HIV/AIDS and that messages are regularly conveyed to remind people on the importance to get HIV tested and to be aware of their HIV status.
TB test
An extremely important role of HIV testing and counselling is that it is also the entry point to HIV care and treatment services. Furthermore it offers access to HIV prevention information which can persuade people who are at-risk to change their behaviour and reduce the risk. In India, TB is also widespread. Thus greater efforts are required to educate newly detected people living with HIV, and those already detected with HIV, to get a TB test.
Today a person infected with HIV can remain healthy and live long with antiretroviral therapy. The person can also take measures to prevent spreading the virus to others. However most at-risk populations are reluctant to approach HIV testing and counselling services, so large numbers are not aware of their HIV status, and many continue to become HIV infected.
In this region, most “at-risk” populations remain highly marginalised and vulnerable to HIV. The HIV epidemic among them is either long established and largely unresolved or newly emerging and rising at an alarming rate. Overall, South-East Asia still has a significant problem of injecting drug use, with an estimated 4,50,000-5,00,000 drug injectors. Many drug injectors become HIV infected due to sharing of contaminated needles. Due to the stigma, only a minority of HIV-infected drug injectors receive treatment. Despite gradual decline in the general population, HIV prevalence among them remains high, ranging from nine per cent in India to 36 per cent in Indonesia. More than 50 per cent of drug injectors are co-infected with HIV and Hepatitis C in many countries in South-East Asia. Harm reduction programmes need to be expanded to halt the spread of HIV among drug injectors.
Men who have sex with men (MSM) and transgender people continue to have an alarmingly high and rising HIV prevalence rate in the region. One in three MSM are reported HIV infected in Bangkok, while nine States in India have more than five per cent HIV prevalence among MSM. Unless HIV prevention measures are improved, it is likely that a substantial growth of new HIV infections in the region could be among MSM. However, many MSM face stigma and discrimination which prevents health-seeking behaviour. Criminalisation of same sex behaviour promotes risky behaviour, prevents MSM from accessing prevention measures and exacerbates social inequalities making them vulnerable to HIV infection.
Addressing the health needs of at-risk populations can be challenging when laws and practices criminalise populations at highest risk for HIV, and deter them from HIV prevention and care services.
We know what needs to be done for halting and reversing the HIV epidemic among the vulnerable and those at highest risk. There is an urgent need for scaling up services. We need to expand HIV testing and counselling; involve affected and infected communities for spreading awareness about knowing one’s HIV status and enrolment into care for those who test positive. Ongoing support and care is critical as more and more HIV-positive people on treatment live longer. Prevention benefits of early treatment are well established and all the more pertinent for at-risk populations and their partners.
Updates on treatment
The health sector needs to provide more inclusive services for these communities, to promote and support legal and social frameworks that are rights based and consistent with public health and HIV prevention goals.
WHO continues to advance and update evidence on newer technologies and treatment initiatives in collaboration with country programmes and other stakeholders to ensure that we move together and faster towards the end of AIDS.
(Dr. Samlee Plianbangchang is WHO Regional Director for South-East Asia.)
