Globally, the world has halted and reversed the spread of HIV, and achieved Millennium Development Goal 6 that seeks to combat HIV/AIDS, malaria and other diseases. Since the year 2000, new infections have fallen by 35% and AIDS-related deaths by 24%. Close to 16 million people are now receiving antiretroviral treatment (ART).
This holds true for the WHO Region of South-East Asia as well. The number of new infections has declined by 32% between 2000 and 2014. Almost 1.3 million people have been put on ART.
However, gaps remain; more than half of the people with HIV are unaware of their status; those who test, do so late when they have symptoms and their immune systems are already compromised; only 36% of the people living with HIV (PLHIV) in the Region are on treatment; and fewer than 30% of people with HIV get to the last point in this so-called “cascade” of care i.e. achieve viral suppression. Late diagnosis prevents us from accruing the prevention benefits of early treatment. Low viral suppression means transmission continues to occur.
At the UN General Assembly, world leaders endorsed the new sustainable development agenda. This included the target of ending the AIDS epidemic by 2030 – by reducing the number of new infections by an additional 25% by 2020; ensuring that 90% of people living with HIV are aware of their infection, 90% of PLHIV are on ART, and 90% of those on ART have no detectable virus in their blood (the “90-90-90” targets).
This provides us with the opportunity of including an AIDS response within the universal health coverage framework that ensures equity and coverage and financial protection for all populations. It also helps in removing some of the structural barriers like stigma and discrimination.
Bold actions will be required to achieving the target for ending AIDS by 2030, with the health sector playing a central role. WHO is working with countries for accelerating progress towards achieving these targets.
1. Refocusing HIV programmes for the greatest impact
The new WHO guidelines emphasize data collection and use of 10 essential indicators along the cascade of prevention, care and treatment services needed to achieve “90-90-90”. A better understanding of the service cascade will help improve linkage of services, focus interventions for impact and improve the quality of care. It will also improve accountability by highlighting bottlenecks and addressing gaps in service delivery. Robust sub-national data helps in prioritizing services geographically and for population groups most at risk and need. This helps in making programmes more effective and efficient and achieving the intended impact.
2. Innovative testing to boost awareness of HIV infection
WHO recommends that HIV testing be expanded with specific engagement of communities to reach the most vulnerable and marginalized; to use available technologies that facilitate HIV testing closer to where people live, like community based testing and HIV self-testing.
3. All PLHIV should receive antiretroviral treatment
In September 2015, WHO recommended offering ART to all PLHIV, regardless of their CD4 count. On World AIDS Day 2015, WHO will launch key recommendations on clinical interventions and service delivery for expanding treatment to all PLHIV.
4. Step-up prevention
The number of newly infected PLHIV continues to exceed the number of those who started on ART within the same time period. Progress towards ending AIDS can only be made if greater attention is given to preventing new infections on a larger scale.
In 2015, WHO recommended offering pre-exposure prophylaxis as part of the combination prevention package for people at substantial risk of acquiring HIV, such as men who have sex with men, sex workers and transgender people. This adds to the arsenal of a combination of preventive measures for key populations.
The new targets are ambitious but achievable! By the end of 2014, Thailand had tested and enrolled more than 60% of its PLHIV into treatment. It is one of ten countries in the world to have achieved this distinction. Many other countries in the Region can and must accelerate and scale up HIV testing and treatment programmes.
Efforts over the next five years will decide whether we will end AIDS by 2030 or face a resurgence in an epidemic that has seen the most phenomenal journey of our times – from a death sentence to chronicity with almost full lifespan. In over four decades of the epidemic, science, social mobilization, political commitment and coordinated response among key stakeholders have made it possible to end AIDS. History shall not be kind to us if we become complacent now.
Ending AIDS will require investments, but these will be worthwhile. Countries in the Region are leading the way in funding a HIV response through domestic budgets; but more remains to be done. We need to ensure that HIV response is firmly positioned in the development and health agenda of the Sustainable Development Goals. We need to ensure that community responses are not only sustained, but further scaled up and fully funded. Stigma, discrimination and punitive laws still hamper access to key services for those most in need. We need to reaffirm and renew our resolve to work towards realizing our goal of ending AIDS in the WHO South-East Asia Region by 2030.