By Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region
The world has made steady progress in the battle against the HIV epidemic. Globally, of the estimated 37.9 million people living with HIV in 2018, 79% were aware of their condition. 62% were covered with treatment and 53% had achieved viral suppression. Across the world, a greater proportion of people living with HIV are receiving the care they need to lead healthy lives and minimize the risk of transmitting the virus. Achieving a world in which all people can access quality services to detect and treat HIV, as the pursuit of universal health coverage (UHC) demands, is possible. So too is reaching the Sustainable Development Goal target of ending AIDS as a public health threat by 2030.
To do both, the world’s ‘steady’ progress must become ‘rapid’. In 2018 an estimated 1.7 million people were newly infected with HIV. Around 770 000 people died of HIV-related causes – substantially less than the number of people that died of them just five years ago, but well short of the 2020 Fast-Track target of 500 000, which is also the global target for the number of new infections annually. HIV has now claimed more than 32 million lives since the epidemic first began.
The WHO South-East Asia Region has had several recent successes. In 2016 Thailand became the first country in Asia to eliminate mother-to-child transmission of HIV and syphilis. In 2019 Maldives became the second country in the Region to achieve the milestone. Other countries are stepping up efforts, with several on the cusp of being validated for eliminating mother-to-child transmission. Between 2010 and 2018 the Region reduced the number of new HIV infections by an estimated 33% and the number of AIDS-related deaths by 27%. The Region now accounts for 22% of all HIV-related deaths globally, which is less than its share of world population.
As the theme of this year’s World AIDS Day emphasizes, community engagement is crucial to bridging gaps and making much-needed gains. It will in fact be the difference between success and failure – a critical point as the Region prepares to undertake a root-and-branch review of progress with a view to accelerating it via a new action plan, which will come into effect in 2022. As noted at a 2018 SEARO Think Tank meeting, to pursue the Region’s ‘Sustain. Accelerate. Innovate’ vision we must make full use of all opportunities, including the buy-in and engagement of affected communities.
As a first priority, communities should be empowered to access services that detect and treat HIV. Information campaigns can ensure all key populations know where and how to access services. Engagement initiatives can ensure they are comfortable doing so. Both outcomes will help countries make full use of a range of new tools, including better antiretroviral drugs such as Dolutegravir, in addition to enhanced testing strategies (outlined in a new set of WHO recommendations) such as community-based testing and HIV self-testing. On that score, it is imperative that Member States, in collaboration with communities and partners, scale up successful feasibility studies and pilot initiatives conducted in the Region, which evidence shows hold great potential.
We must likewise make full use of the rich experience of communities affected by HIV. The insights of key populations should inform and guide prevention programmes, ensuring they are aligned with the evolving disease burden and can overcome the present plateau in new infections. To achieve our targets and goals, the number of annual new infections must be reduced from 170 000 to just 51 000. A series of small-scale interventions have shown that introducing Pre-Exposure Prophylaxis (PrEP) as part of combination prevention could help do that. All Member States should consider including PrEP in their national programme.
Importantly, all community engagement initiatives must be fully funded and synergised with the quest to achieve UHC, which the Region has pursued as a Flagship Priority since 2014. The HIV response to date has underscored the need to build ‘systems for health’ that promote community engagement and buy-in as opposed to simply ‘health systems’ that fail to inspire their constituents. As part of Member State initiatives, community services should be fully costed. Work at the community level should be adequately remunerated. UHC is an opportunity to build momentum based on our conviction that no one can be left behind.
On World AIDS Day, WHO reaffirms its commitment to putting communities at the fore of efforts to end the AIDS epidemic. WHO will continue to support Member States in the Region as they strive to reach the unreached and underserved, and ensure all people living with HIV know their status, can access treatment and achieve viral suppression. By better engaging communities, especially key populations, we can turn steady progress into progress that is rapid and sustained. Our vision of a world in which AIDS is no longer a public health threat can be achieved. Together we must act.