HIV AIDS - a winnable battle
Zero - new HIV infections, AIDS related deaths and discrimination
Dr. SAMLEE PLIANBANGCHANG- Regional Director,
WHO-South-East Asia Region
Thirty years since the first reported cases of Acquired Immuno
Deficiency Syndrome (AIDS) in 1981, the response to the HIV/AIDS
epidemic has been unprecedented, especially in terms of global and
national initiatives. Substantial progress has been made,
such as a 31 percent reduction in the number of new infections
between 2001 and 2009 in South-East Asia. A revolutionary new approach
to treatment endorsed by UNAIDS and WHO, which includes improved,
lower-cost drugs, simplified HIV diagnostic technologies, improved
delivery systems, and innovations in prevention of HIV infection,
give hope for achieving universal access to prevention, care and
treatment of HIV/AIDS, even in resource-constrained settings.
Yet, the challenge is far from over. HIV still remains a formidable
foe, affecting 33.3 million people globally, including 2.5 million
children. Despite years of concerted
global efforts and investments, there is still neither a cure nor an
effective vaccine for the disease. However, over time, the profile of
the HIV epidemic is evolving from a life
threatening to a chronic disease, thanks to availability of more
effective drugs and efficacious service delivery models involving
communities and people living with HIV/
AIDS. With changing realities, it is time, then, to reflect and
re-strategize in the long-drawn war against HIV/AIDS. Fundamental to
success is acknowledging that HIV/AIDS is a social and developmental
issue as much as a health one.
PMTCT programme
The impact on women and children is devastating. An estimated 1.3
million women aged 15 and above currently live with HIV in the WHO's
South-East Asia Region
(Bangladesh, Bhutan, Democratic People's Republic of Korea, India,
Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-
Leste). The estimated number of children living with HIV has increased
by 46 percent during 2001 - 2009. Of the 448 million cases of sexually
transmitted infections that occur globally, 71 million are in South-East
Asia. Due to low coverage of the prevention of mother-to-child
transmission (PMTCT) programme in the South-East Asia Region, a large
number of babies born to HIV-positive mothers acquire HIV infection in
the womb.
Despite considerable diversity in the HIV epidemic among the
countries of the Region, unsafe sex and injecting drug use are the main
drivers. Five countries -India, Indonesia, Myanmar, Nepal and Thailand -
account for a majority of the disease burden. Sexual transmission
accounts for the majority of cases in Bhutan, India, Myanmar, Sri Lanka,
Thailand and Timor- Leste. The HIV epidemic among people who inject
drugs is significant in Indonesia, Myanmar, Nepal, Thailand and some
regions of India. The Maldives has a growing threat of the HIV epidemic
due to injecting drug use.
Health services
The evolution of the epidemic from life threatening to a chronic
disease, with better drugs and better access to drugs, has resulted in
prolonging survival and quality of care for people living with HIV/AIDS.
This necessitates evolution of an HIV care model that is in line with
chronic disease management, with primary care providers playing an
important role.
The spectrum of HIV care needs to evolve into a comprehensive primary
care model that has an integrated, patient-centred approach, and is
linked to specialist care where and when needed. It also needs to
address the various socio-cultural issues that take the response beyond
the health sector into the families and communities.
Other key challenges include late diagnosis of HIV, stigma and
discrimination faced by people with HIV and most-at-risk population;
limited capacity of health systems; high prices of antiretroviral drugs
especially the second line drugs and lack of sustained finances. The
health sector can only overcome these challenges if it collaborates with
other sectors in order to tackle the social, economic, cultural and
environmental issues that shape the epidemic and access to health
services.
Care and treatment
The WHO's Health Sector Strategy on HIV for South-East Asia has been
endorsed by all the eleven Member States of the Region. It envisions
"Zero new HIV infections, zero AIDS-related deaths and zero
discrimination in a world where people living with HIV are able to live
long, healthy lives." The four strategic directions to achieve the goal
include: optimizing HIV prevention, care and treatment outcomes;
strengthening strategic information systems for HIV and research;
strengthening health systems to ensure that the expanded response to HIV
will build effective, efficient and comprehensive health systems in
which HIV and other essential services are available, accessible and
affordable; and fostering supportive environment to ensure equitable
access to HIV services.
The WHO continues to work with countries to achieve universal access
to comprehensive HIV prevention, treatment and care and to contribute to
health-related Millennium
Development Goals (MDGs), particularly MDG 6 (combat HIV/AIDS,
malaria and other diseases). Together, we hope to move closer to a world
free of AIDS. |