The Need for Early Action on AIDS in Asia and the Pacific Dr. Bertrand Desmoulins, UNICEF Representative in Mongolia UN Theme Group Chair December 2, 2008

Global summary of the AIDS epidemic, December 2007 Total33 million [30 – 36 million] Adults30.8 million [28.2 – 34.0 million] Women15.5 million [14.2 – 16.9 million] Children under 15 years2.0 million [1.9 – 2.3 million] Total2.7 million [2.2 – 3.2 million] Adults2.3 million [1.9 – 2.8 million] Children under 15 years [ – ] Total2.0 million [1.8 – 2.3 million] Adults1.8 million [1.6 – 2.1 million] Children under 15 years [ – ] Number of people living with HIV in 2007 People newly infected with HIV in 2007 AIDS deaths in 2007

Summary of the Asian epidemic, December 2007 Number of people 4.9 million [ Million] living with HIV In 2007 People newly 440,000 [210,000 – 1 Million] infected with HIV in 2007 AIDS deaths 300,000 [250,000 – 470,000] in 2007

There is no single Global Epidemic

Asian epidemics Report of Commission on AIDS in Asia, 2008

Major Characteristics of Asian Epidemic Mainly Most-at-risk Population driven Low level of awareness (general public and MARPs) Wide spread stigma and discrimination Limited service coverage Unfocused HIV testing and counselling services

Most-at-risk Populations Driven HIV epidemic The HIV epidemics in Asia and Pacific largely driven by most-at-risk-populations and male clients of sex workers People are at risk of infection but might not aware of it: –Injecting drug users –Sex workers –Men who have sex with men –Client of sex workers –Sexual partners of the above

Varied patterns of adult male behavior in Asia: Percentage adult male visiting sex workers Countries 10-20%Thailand, Cambodia 5-10%India, China, Indonesia 2-5%Laos, Philippines determining factors of the epidemic

WomenMen Epidemic Characteristics 75 million Men in Asia visit sex workers (2-20% of adult men) 50 million Women married to men who visit sex workers 10 million Men who inject drugs 10 million Men who have sex with men 10 million Women sell sex 1 million infants and children Asian Population: 3.3 billion

The Need for Early Action

Four Reasons to Act Early Early action in HIV prevention can: Save money: $1 in prevention saves $8 in future treatment costs Avert large-scale epidemics Focused intervention for 5% population can avert large scale epidemic Free up development resources

Benefits of Early Action Early and immediate action in Asia can: –Reduce HIV infections (up to 2020) from 8.2 to 3.2 million –Reduce AIDS deaths (up to 2020) from 5.5 million to 3.2 million –Avert large-scale epidemics

Avert large-scale epidemics Early and focused action can avert large- scale epidemics; for example: –Reducing needle-sharing behaviors among IDU can delay onset of a sex-work epidemic –Safe sexual practices within sex work will avoid infection in wives

Prioritization of resources: Averting new infections Cost of Interventions Low-cost, High-impact (prevention among most-at- risk populations) High-cost, High-impact (antiretroviral treatment and prevention of mother-to-child transmission) Low-cost, Low-impact (general awareness programmes through mass media and other channels) High-cost, Low-impact (universal precautions) IMPACT

Prevention in Asia High-impact prevention should receive at least 40% funding - $ 0.30 per capita Removal of road blocks to service access (enabling environment) Prevention coverage must reach 80% to reverse the trend of the epidemic

Coverage is critical Coverage of services to at-risk populations

Modeling Early Action in an Expanding Epidemic Without intervention SW prevention SW + IDU SW + IDU + MSM

Early Action in an expanding epidemics: Thailand Without intervention Thailand’s sex worker prevention program Early Action in Thailand Cambodia kept HIV low from 10% to 1% saved 6 million

Barriers are more political … Most barriers to early action are neither financial nor technical, but political; such barriers often impede: –Effective and appropriate prioritization of most-at-risk populations –Protection of legal rights of infected, affected and at-risk communities –Involvement of communities and civil society

Lack of Harmonization between legal and health services Sodomy laws prohibiting male-male sex persist in 12 countries in Asia-Pacific Sex work is illegal across most Asian countries Only 3 countries have laws to explicitly protect the rights of PLHIV

The Way Forward

The Way Forward: What Governments should do Scale-up resources to implement costed National Strategy Plans Focus resources where they will have the largest effect (impact) on the epidemic Response must integrate prevention and treatment

Management and Governance Entrust the programmes to competent professionals Clearly define the lines of authority and accountability between entities like CCMs, NCAs and national programmes Independent AIDS watch bodies to monitor the performance of all players

The Way Forward: What Governments should do Improve data collection and analysis through a multi sectoral team KNOW YOUR EPIDEMIC Ensure access to services for all most-at-risk populations Conduct a bi-annual impact assessment to monitor the epidemic

The Way Forward: What civil society should do Continue AIDS activism at the national and regional level Adopt transparent mechanisms (such as national alliances) for representation on CCMs and NCAs Build capacity of CBOs, with a long-term view toward community ownership Use public-private partnerships for efficient fund disbursement

Meaningful Involvement of civil society Public private partnerships to finance community based programmes Community involvement in HIV prevention, treatment, care & support services for most-at- risk populations Involve networks of positive people for recruitment into treatment, care & support programmes

The Way Forward: What donors should do Scale-up resources to close the funding gap Remove conditionalities on funding, which often prohibits effective programming Earmark funds and budget for the creation of an enabling environment

The Way Forward: What UNAIDS should do Assume a monitoring and coordinating role Redefine the epidemic, through creation of a Regional Reference Group Continue advocacy for greater funding for and attention to AIDS in the Asian region Meet the challenges to provide strong and coherent technical support for scaling-up

The Way Forward: What UN ESCAP should do As a platform to promote dialogue, harmonization, cooperation and new approaches among countries and UN partners Strengthen monitoring of regional progress towards Universal Access and MDG-6 Support joint negotiations on antiretroviral drug prices and bulk purchasing

We have the information, the institutions and the means to achieve huge reductions in new HIV infections.

The most important ingredient is political will. If the governments of Asia and the Pacific take early and urgent action to meet this challenge, then the battle against HIV in Asia can be won.