Universal Access still tough challenge

Nusa Dua, 11 August 2009 - With  its  2010  deadline  drawing nearer,  the  slow progress  of  Universal  Access to  prevention,  treatment  and care  for  HIV  and  AIDS  was scrutinized  by  speakers  during  the frst plenary session at the 9th International Congress on AIDS in Asia and the Pacifc (ICAAP)  at  the  Bali  International Convention Center.

The  plenary  started  with  a keynote  speech  reading  from Indonesia’s  Health  Minister Siti  Fadilah  Supari,  noting  in particular  the  positive  results recorded  through  provisions of  antiretroviral  (ARV)  drugs and  therapy  (ART)  across  the country.

“A  total of  12,493 AIDS cases  are  currently  under  treatment  [in Indonesia]. The ARV is  provided  for  free,  since  the drug  is  fully subsidized by  the government.  The  tremendous impact  has  been  seen  with the  decreasing  death  rate  after therapy from 46 percent in 2006 to 17 percent in 2008,” the minister’s deputy read.

After  the  speech  was  read out,  UNAIDS  Regional  Director for Asia-Pacifc JVR Prasada Rao gave a mixed review of progress and challenges  in the implementation  of  Universal Access across Asia and the Pacifc.

“Two  years  since  Colombo, the  Commission  on  AIDS  in Asia has seen improved understanding of context and drivers of the epidemic and also more cost-effective  and  appropriate responses,” said Rao while addressing the congress on Monday.

Yet  while  the  region  has seen the frst steps toward decriminalization  (with  India’s Section  377)  and  an  increase in  harm  reduction  programs and more emphasis on prevention  among  key  populations, new  infections  are  still  being recorded across the board with gaps  remaining  among  youth and  migrants,  and  through partner transmission.

According to 2007 UNAIDS data  disclosed  by  Rao,  HIV prevalence  among  men  who have sex with men is highest in Thailand, while  rising  female sex  workers  prevalence  is  recorded in Myanmar, Cambodia and  Indonesia.  In  Indonesia, the percentage of safe injection practices among injecting drug users has also decreased.

“Currently, there is progress in prevention coverage but it is difficult  to  assess  due  to  poor monitoring. We also face competing  claims  and  the  global financial  crisis  which  affects resources,” described Rao.

He  noted  in  particular  the poor performance recorded on the  Prevention  of  Mother-to-Child Transmission (PMTCT), a point also raised by congress co-chair  Samsuridjal  Djauzi while  presenting  a  report  he compiled with congress chair Zubairi Djoerban.

“Since 2006, the global community  had  decided  that Universal  Access  to  treatment, prevention,  care  and  support would be achieved by 2010,” he recounted. “Now that we have a  global  commitment,  how  is the situation in the field? ”

Samsuridjal  brought  up  the case  of  a  hypothetical  HIV-positive couple  living  in Indonesia, where  the husband  suffered  from  an  opportunistic infection  that  put  him  out  of work while his expecting wife was  prone  to  transmitting  the virus onto the child.

“They  may  have  access  to information,  ART  and  hospital  services –  the  latter  if  they are included in the social service  scheme – but  treatment  to cure  opportunistic  infection and PMTCT are not available, let alone laboratory monitoring for ARV, CD4  and  viral  load,” he said.
Samsuridjal  also mentioned that currently, PMTCT  is only available in nine provinces out of Indonesia’s 33. Part of the obstacles in making Universal Access a success, the speakers agreed, is funding.

As  pointed  out  by  Samsuridjal,  frst-line  ARV  therapy is  funded  by  the  Indonesian government  with  additional support  from  the Global Fund to fght AIDS, TB and Malaria and  international  donors. The second-line fund mostly comes from  the  Global  Fund;  and bureaucracy,  regulation  and uncertain  sustainability  have been hampering the progress.

“We  respect  the  commitment from international NGOs and  donors  to  help  out,  yet  it takes some three to six months to start a new program. In some situations,  many  NGO/donors set up their own favorite areas and priorities,” he said.

From  the  medical  point  of view, Prof. David Cooper from the  University  of  New  South Wales  in Australia highlighted several  experiments  from  all over  the world  and wondered why  all  pregnant  women couldn’t  be  given  ARV  therapies – given all the positive results it has turned out.

He also saw a stark contrast between success levels of Universal  Access  in  low/mid-in-come  and  high-income  countries. “We  have  to  abandon  the two  standards  of  treatments between  rich  and  poor  countries,  recommend  testing  and treatment  for all HIV-infected infants  …  and  ultimately  increase our research in prevention  and  new-generation  vaccine … [in response to HIV and AIDS],” Cooper said.


As reported by Andrea Tedjokusumo, the 9th ICAAP Post
The complete 9th ICAAP Post can be downloaded from the Virtual Media Centre section in this website

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