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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