A UNAIDS special report released in November has warned of a risk that regional progress in Asia and the Pacific in stemming the spread of HIV is stagnating, recommending a closer look at value for money and strategic targets for external and domestic co-financing of prevention, treatment and care activities.
Without a rapid and sustained increase in the size of national budgets devoted to HIV programs and better targeting of resources, specifically in prevention activities, to key affected populations, progress including the 26% reduction in new HIV infections since 2001 could be undermined.
With an estimated 350,000 new cases diagnosed in 2012, the total number of people living with HIV in the region of 38 countries climbed to 4.9 million. Two of those countries have been designated as High Impact by the Global Fund: Pakistan and the Philippines. Trends of new HIV infections are also increasing in Indonesia, also a High Impact country.
The report attributes much of the increase in new infections to highly concentrated epidemics among key populations and within urban environments, and a disasterously low level of knowledge within those populations about testing and diagnosis. Stigma at the institutional level that manifests itself in discriminatory legislation and poverty were also cited as drivers of the increase.
It is in prevention where the gaps in service delivery and activities targeting key populations make themselves known most acutely. According to the report, “only by reaching 80% prevention program coverage among key populations can there be a significant impact on behavior and new infections.”
Investments in targeted interventions for key populations have failed to keep pace with the spread of the virus, according to the report. There are potentially 27 million men who have sex with men who are at risk of infection, yet funding for HIV prevention services specifically targeting that population is meager.
Rising rates of infections in Indonesia, Pakistan, the Philippines and Bangladesh are linked to increasing rates of infections among MSM as well as to increased injected drug use, yet harm reduction, needle exchange and opioid substitution programs are rare.
UNAIDS has recommended community-based interventions as the best approach to respond to the specific needs of each of the key populations at heightened risk of HIV transmission. By implementing a community-based rather than facility-based approach that focuses specifically on key populations and geographic regions with high concentrations of infection, interventions are likely to have a greater impact, according to UNAIDS.
Global Fund-supported programs implementing a community-based approach in service delivery including anti-retroviral treatment as well as prevention activities have achieved considerable success, reaching some 10 million people – denoting the need for wider application of these approaches.
Figures generated in the Fund’s 2012 Progress Report suggest that 560,000 people in Asia in 2011 were on ARVs paid for at least partially by Global Fund grants. Grants have also supported 60 million HIV counseling sessions across the region.
There have, however, been some weaknesses in grant implementation.
A regional HIV grant for South Asia underwent considerable modification to qualify for renewal funding in Phase 2 after poor performance in Phase 1.
The South Asia Regional HIV Program covers Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka, seeking to reduce the impact of HIV on men who have sex with men and transgendered people.
The region was estimated in 2010 to be home to some 4 million MSM, though data collection and analysis has been extremely limited due to the pronounced stigma, discrimination and social exclusion confronting the population.
Program strategies de-emphasizing service delivery in favor of targeted high-impact interventions such as capacity-building and policy dialogue for key populations under a new principal recipient, the UN Development Program’s Asia-Pacific Center, received approval for $10 million.