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Altering the AIDS response

A young participant joins an HIV/AIDS awareness rally in Phnom Penh last year.

Efforts in the Asia and Pacific regions can be combined with development to increase public health and reduce poverty.

More than a thousand people become infected with HIV in Asia each day. If only we had invested in reaching populations at higher risk and their partners, most of these infections could have been averted - at a cost of less than half a US dollar per person.

We are beginning to see success in some parts of the region, but not enough to break the trajectory of the epidemic.

The Commission on AIDS in Asia has recommended that the AIDS epidemic in the region be redefined. We must transform the AIDS response so that it works for people - especially for those who are marginalised and without a voice. This means protecting sex workers, men who have sex with men, transgender, injecting drug users and women.

How can we do this?

Decriminalise consensual adult sexual behaviour and drug use
Many countries are changing laws that criminalise consensual adult sexual behaviour (including sex work) and drug use, and courts are helping to clarify bad laws. In Indonesia, the Supreme Court ruled that drug users need care, not prison. In Nepal, the highest court has established that transgender and men who have sex with men have equality under the constitution. And in India, the Delhi High Court has restored dignity to millions by reading down an archaic law that discriminated against men who have sex with men. New Zealand has legalised sex work and reaped the dual benefits of public health and public safety. We can remove punitive laws and policies that block effective responses to AIDS.

But the real transformation has to be in the hearts and minds of people. Courts and parliaments can only create an enabling environment. Societies and communities have to change the social norms that allow stigma and discrimination.

In India, a pregnant woman was recently branded on her forehead as being HIV-positive by hospital staff during a routine checkup. This inhumane treatment of the woman triggered protests by the local community and by human rights activists, which led the Gujarat government to open an investigation. It is this sort of community mobilisation that is needed to put an end to such discriminatory acts.

Address HIV transmission among intimate partners
Bad laws and a discriminatory society have had a severe impact on women. Many women in Asia become infected because their husbands or male partners contracted HIV through drug use or through sex with another man or with a sex worker. In India, being monogamous is the only risk factor for an estimated 90 percent of women living with HIV.

In 2008, some 35 percent of adults living with HIV in Asia were women, and most of them were in steady relationships.

Invest in evidence-informed HIV-prevention, treatment, care and support programmes
HIV-prevention programmes must be scaled up. Political leaders must ensure that existing HIV services are expanded to reach the most vulnerable. This includes starting needle-exchange programmes and offering oral substation therapy to drug users, increasing access to antiretroviral drugs, distributing condoms and offering voluntary HIV counselling and testing services to those at higher risk. It is heartening that requests to the Global Fund to Fight AIDS, Tuberculosis and Malaria for such programmes have increased substantially in recent years. However, we need US$7.5 billion in 2010 to reach country targets, but only 10 percent of this was available in 2007. We must, therefore, invest wisely and equitably.

Adopt an 'AIDS plus Millennium Development Goal (MDG)' approach
Unlike Africa, where the AIDS epidemic can overwhelm development efforts, the Asia and Pacific region can combine development and the AIDS response. Reducing poverty, increasing education and investment in health must become the foundations for sustainable economic growth in the region.

Recently, I read about Nisha, a person living with HIV in Nepal. She lost her husband in 2004, when there was no access to treatment. Today, she is on antiretroviral therapy. She is staying healthy, has gone back to work and can look after her three children. Her family has come to accept her, and her children go to school, where they are being taught how to protect themselves. Access to treatment has given her an opportunity to fulfil her dreams - this is hope becoming reality.

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Michel Sidibe is the executive director of UNAIDS, the United Nations' joint programme on HIV/AIDS. UNAIDS is based in Geneva.



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