Eight million people could become infected with HIV between now and 2020 unless Asian governments mount more effective HIV prevention programmes, according to the report of the Commission on AIDS in Asia, issued last week.
In particular, they need to prioritise those most at risk of infection – men who have sex with men, injecting drug users and sex workers – and drastically increase the coverage of prevention services which target these groups, involving them in the planning and delivery of services.
Nearly five million people are living with HIV in Asia, with 440,000 people acquiring the infection in 2007 and 300,000 dying from AIDS related illness in the same year.
Although it is unlikely to have a long-term effect on macroeconomic growth in the region, the Commission estimates that AIDS remains the most likely cause of death and work days lost among 15-44 years-olds in Asia.
According to the report, if Asian countries fail to mount a scaled-up response to HIV they will incur susbstantial costs due to their inaction. Almost 8 million adults and children in Asia-Pacific will be newly infected between 2008 and 2020, and the annual death toll will increase to almost 500,000 by 2020.
The Commission on AIDS in Asia, convened by UNAIDS in 2006, conducted an extensive review of epidemiological data and HIV programme activities in Asia, and also carried out modelling of potential epidemic trends.
Based on this research, the Commission has made a series of recommendations to Asian governments:
- Commit to spending $0.50 - $1 per capita on HIV – this should include focused prevention activities, antiretroviral treatment and support for orphans.
- Prioritise prevention activities amongst the most vulnerable groups, with a focus on the activities that will have the greatest impact on limiting new infections; in particular, prevention activities focused on sex workers and their clients are highly cost-effective.
- At least $0.30 per capita should be spent on HIV prevention for it to be effective; countries that have delayed scaling up prevention will need to spend more.
- Most Asian governments can afford to provide free antiretroviral tretament, but only one in four who need it are able to obtain it.
- Focus support on community-based organisations – these should have the pivotal role in HIV prevention, care and support.
- The most effective way to assist prevention scale-up is to decriminalise sex work, homosexual acts and the use of needles, syringes and drug treatment among injecting drug users. Goverments need to direct the law enforcement system to stop impeding HIV prevention and care, and discourage `social evil` campaigns that hamper prevention work.
- Heads of government must become more closely involved with National AIDS Councils.
Commission on AIDS in Asia. Redefining AIDS in Asia: crafting an effective response. Oxford University Press, Delhi, 2008.