Publications

In June 2010, the UNAIDS Secretariat and WHO launched Treatment 2.0, an initiative designed to achieve and sustain universal access and maximize the preventive benefits of antiretroviral therapy (ART). Treatment 2.0 builds on '3 by 5' and the programmatic and clinical evidence and experience over the last 10 years to expand access to HIV diagnosis, treatment and care through a series of innovations in five priority work areas: drugs, diagnostics, costs, service delivery and community mobilization. The principles and priorities of Treatment 2.0 address the need for innovation and efficiency gains in HIV programmes, in greater effectiveness, intervention coverage and impact in terms of both HIV-specific and broader health outcomes. Since the launch of Treatment 2.0, the UNAIDS Secretariat and WHO have worked with other UNAIDS co-sponsoring organizations, technical experts and global partners to further elaborate and begin implementing Treatment 2.0.

Papua New Guinea (PNG) is a low income country that has experienced a rapidly expanding HIV epidemic. It has the highest HIV prevalence and incidence rate in the Pacific region with 28,294 HIV infections reported by December 2008 since the first diagnosed case in 1987. The vast majority of HIV cases have been due to heterosexual transmission with similar numbers of diagnoses in men and women. Fortunately, recent estimates suggest there has been a leveling out of HIV prevalence in PNG at approximately 1%. The reasons for this leveling of prevalence are currently unknown but could be due to the saturation of HIV in particular at risk population groups or geographic areas, or reflect the impact of the roll-out of intervention programs in recent years and the successful scale-up of antiretroviral therapy (ART) services across the country. ART first became available in PNG in 2004 and the PNG National Department of Health recently estimated that more than 70% of people requiring treatment were receiving it in 2009.

It is more than a decade since the first report appeared of a laboratory test aimed at distinguishing recently acquired HIV infections from infections of a longer duration. Several expert groups have now developed tests of this kind, based on the underlying principle that the immunological response to HIV infection evolves for a number of months following infection, and that it is possible to identify a marker for the early period. This marker eventually disappears and can therefore serve as an indicator of recent infection. For the purpose of these tests, “recent” generally means a period of up to a year after infection has been acquired. The document reviews the public health importance of estimating the HIV incidence in populations, and the various methods that have been used for this purpose. It provides guidance on the way in which laboratory tests for recent HIV infection may be used to estimate HIV incidence in populations, particularly with regard to sampling designs, sample size and the statistical analyses that should be employed.

HIV stigma and discrimination adversely affect every aspect of life for people living with HIV and their families. In many settings, an HIV diagnosis still can be as devastating as the illness itself, leading to job loss, school expulsion, violence, social ostracism, loss of property, and denial of health services and emotional support. People living in fear are less likely to adopt preventive behavior, come in for testing, disclose their sero-status to others, access care and adhere to treatment. At present, the building blocks are in place for scaling up the response to stigma and discrimination. Promising tools and approaches are available. Practitioners know how to inspire change in communities, health care settings and workplaces. There is a core agenda for legal reform to establish better protections for people living with HIV, guarantee their human rights and banish laws that discriminate against people living with HIV. This brief lays out the rationale for intensified action, and what can—and must—be done to reduce HIV stigma and discrimination worldwide.

This People Living with HIV Stigma Index study is the first study of this kind that has been conducted on such a comprehensive scale among people living with HIV (PLHIV) in Nepal. HIV and AIDS-related stigma and discrimination exists worldwide and varies only in intensity across countries, communities and individuals. HIV stigma and discrimination together have long been recognized as one of the main obstacles to the prevention, care and treatment of HIV and AIDS. Stigma remains the primary barrier to public action; on a personal level, it can make individuals reluctant to access HIV testing, treatment and care. The PLHIV stigma index aims to collect information regarding the experiences of PLHIV related to stigma, discrimination, knowledge of their rights and violation of those rights. Currently, over 40 countries across the world, including Nepal, have joined this research.

This report provides findings from the rollout of the People Living with HIV Stigma Index (PLHIV Stigma Index) in nine countries in the Asia/Pacific Region (Bangladesh, Cambodia, China, Fiji, Myanmar, Pakistan, Philippines, Sri Lanka, and Thailand). It provides the first large-scale regional comparison of standardised HIV-related stigma indicators. The results represent an extraordinary effort by people living with HIV, PLHIV organisations and supporting domestic and international agencies.

This report provides a regional perspective on the progress made by Pacific island countries (PICs) in achieving the Millennium Development Goals (MDGs). It also discusses the implications of climate change, rising food and fuel prices, the 2008 financial crisis, and emerging trade agreements. Most PICs face considerable challenges in achieving the MDGs, largely because of stagnant economic growth, a lack of employment opportunities in the formal sector, and the subsistence nature of the informal sector. The Cook Islands, Niue, Palau, Samoa, and Tonga are “on track” toward achieving the MDGs. Fiji, the Marshall Islands, the Federated States of Micronesia (FSM), Solomon Islands, Tuvalu, and Vanuatu are exhibiting “mixed progress” in realizing the goals by 2015. Conversely, Kiribati, Nauru, and Papua New Guinea are “off track” in achieving the MDGs.

In collaboration with various community-based organisations, APN+ conducted a peer-led mixed method research project in six Asian countries to document the range of services available for MSM and transgender people living with HIV and to identify barriers to access and use of these services. The following report consists of six separate country reports: India, Indonesia, Malaysia, Myanmar, Nepal, and Singapore. Each report has a standard format and can be read independently. A summary of key findings has been included at the end of this section. Summary findings are also provided for each country report for easy reference. Quantitative survey data forms the background of each country report, both to provide an overview of population demographics and to establish the structural barriers that shape treatment access among communities of MSM in these populations. The statistics give a sense of the size of the problem faced by local communities.

This report describes specific examples of programme activities that seek to address HIV and promote health and rights among MSM and transgender people in six Asian cities: Bangkok, Thailand; Chengdu, China; Ho Chi Minh City, Viet Nam; Jakarta, Indonesia; Manila, the Philippines; and Yangon, Myanmar.  These examples, identified through consultation with local HIV leaders and practitioners in those six cities, are presented here to inform planning, design, and delivery of health and community services at the municipal level. Ultimately, these types of activities, if widely adopted and scaled up in combination, would lead to a reduction in rates of HIV infection, improve access to health services, and reduce human rights violations in urban areas and cities in the Asia-Pacific region.

The HIV epidemic in Asia-Pacific is growing rapidly, although most countries have low HIV prevalence while some have concentrated epidemics. AIDS is increasingly feminized through intimate partners’ transmission with gradual increase of new HIV infections among low-risk women and consequent mother-to-child transmission. In 2008, an estimated 1.4 million women and 161,000 children aged 14 years and under were infected with HIV in the region. The estimated number of HIV-positive pregnant women was 85,000. New infections in children totalled 19,700, while 11,700 children died of causes related to AIDS. Several regional initiatives have been made to address these issues, including a recent focus on eliminating new HIV infections in children and congenital syphilis. On 25 November 2010, UNICEF, WHO, UNAIDS and UNFPA, with support from over 150 delegates from 20 countries across Asia-Pacific, adopted the historic goal of eliminating all new paediatric HIV and CS infections in the region by 2015. The declaration of elimination as an aim by the Asia-Pacific UN PPTCT Task Force represents a paradigm shift in the response to HIV & AIDS and CS. Previously, agencies and health care providers had been working to prevent as many new infections as possible, with growing success but still with enormous gaps to be filled.