The Prince Mahidol Award Conference brought together international leaders in public health to discuss high-priority health issues in Bangkok, Thailand. The 10th annual gathering was held under the theme “Addressing the health of vulnerable populations for an inclusive society” and took place from 29 January to 3 February.

Her Royal Highness Princess Maha Chakri Sirindhorn attended the opening session, which included a keynote address from Nobel Laureate Amartya Sen, of Harvard University, who spoke about how living in a sharply unequal society affects health.

UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria organized a session called From Exclusion to Leadership: Learning from the AIDS Response. The session explored how knowledge from the response to HIV could be used in addressing vulnerability, marginalization and social exclusion at the global, regional and national levels. It looked at lessons and approaches that are transferable to the broader health agenda.

Another session co-organized by UNAIDS and the World Health Organization was entitled Discrimination in Health Care—Determinants and Consequences. It examined how discrimination leads to poor health outcomes, leaving people who are stigmatized even more vulnerable to ill-health and its consequences.

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GENEVA, 18 January 2017—UNAIDS has presented Professor Peng Liyuan, the First Lady of China, with the UNAIDS Award for Outstanding Achievement in recognition of her remarkable contribution to the global response to HIV. The award was presented to Professor Peng by the Executive Director of UNAIDS, Michel Sidibé, at a special ceremony held in her honour organized by UNAIDS and the World Health Organization (WHO) in Geneva, Switzerland.

A renowned soprano singer, Professor Peng has been working on HIV and tuberculosis for more than 10 years and has advocated for a stronger response to the two diseases at major international events, including at meetings of the Group of Twenty and the United Nations General Assembly.   

“This is a great honour and I am deeply humbled,” said Professor Peng on accepting the award. “A caring heart is our best weapon against AIDS—we can save lives if we take action. We must succeed and we will succeed.”

Professor Peng’s work to break down the barriers of stigma and discrimination is allowing more people to be reached with essential HIV services. Through her work with children and young people, in particular children orphaned by AIDS, she has enabled a broader understanding of how to support children living with HIV to live a healthy life with dignity and free from discrimination.

“Professor Peng has helped to open a national conversation around HIV in China that has spread empathy and compassion for people affected by HIV,” said Mr Sidibé. “She is a true champion for the most vulnerable, especially children affected by HIV, and has helped to create an environment for children to not just survive, but thrive.”

The work of Professor Peng and other prominent advocates has made an important contribution to the scale-up and improvement of services to prevent mother-to-child transmission of HIV around the world. These efforts have helped to more than halve the annual number of new HIV infections among children globally since 2010. 

Progress has also been made in ensuring that children living with HIV have access to treatment. In 2005, less than 10% of children living with HIV had access to antiretroviral medicines, but heightened awareness and improvements in diagnostics and treatment availability have ensured that around 50% (870 000) of the 1.8 million children living with HIV had access to the life-saving medicines in 2015.

However, to reach the target countries committed to in the 2016 Political Declaration on Ending AIDS, the number of children accessing antiretroviral therapy needs to increase significantly, to 1.6 million children by 2018. “The world has made significant gains, but there is still much more to do and we need people like Professor Peng to continue speaking out and leading the way towards ending AIDS and tuberculosis,” said Mr Sidibé.

In 2015, Professor Peng collaborated with the Organisation of African First Ladies against HIV/AIDS in Johannesburg, South Africa, speaking out on key issues critical to ending AIDS by 2030. In 2011, Professor Peng was designated as a Goodwill Ambassador for Tuberculosis and HIV/AIDS by WHO. Her ambassadorship was renewed for a further term by WHO during the special ceremony.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Veena has been living with HIV for more than 15 years and works as a community educator in Bangalore, India. But she still remembers the day she learned of her HIV-positive status.

“I was so angry and I cried. I was so fearful and I was suffering,” said Veena, who prefers to be known by her first name. In the early days of her diagnosis she had a lot of health issues and lost weight. She also experienced discrimination from her family.

After starting HIV treatment in 2004, the situation changed for the better. “This medicine is very good and I’m very happy,” Veena said. “My weight increased.”

Now Veena has good relations with her family and is busy with her job and watching her teenage daughter grow into a healthy and engaging adult.

Veena is one of the 1 million people with access to life-saving treatment in India. The Minister of Health and Family Welfare, Jagat Prakash Nadda, made the announcement on treatment at a World AIDS Day event on 1 December in New Delhi. He said, “I am proud to announce the attainment of the milestone of initiation of treatment of the millionth person with free antiretroviral medicines.”

The scale-up in treatment is due to the country’s network of facilities providing HIV services and to greater inclusiveness in India’s policy regarding the eligibility of treatment, which has allowed more people to access antiretroviral medicine. Mr Nadda also announced that India is working towards free treatment for all the estimated 2.1 million people living with HIV in the country.

UNAIDS has congratulated India for this significant achievement. “The Government of India and the community of people living with HIV are to be acknowledged on reaching this important milestone,” said Oussama Tawil, UNAIDS Country Director for India. “The continued participation of communities in all aspects of the AIDS response is critical as India aims to further expand the provision of treatment”, he added.

India has the third largest epidemic in the world. According to the national AIDS programme, annual AIDS-related deaths declined by 54% and new HIV infections dropped by 32% between 2007 and 2015. While acknowledging the overall decline in new HIV infections, Mr Nadda cautioned about the emergence of HIV in new areas. He emphasized the need to re-strategize and to expand the scope of services.

“In 2010, I participated in a study visit to learn about prison-based methadone programmes in Spain. Witnessing the positive impacts of the programme on prisoners as individuals and prisons as a whole, I reported the results and recommendations of the visit to the Ministry of Public Security,” said Nguyen Xuan Truong, Chief Prison Officer at Phu Son Prison. “It has been quite a wait since then, but I am happy that Phu Son is the first prison in Viet Nam to provide methadone services for prisoners.”

The launch of the pilot opioid substitution therapy service in Phu Son Prison marks a significant milestone in the efforts of the United Nations Office on Drugs and Crime (UNODC) and the Government of Viet Nam for HIV prevention, treatment and care in Viet Nam’s prisons.

“Since 2009, the United Nations Office on Drugs and Crime has worked with the Government of Viet Nam to provide opioid substitution therapy as part of a comprehensive HIV service package for people who are living and working in prisons,” said Christopher Batt, UNODC Officer-in-Charge.

Opioid substitution therapy is an evidence-informed service for opioid dependence. It reduces opioid use by eliminating withdrawal symptoms and drug craving, decreasing the risk of the transmission of HIV or other bloodborne infections and criminal behaviour. In addition, it integrates the patient into a continuum of care during and after his or her stay in prison.

“The opioid substitution therapy service unit is expected to enhance the quality of life of prisoners, reducing transmission of HIV and other diseases and decreasing the rate of relapse and overdose in prison settings,” Mr Batt added.

The Viet Nam Ministry of Public Security estimates that three out of 10 prisoners use drugs.

Prisoners are at higher risk of becoming infected with HIV or other bloodborne infections, including viral hepatitis B or C, relapse or overdose if their treatment needs are not met.

A second opioid substitution therapy service unit will soon be launched in Thanh Xuan Prison, and there are plans for the service to expand to other prisons. 

UNAIDS China has appointed the actor and humanitarian Huang Xiaoming as a UNAIDS National Goodwill Ambassador for China. The announcement was made on 28 November at an event at the UNAIDS office in Beijing, China.

“Huang Xiaoming is an inspiration for millions of people,” said Catherine Sozi, UNAIDS Country Director for China. “I am thrilled that he will leverage his platform as a gifted actor, entrepreneur and philanthropist to help end the AIDS epidemic by 2030. His efforts can re-energize HIV prevention and transform many lives in China and beyond.”

The nomination ceremony included a panel discussion with young people on HIV prevention. The football champion and UNAIDS National Goodwill Ambassador for China, Shao Jiayi, participated in the event and gave congratulatory remarks.

In his new role, Mr Huang will raise awareness on the importance of universal access to HIV prevention, treatment, care and support, with a special emphasis on HIV prevention among young people. Immediately after his appointment, the star showed his support for the UNAIDS global “Hands up for #HIVprevention” campaign, which has been taking place in the lead-up to World AIDS Day on 1 December. Mr Huang posed for photographs with an HIV prevention message written on the palm of his hand. People around the world have been sharing similar photographs and messages through social media.

“I am honoured by this appointment as a UNAIDS Goodwill Ambassador for China,” said Mr Huang. “I am glad that I can play at a least a small part in helping to intensify efforts on HIV prevention. My hope is that young people understand the need to take proper measures to protect not only their own health but the health of the people they love.”

Chinese authorities say there were 654 000 people reported to be living with HIV in China by the end of September 2016. Young people are particularly vulnerable to HIV. Thirteen young people (age 15–24) are infected with HIV every hour in Asia and the Pacific.

The UNAIDS Country Director for China, Catherine Sozi, has received an award for her exceptional contribution to health cooperation between China and Africa. The China Alliance for South–South Health Cooperation Research presented Ms Sozi with the special award during the 6th International Roundtable of China–Africa Health Cooperation on 22 November in Shanghai, China.

Ms Sozi has helped to strengthen China’s collaboration with Africa, especially around increasing access to medicines and health commodities. She has supported China’s efforts to scale up Africa’s pharmaceutical industry, helping to ensure that the more than 25 million people living with HIV on the continent access life-saving HIV treatment.

Africa imports 80% of its antiretroviral medicine from Asia, with many of the ingredients coming from China. The China–Africa Development Fund is supporting the local production of medicines and health commodities in Africa through joint ventures with China. Ms Sozi has advocated for an equal partnership that puts the needs of Africa at the centre of the dialogue for collaboration.

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It is nine o’clock in the evening and the night is just beginning in one popular area of Phnom Penh, Cambodia. One multistorey building offers a range of entertainment options: diners enjoy a meal on the ground floor, the bars in the middle level vibrate with popular songs and on the top floor is a hotel.

However, in one corner, next to several karaoke rooms, a serious conversation is taking place. It seems out of context amid the high-pitched laughter, strobe lights, brightly dressed women and male customers. Five entertainment workers are sitting on a sofa talking about why they don’t get tested for HIV.

One woman said, “I don’t know where to go.”

A co-worker agreed and added, “I daren’t go. I am too afraid.”

Their interviewer is 22-year-old Rath Chan Molika. She recently quit her job as an entertainment worker and is now an outreach worker and counsellor with the SMARTgirl programme. She explained why the women working in the karaoke parlour feared public health clinics. “First of all, it’s because they’re scared to go alone,” she says. “Secondly, they’re afraid of the needle and blood.”

There were an estimated 34 000 entertainment workers in Cambodia in 2015, meeting clients in hotels, karaoke parlours, beer gardens, casinos and massage parlours. Unprotected sexual relations with male customers can place some women at higher risk of HIV.

“Some go out with customers without using a condom correctly and consistently. And sometimes they use drugs together, sharing needles and syringes, which increases their risk of HIV,” said Ms Molika.

As part of her job with the SMARTgirl programme, she informs entertainment workers about how to protect themselves from HIV and other sexually transmitted infections and unintended pregnancy. While HIV peer counselling in entertainment establishments has been conducted for a few years, Ms Molika is participating in a highly innovative HIV testing programme.

When the group counselling session ends, she breaks away and in a separate room welcomes Mao Soma. The two women chat quietly for a moment. Ms Molika has been trained to provide pre- and post-HIV-test counselling and to conduct a rapid finger prick test. While Ms Soma winces as the needle pricks her finger, the procedure is over before long. Within 15 minutes there is a result, which suits Ms Soma. “The test is quick and I can get the result immediately,” she says.

Cambodia’s AIDS epidemic is concentrated in key populations

As in many other countries in the region, Cambodia’s AIDS epidemic is concentrated in key populations at higher risk of HIV, which includes entertainment workers, gay men and other men who have sex with men, transgender people and people who inject drugs.

“The government of Cambodia gives importance to collaboration with civil society and also with local people at the community level,” says Ieng Mouly, the Chair of the National AIDS Authority.

Technological innovation in HIV testing

The government, civil society partners and international organizations are now promoting rapid finger prick testing for key populations to replace traditional tests that require laboratory analysis.

“Bringing the facility close to the people is always best. People don’t have to depend on sophisticated laboratory equipment,” explains Ly Penh Sun, the Director of the National Centre for HIV/AIDS, Dermatology and STD.   

“The people who are conducting the tests are familiar with the people they are testing. They can interact more. They can support each other,” says Choub Sok Chamreun, of the nongovernmental organization Khana, which provides HIV prevention, care and support services at the community level. 

The need for community-based approaches 

This community-based HIV testing programme is one of the first of its kind in the Asia and the Pacific region. Across the region, HIV testing coverage among key populations is low. While many countries have scaled up HIV testing in health clinics, representatives of civil society have called for more community-based approaches, focusing on key populations, who often do not attend health clinics.

The results from the Cambodian model are encouraging. Over the past year, implementers reported that more than 36 000 people from key populations were tested, 80% more than in 2014. If a person has a positive reaction on a first rapid screening test, they are accompanied by outreach workers to health facilities for confirmatory tests. Once a medical professional confirms the result, the person has access to HIV treatment.

To improve their efforts to find more people living with HIV, implementation partners are retooling the programme to intensify outreach to people at the highest risk within each key population.

“The plan is to modify the outreach guidelines to the populations at highest risk and intensify targeted outreach activity, as well as active case management, to register and retain the people who were found to be HIV-positive, to ensure they receive treatment,” says Mr Sun. 

The Thai Red Cross Anonymous Clinic (TRCAC) sits back from a busy street in Bangkok, Thailand. It’s a familiar place for Jonas Bagas, who visits the leafy compound regularly because he is taking pre-exposure prophylaxis (PrEP) as part of a project being piloted by the clinic.

PrEP is the use of antiretroviral medicine in the form of a daily pill to prevent people from acquiring HIV. It is demonstrated to be highly effective in preventing the transmission of HIV among people at high risk of becoming infected.

“One reason I started was because I had a sexual partner who was HIV-positive,” explains Mr Bagas, who is from the Philippines but living in Bangkok for his job with APCASO.

TRCAC started its PrEP project at the end of 2014. Users are charged US$ 1 a day for their supply of pills, along with the recommended counselling and health evaluations. PrEP is only for people who are HIV-negative, so users undergo an initial HIV test and a check for other sexually transmitted infections as well as tests to measure how the liver and kidneys are functioning. After the first month, users repeat the evaluation and then return for testing every three months.

The most common side-effects of PrEP are nausea, headache and weight loss in the first month, but no serious toxicity has been observed during trials. “I find a huge urge to sleep right after taking PrEP, but since I take it at night, that’s not a huge minus,” said Mr Bagas.

While adherence and regular HIV testing present challenges for scaling up PrEP use, researchers describe it is a breakthrough in HIV prevention. Consistent condom use remains low in Asia. In most major cities less than half of gay men and other men who have sex with men are using condoms consistently, which is too low to have an impact on stopping the AIDS epidemic. UNAIDS and the World Health Organization recommend PrEP as an additional prevention choice for people at substantial risk of HIV exposure and who are ready to have regular HIV testing.

“We have been waiting quite a long time to get an HIV prevention method that you can use in privacy and without anxiety. PrEP is the answer to that,” said Nittaya Phanuphak, Head of the Prevention Department at the Thai Red Cross AIDS Research Centre.

PrEP does not prevent other sexually transmitted infections and is not a contraceptive, so health experts say it is best integrated with other sexual and reproductive health services, including the supply of condoms.

Surveys of potential users in Asia find that there is still a low awareness of PrEP as a prevention method. “I hope that PrEP becomes available in the Philippines soon,” said Mr Bagas.

In fact, the nongovernmental organization LoveYourself is starting a pilot project for PrEP, including regular check-ups, risk reduction and adherence counselling, in two of its clinics in Manila, Philippines, in November. “We will embed PrEP education in the HIV testing process. So all those who are going through HIV testing in our clinics, which is about 60 to 100 people a day, will be given PrEP information,” says Chris Lagman, the Director of Learning and Development at LoveYourself. 

The First Lady of Malawi and Vice-President of the Organisation of African First Ladies against HIV/AIDS (OAFLA), Gertrude Mutharika, has spoken to Chinese high school students about the impact of the AIDS epidemic on African women and children. The First Lady spoke at an event in Beijing, China, on 31 October celebrating the participation of the Affiliated High School of Beijing University in an ongoing campaign called China–Africa Hand in Hand: Chinese Youth’s Campaign for the Social Benefit of Africa.

Students from several high schools in Beijing and representatives of UNAIDS, the China–Africa Business Council (CABC), the China–Africa Development Fund and volunteer groups participated in the event.

The CABC and partners have established the Increasing Love for Decreasing AIDS Fund, which has raised US$ 200 000 for HIV programmes in eight African countries. High schools participating in the youth campaign are helping to collect donations for the fund. The campaign is also encouraging young people to join hands with their counterparts in Malawi and other African countries in order to build a brighter future together.

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Sixteen years ago, Anya Nopalit was thrilled to learn that she was pregnant, but then she received devastating news. “I learned that I had HIV. I was really sad and disappointed. I wondered, why did this happen to me?” said Ms Nopalit, who lives in a fishing village in Chantaburi province in south-east Thailand.

Her doctor encouraged her to have an abortion, but she was determined to keep her baby. “I thought what will be, will be,” said Ms Nopalit.

Luckily, in the very same year that Ms Nopalit learned about her diagnosis, Thailand became one of the first countries in the world in which pregnant women living with HIV had access to free antiretroviral therapy. Untreated, women living with HIV have up to a 45% chance of transmitting the virus to their children during pregnancy, delivery or breastfeeding. However, the risk drops dramatically if HIV treatment is given to both mother and child.

Ms Nopalit followed the treatment regimen advised by her doctor and her son was born HIV-free.

“I was so happy when the doctor told me he was HIV-negative,” said Ms Nopalit.

Thailand’s early commitment to stop babies from being born with HIV has saved many lives and in June 2016 the country received validation from the World Health Organization (WHO) for having eliminated not only the transmission of HIV but also of syphilis from mothers to their children.

According to Thailand’s Ministry of Public Health, the number of children who became infected with HIV in 2015 was 86, a decline of more than 90% over the past 15 years. The rate of mother-to-child transmission of HIV in Thailand declined from 13.6% in 2003 to 1.1% in 2015. The WHO global guideline considers mother-to-child transmission of HIV to be effectively eliminated when the rate of transmission falls below 2%.

At the Tha Mai Hospital in Chantaburi province, where Ms Nopalit accesses her HIV treatment, paediatric HIV cases have become uncommon.

“For the last three years, there were no new cases of mother-to-child transmission,” said Monthip Ajmak, Senior Nurse, Antenatal Care, Tha Mai Hospital.

One of the factors behind Thailand’s remarkable achievement is a well-developed national health system that provides quality services in even the most remote areas. According to Thai health authorities, nearly all pregnant women are routinely screened for HIV and if they are found to be HIV-positive the women start lifelong antiretroviral therapy. More than 95% of pregnant women diagnosed with syphilis also receive treatment.

In Thailand, health-care services for mothers living with HIV are fully integrated into maternal and child health-care programmes in hospitals and are covered by Thailand’s universal health-care coverage.

“Public sector staff receive continuous training, from basic counselling skills to providing a treatment regimen,” said Danai Teewanda, Deputy Director-General, Department of Health, Thailand Ministry of Public Health.

Community leadership has ensured that mothers living with HIV are linked to hospitals and supported throughout their pregnancy. The Best Friends Club at the Thai Mai Hospital has 160 members, who include men and women living with HIV. The club is divided into three groups, with more recent members meeting every month and long-time members meeting twice a month.

“Our club provides counselling services at the antenatal clinic. We coordinate with the hospital staff and provide information to women on how to take care of themselves,” said Malinee Vejchasuk, a counsellor with the Best Friends Club.

Ms Nopalit and her husband wanted to have another child. Four years ago, she gave birth to her second son.

“I am so happy that my two children are healthy and HIV-free. They are lively and play like their friends,” said Ms Nopalit.

When he is not in school, her eldest son now accompanies his parents when they catch crabs, which is their family business, while their youngest son runs around the beach and builds sand castles.

Video: Thailand is first country in Asia to eliminate mother-to-child HIV transmission

Thailand has received validation for having eliminated mother-to-child transmission of HIV and syphilis, becoming the first country in Asia and the Pacific region and also the first with a large HIV epidemic to ensure an AIDS-free generation. Meet Anya Nopalit, a mother living with HIV who has two HIV-negative children.