The Asia–Pacific Intergovernmental Meeting on HIV and AIDS has opened in Bangkok, Thailand. More than 250 representatives of governments, civil society and international organizations from across the region are assessing progress on the response to the AIDS epidemic and considering challenges for the future.

The Asia–Pacific region has achieved significant results in the HIV response over the past decade. In 2013, there were an estimated 350 000 new HIV infections in the region, a decline of 25% since 2001. Between 2005 and 2013, the number of AIDS-related deaths in the region fell by 27%.

Around 1.56 million people living with HIV in the Asia–Pacific region had access to antiretroviral therapy in 2013, a 25% increase over the previous year. However, this still accounts for only one in three people living with HIV, and many people start treatment late.

One of the most pressing challenges for the region is how to ensure that the AIDS response remains financially sustainable. In 2013, more than US$ 2 billion was mobilized for the region’s response to AIDS, with 43% of the funding supplied by international donors. The participants of the meeting are reviewing the financing of national AIDS programmes, with the aim of increasing national investment.

Participants are also discussing the new 90–90–90 global treatment targets, with civil society representatives calling for more community-based HIV services. Although the epidemic in the region is concentrated among key populations, less than 8% of overall AIDS spending is dedicated to HIV prevention among such populations.

Convened by the Economic and Social Commission for Asia and the Pacific in cooperation with UNAIDS, the United Nations Development Programme and other organizations, the meeting runs until 30 January and is expected to see the adoption of a new regional framework to respond to the epidemic.

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A report on the AIDS funding landscape in the Asia–Pacific region, Investing for results: how Asia–Pacific countries can invest for ending AIDS, has been launched at a side event at the Asia–Pacific Intergovernmental Meeting on HIV and AIDS, which took place in Bangkok, Thailand, from 28 to 30 January. The report summarizes an analysis carried out by an independent advisory panel.  

Convened jointly by UNAIDS and the World Bank  and chaired by the United Nations Secretary-General’s Special Envoy for AIDS in Asia and the Pacific, J.V.R. Prasada Rao, the 11-member panel was comprised of public health experts, policy leaders and representatives of civil society organizations.

With many countries in the region graduating to middle-income status, external funding is shrinking and the panel was tasked with resolving the funding gap.

It analysed the existing policy and funding commitments for the national AIDS response in the region and suggested a set of nine concrete recommendations to help guide and sustain the AIDS response in the coming years.

The recommendations included introducing funding transition plans to enable countries to take advantage of continued donor assistance while shifting to greater domestic investment, focusing resources where most new HIV infections occur and protecting funding for civil society.

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Nearly 4000 delegates from more than 80 countries gathered in Bangkok, Thailand, this week, for the 11th International Congress on AIDS in Asia and the Pacific (ICAAP11). The Congress opened officially on 19 November. Building on UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, the theme for this year’s ICAAP is Triple Zero – Investing in Innovation.

Opening the Congress on behalf of the Prime Minister of Thailand, Yingluck Shinawatra, Thailand’s Minister of Health, Dr Pradit Sintavanarong underlined the opportunities presented by the four-day event to drive progress towards the end of the AIDS epidemic in the region.

“We can only achieve this by integrating the preventive effects of antiretroviral therapy, focusing our efforts both geographically and demographically, and by normalizing HIV among the general population and, importantly, among key populations,” he said.

“Action now will pay off in the future,” he added, emphasizing the need for effective investments in areas where they will have most impact.

Addressing delegates at the opening ceremony, UNAIDS Deputy Executive Director Jan Beagle called for greater innovation and focus in region’s response to HIV. “The annual number of new infections has remained largely unchanged over the past five years, and emerging epidemics are evident in a number of countries in the region,” said Ms Beagle.

Ms Beagle spoke about the important linkages between HIV and other development goals. “Experience has shown that AIDS is an entry point to advance broader issues of human rights, redistribution of opportunity and social justice for all. The AIDS response is a pathfinder for transformative development,” said Ms Beagle.

The opening ceremony of the conference saw representatives from the communities of people living with HIV, sex workers, transgender people, people who inject drugs and men who have sex with men voice their hopes and expectations for the congress through performance art. “Through the performance we wanted to send the message that we are trying to put faces to the epidemic. We are the people behind the data, and this is where the focus should be,” said Mehrdad Pourzaki who works with Youth LEAD, the regional network for young key populations at higher risk.

Fragile gains in Asia and the Pacific

On the opening day of the Congress, UNAIDS launched the 2013 HIV in Asia and the Pacific report. The report shows that while important gains have been made in the region’s response, the pace of progress is too slow and significant challenges remain.

According to the report, an estimated 4.9 million [3.7–6.3 million] people were living with HIV in Asia and the Pacific in 2012. Regionally, numbers of new HIV infections have fallen by 26% since 2001, with a number of countries reducing infections by over 50% in that time. However, the overall number of new HIV infections across the region has remained largely unchanged in the past five years.

The number of people accessing antiretroviral treatment in the region rose to 1.25 million people by the end of 2012. But the rate of increase in access to treatment has slowed in recent years.

Get to Zero HIV: Run for a reason

Echoing the messages and themes from ICAAP11, several key events took place during the days leading up to the conference. For the Bangkok Marathon, Thailand’s largest sporting event, official sponsor Standard Chartered Bank Thailand teamed up with UNAIDS Asia and the Pacific to promote HIV awareness under the theme Run for a Reason: Get to Zero HIV.  Many of the 57,000 runners taking part in the marathon and ‘fun-walk’ events, wore Get to Zero HIV t-shirts and hats, and carried banners promoting the theme. UNAIDS Deputy-Executive Director Jan Beagle officially started a number of the race events accompanied by CEO and President of Standard Chartered Thailand Bank Ms Lyn Kok and dignitaries from the National Jogging Association of Thailand.

On 29 August at the AIDS Vaccine Efficacy Consortium (AVEC) Summit for an AIDS-Free Generation in Thailand, a Thailand-United States partnership working on the development of an HIV vaccine has announced its commitment to build on the success of previous trials, giving a renewed push to vaccine research.

In 2009, the landmark RV144 Thai vaccine study—jointly developed by the Thai health ministry and US military researchers—proved the first evidence in humans that a safe and effective preventive HIV vaccine is possible. Results of the RV144 found 31.2% efficacy at the end of the study among 16 000 Thai volunteers.

Building on this, researchers will work to improve the levels of protection found previously and conduct additional trials in Thailand over the coming years, focusing on key populations at higher risk of infection, including men who have sex with men. The aim of the on-going research is that a modified version of the vaccine would raise the protection rate to around 50%—the figure needed to obtain regulatory approval for public release.

The Thai Government will take a leadership role by supporting the future HIV vaccine efficacy study and assisting in the establishment of flexible manufacturing systems and infrastructure that could support the production of a registered HIV vaccine.

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