Participants at the judicial dialogue on HIV, human rights and the law. Bangkok, Thailand. 2-4 June 2013. Credit: UNAIDS

In Asia and the Pacific, almost all countries have some kind of punitive laws, policies and practices that hamper access to HIV services for people living with HIV and key populations at highest risk including people who use drugs, sex workers, men who have sex with men, and transgender people.

Faced with punitive legal environments, many people in need of HIV prevention and treatment services are not able to access them for fear of stigma, discrimination, legal reprisals and even violence.

Seeking to address these challenges, some 30 judges from the highest national courts of 16 countries in Asia and the Pacific joined to discuss the role of the judiciary in responding to HIV. They also debated about the specific actions that can be taken to create a more supportive legal and social environment for people living with and vulnerable to HIV in the region.

Convened by UNAIDS, UNDP and the International Commission of Jurists, the meeting was part of efforts to support judges become leaders in the HIV response. Participants stressed the critical role of Judges and courts in protecting people living with and affected by HIV and achieving the UNAIDS vision of ‘zero discrimination’.

30 years into the AIDS response, the need for legal environments to be aligned with the latest scientific developments on HIV and treatment was underlined. “Our authority is based on reason and evidence—this is the strongest ally we have in addressing the HIV epidemic and what we need for just and fair outcomes,” said Hon. Justice Edwin Cameron, Justice of the Constitutional Court of South Africa.

During the gathering, UNAIDS launched a new Judicial handbook on HIV, Human Rights and the Law, providing updated information on the latest scientific developments on HIV as well as key human rights and legal considerations to assist and guide judges’ HIV-related work.

Of the 38 United Nations Member States in the region, 11 impose some form of restriction on the entry, stay and residence of people living with HIV based on their HIV status; 37 criminalize some aspect of sex work; 18 criminalize same sex relations; 11 impose compulsory detention centres for people who use drugs; and 15 provide the death penalty for drug-related offences.

“The time has come for us to address all laws concerning people from marginalized sections of society. We need to re-look at legislation through the lens of the human rights guaranteed under the Constitution and ensure it is aligned to enable progress and to move with the necessary urgency,” said former Chief Justice of the Delhi High Court in India, Hon. Ajit Prakash Shah. Judge Shah was on the bench that handed down the July 2009 ruling that found India's 150-year-old statute (Section 377 of the Indian Penal Code) prohibiting homosexual acts as discriminatory and therefore a violation of fundamental rights.

Transformative jurisprudence

The striking down of Section 377 through the Delhi High Court was one of a number of protective jurisprudence examples that have had a transformative and beneficial impact on the national AIDS response and on public perception of HIV. Other examples are the progressive court decisions in Nepal, India and Bangladesh that have recognized the human rights of sex workers as defined under national Constitutions; decisions in Thailand and India that have ensured access to affordable generic medicines; and Pakistan’s inclusion of transgender people in population registration under the status of a third gender, among others.

Discussions at the Bangkok dialogue were supported by active involvement of representatives from groups of people living with HIV and key populations at highest risk, together with United Nations agencies and partners, who underlined the importance of the judiciary’s active support to the revision and removal of punitive laws in the region.

“If we don’t deal with these issues, we are not going to end AIDS,” said Mr Shiba Phurailatpam, Regional Coordinator of the Asia Pacific Network of People Living with HIV. “Judicial action can affect social views and have an impact on stigma and discrimination—it can save people’s lives,” he added.

“The law must be a shield that protects, not a sword that punishes and increases vulnerability to abuse, harassment and HIV infection,” said UNAIDS Deputy Executive Director, Management and Governance, Jan Beagle who delivered the keynote address at the meeting. “Judges can help shape social and community attitudes by stance and attitude toward people living with HIV and members of key populations,” she added.

Director of the UNDP HIV Health and Development Practice, Dr Mandeep Dhaliwal stressed that judicial leadership is an essential component of addressing inequality. “Getting the legal environment right is essential for addressing the social and structural inequalities which fuel HIV and impede health and development progress,” she said.

UNAIDS Goodwill Ambassador Mr Myung-Bo Hong (second from left) was accompanied on the visit to Thailand by his two sons: 12-year-old Jeongmin (left) and 14-year-old Seongmin, standing next to UNAIDS Executive Director Michel Sidibé. Credit: UNAIDS

South Korean football star Hong Myung-bo—a UNAIDS International Goodwill Ambassador—described his HIV fact-finding visit to Thailand this week as an “eye-opening experience” and a great learning opportunity.

“I’ve been able to see first-hand the tremendous work that UNAIDS and its partners are doing in Thailand and across Asia,” said Mr Hong, who played for South Korea’s national football team in four consecutive World Cups (1990-2002) and is currently Korea’s Olympic Football Team coach.

“A football match lasts 90 minutes and even if you are leading in the first half, you can still lose the match,” said Mr Hong, adding, “We cannot afford to drop the ball” in terms of HIV awareness.

During his five-day mission, Mr Hong visited community organizations and met with members of key affected populations in the national HIV epidemic, including female sex workers at the Empower Foundation—a national non-governmental organization that protects the rights of female sex workers.

Mr Hong pledged to share impressions and highlights from the visit on his return to South Korea with key stakeholders and to underline the importance of shared responsibility and continued funding for the AIDS response. While connecting with UNAIDS Executive Director Michel Sidibé in Bangkok, he shared his plan to arrange a charity football match in December to raise money for AIDS-related projects in the region.

“The power of sport is impressive and can be an agent for change, especially for young people,” said Mr Sidibé, who was in Thailand as part of a three-country official mission in South-East Asia. “Mr. Hong is a compelling voice to empower young people to protect themselves from HIV—to address stigma and discrimination against people living with and affected by HIV.”

During his visit to Thailand, Mr Hong took part in a football training session for coaches organized by Thailand’s National Olympic Committee and the Physical Education Institute.

Mr Hong was accompanied on the visit to Thailand by his two sons, 14-year-old Seongmin Hong and Jeongmin, aged 12. While meeting with Mr Sidibé, Seongmin presented the Executive Director with a US$ 3000 donation, which he had raised at an art exhibit for AIDS.

Mr Sidibé applauded the young man’s initiative: “You have made a very powerful gesture. Efforts like yours show that we can be inclusive, tolerant, open and compassionate—that we can all work together to stop HIV.”

Thailand’s Deputy Prime Minister and chair of the National AIDS Committee, H.E. General Yuttasak Sasiprapha giving an address at the launch of Thailand’s new national AIDS plan.
Credit: UNICEF Thailand / P.Kitatnaruyuth

Thailand has become the latest country in the Asia and the Pacific region to align its national AIDS strategy with the UNAIDS vision of getting to zero new HIV infections, zero discrimination and zero AIDS-related deaths.

Launching the country’s new national strategy on HIV/AIDS 2012-2016—entitled ‘AIDS Zero’—the chair of the National AIDS Committee, H.E. the Deputy Prime Minister General Yuttasak Sasiprapha noted that, “Thailand has a long tradition of close cooperation between government, non-government organizations, civil society, communities and private sector, and this working together will lead Thailand to ‘AIDS Zero’.”

Over the past 25 years, Thailand has become known as a model for its rapid and multi-sectoral HIV response. Early investments in the HIV epidemic have shown concrete results including in the elimination of new infections among children—nearly 97% of women living with HIV in Thailand are now accessing services for the prevention of mother-to-child transmission. There has also been a dramatic increase in providing access to HIV treatment which is now a reality for nearly 80% of all in need.

However, despite significant progress, the country is still experiencing concerning trends among key populations at highest risk including people who inject drugs, men who have sex with men and sex workers, particularly in urban centres. National spending data shows that investments in HIV prevention are under-resourced, particularly for programmes focused on populations most at risk of HIV.

The new national AIDS strategy addresses two critical questions: What is Thailand doing well that should continue, and what needs to change to get to zero new HIV infections, zero AIDS-related deaths, and zero discrimination? Accordingly, the plan has two main strategic directions: ‘Innovation and Change’ and ‘Optimization and Consolidation’.

The ‘Innovation and Change’ prong focuses on promoting strategies to better prevent new HIV infections—particularly among key affected populations; to better localize responses and ownership at the sub-national level; and to better address the socio-environmental factors which hinder access to HIV prevention and care services, and fuel stigma and discrimination.

Under the ‘Optimization and Consolidation’ section, strategies aim at continuation, optimization and sustainability of proven programmes already carried out in the country. Examples of strategies falling under this area are on the elimination of new infections among children and HIV prevention among young people, where Thailand has already seen significant progress.

Among the strategic goals emphasized in the new plan is the aim to reduce new HIV infections by two thirds by 2015—over and above the global goal agreed through the 2011 Political Declaration on AIDS of reducing new infections by 50%. The strategy also aims for total elimination of new HIV infections among children.

“The new approach recognizes that while impressive progress has been made in a number of areas in Thailand, there is still room to push forward on certain priorities that may have already been defined in the past but have thus far not been implemented,” said UNAIDS Country Coordinator for Thailand, Michael Hahn. “By operationalizing these new strategies—and ensuring dedicated resourcing through domestic and international sources—Thailand is taking critical steps towards making ‘getting to zero’ a reality in the country.”

Representatives from government, civil society and the international community agreed that the most important thing now is turning the strategy into action as soon as possible. It was also highlighted the need for stakeholders to mobilize adequate resources, national leadership, and effective management to ensure that the Thai national AIDS strategy moves from principle to reality. 

In Asia and the Pacific, a number of countries and regional bodies have realigned their national strategies and goals around the ‘Getting to Zero’ vision. At their 2011 Summit, the ASEAN Heads of State adopted a Declaration to ‘Get to Zero’ on HIV and reaffirmed their commitment in working towards realizing an ASEAN community with Zero HIV Infections, Zero Discrimination and Zero AIDS-related Deaths.

Sex workers share their ideas for new business ventures that will bring greater economic independence.
Credit: ILO

When San, a sex worker in Bangkok, was given the opportunity to participate in a pilot business skills training scheme, she jumped at the chance. She wanted to put her idea of setting up a bakery into practice.

“I’ve always enjoyed baking and so I was interested in starting a part-time baking business to add to my income from sex work,” she said.

Sitting in the red-light district office of Empower Foundation, a sex worker advocacy group, San chats with Au and Wii, fellow graduates of the International Labour Organisation (ILO) Community-based Enterprise Development (C-BED) training. Au is working on a business plan in partnership with another C-BED graduate to start a food delivery service supplying spicy Thai salad to apartment buildings around Bangkok. And Wii intends to open a small store specialising in traditional clothing.

C-BED is a new tool which builds the capacity of current or aspiring entrepreneurs through self-facilitated business skills modules which rely on activity-based, participant-run, social learning principles.

Sex workers face a range of challenges in their daily lives such as long working hours, employment-related violence and a lack of access to health care and social security benefits. They also have an increased vulnerability to HIV: nearly 3% of brothel-based sex workers were living with HIV in 2009 and one 2007 study showed their HIV prevalence as high as 20% in Bangkok and Chiang Rai.

Empower Foundation and other similar groups in Thailand have been calling on the government and development agencies to address the economic vulnerability of sex workers and to create access to additional forms of income generation. The C-BED training addresses this gap through a low cost, innovative methodology emphasising the value of recognising and sharing community knowledge.

“C-BED empowers vulnerable groups, including sex workers and HIV-positive people, to improve their means of income generation,” says Richard Howard, ILO Senior Specialist for HIV/AIDS in Asia Pacific. “Economic empowerment can support sex worker efforts to negotiate for better, safer working conditions free of violence and harassment with improved access to health services, including HIV prevention, treatment and care.”

The recent initial C-BED training took place over three days in Empower’s office, facilitated by a team of staff and volunteers involved with the sex worker community. The 26 female sex worker participants, aged 18-72, had varying levels of literacy so business theory was explained and demonstrated through a series of activities including drama, drawing and discussions. Key entrepreneurial topics included marketing, bookkeeping, productivity, personnel management, costing and quality control, with participants creating action plans.

“I liked that everyone had a chance to introduce their business idea without fear - it was fun and not stressful so everyone was able to learn more,” said one participant. She added, “I now think I can have my own business.”

C-BED is designed for untrained, but literate, participants from the community to facilitate group sessions, so they can share their increased knowledge and expertise.  As the facilitator does not require training or expensive materials, C-BED can be implemented at minimal cost in vulnerable or hard-to-reach communities which would traditionally be inaccessible due to social or geographical isolation.

UNAIDS Country Coordinator, Michael Hahn, welcomes the project. “This is a really good example of an activity designed and implemented with the full participation of sex workers. The business skills they gain will help widen their choices about how they best want to shape their lives and their futures.”

ILO plans to roll out C-BED in partnership with sex worker organisations in Thailand, Cambodia, Vietnam and Sri Lanka over the next two years, aiming to reach more than 2 000 sex workers by the end of 2013.

Since completing the training, San has started a bakery in Samut Sakhorn and hopes one day she can employ staff to help her expand. “C-BED gave me the confidence to start out on my own,” she says.

Many of Thailand’s more than five million migrants find themselves in situations that heighten their risk of HIV and have difficulty accessing key services such as antiretroviral therapy.
Credit: UNDP

Migration plays an integral role in Thailand’s economic development and the country hosts more than five million migrants from Cambodia, Lao People’s Democratic Republic (PDR) and Myanmar.

Many migrants however find themselves in situations that heighten their risk of HIV and have difficulty accessing key services such as antiretroviral therapy (ART). A recent regional conference, organised by the UN Development Programme (UNDP) and the Joint Initiative on Mobility and HIV/AIDS (JUNIMA) from 24-25 April explored ways of ensuring better provision of ART to this potentially vulnerable group.

Although migration is not in itself a risk factor for HIV, it can increase vulnerability, such as exploitative working conditions, which may include sexual violence; and separation from spouses/partners, families and established social and cultural norms and values.

A new study in the six provinces most affected by HIV in Thailand has shown that Cambodian migrants bear the highest burden with an HIV prevalence of 2.5%. The estimated adult prevalence in the country as a whole is 1.3%. 

The Government of Thailand has taken steps to ensure that migrants have access to ART. Speaking at the conference, Dr Petchsri Sirinirund, Director of the National AIDS Management Centre at the Ministry of Health’s Department of Disease control said, “In the new national strategy for 2012-2016, we aim to provide access to quality HIV treatment and care for any person living with HIV in Thailand, regardless of their nationality.”

There is provision of antiretrovirals (ARVs) for certain categories of low skilled migrants but there are more people in need. Those who are officially registered can pay a fee for universal health coverage which includes HIV treatment and a limited number of people with temporary papers, some 2 300, receive ART through Thailand’s Global Fund project.

Political commitment to providing high quality care, including antiretrovirals, is also evidenced by the establishment of a Memorandum of Understanding on Joint Action to Reduce HIV Vulnerability Associated with Population Movement. This was signed in December 2011 by the six members of the Greater Mekong Sub-region (Cambodia, Lao PDR, Myanmar, Thailand, Vietnam and the Yunnan Province of China). A Joint Plan of Action for the memorandum is being formulated.

In addition, Thai and Cambodian authorities have collaborated on a scheme which allowed Cambodian migrants to return to their home country to obtain a three month supply of ARVs.

However, many migrants are not in a position to access antiretrovirals. Each health scheme has a cost to individuals ranging from the equivalent of around 45 US dollars to 90 US dollars and there is also a long waiting list for treatment. A number of those who are unregistered never come to the attention of authorities and therefore receive no help.  

The challenges of cross border navigation of different regulations, health systems, and languages, as well as the often temporary nature of migration, make it particularly challenging for migrants living with HIV to access ART along the migration continuum and to adhere to drug regimens.

Furthermore, being given ART does not only involve obtaining the drugs themselves but also ensuring access to wider HIV services like voluntary and confidential counseling and testing as an entry point to treatment.

According to Promboon Panitchpakdi, Executive Director of the Raks Thai Foundation, a development NGO, “While we need to focus our discussion on availability of ARVs as a commodity, what also needs to be in place is a comprehensive system of medical and social care that is backed up by national and regional policy.”

A number of recommendations emerged from the UNDP/JUNIMA conference. These included: examining ways to use TRIPS intellectual property and free trade agreement flexibilities to lower the cost of treatment services and increase coverage for migrants; harmonize treatment and referral protocols across countries; and ensure that in addition to treatment, migrants have better HIV services available. 

Rathin Roy, Manager of UNDP Asia Pacific Regional Centre, is confident that migrants will be increasingly better served. “Thailand is a pioneer in implementing the human principle that migrants can access the same quality of HIV services and commodities that are available to citizens, and UNDP, through JUNIMA, is pleased to work in partnership with government and civil society across borders to address the challenges that will allow all migrants in need to access vital HIV treatment.”

Representatives from the community of people living with HIV and key populations most at risk urge governments in Asia and the Pacific to work with them to reach global AIDS targets and commitments.
Credit: UN ESCAP

Dressed in a striking blue and red shalwar kameez (traditional dress from South and Central Asia), Akkai, a transgender woman from Bangladesh, steps onto the stage. Turning to her audience of government officials from Ministries of health, justice, public security, drug control, social protection; United Nations officials; and fellow members of key populations most affected by HIV, she started to sing:

“I born as me/ My feelings changed… / I started behaving like a girl / I started walking like a girl / I started dressing as a girl / When my parents forced me to stop myself /  I was beaten up / I was locked up / I was tortured…./ …There was nobody to ask these things / … / This kind of torture, violence, harassment /  Is not faced only by me / Where to live?/ Where to share?/ Where to survive our life?”

Joining the scene, the coordinator of the Women’s arm of the Asia-Pacific Network of people living with HIV explained: “I have been living with HIV for 17 years. Fortunately I have had access to treatment. But now free-trade agreements are compromising access to essential medicines,” she said. “Eighty percent of generic medicines are made in this region. Without access to affordable medicines we cannot get to zero,” she added.

These personal experiences were two of many shared by people living with HIV and key affected populations at the United Nations Economic and Social Commission for Asia and the Pacific (UN ESCAP) high-level intergovernmental meeting held in Bangkok, Thailand from 6-8 February 2012. The meeting was an opportunity to review the region’s progress towards international targets on AIDS.

“For the first time in history we have the possibility to end AIDS and Asia-Pacific nations have shown we can lead the world in making an impact. But we cannot ignore the challenges our region faces and how these can jeopardize our ability to progress,” H.E. Ratu Epeli Nailatikau, President of Fiji, who underlined his long-term commitment and leadership on HIV as Chair of the high-level talks.

Representatives from the most-affected communities urged government delegations from Asia-Pacific nations to recognize the existing challenges in accessing HIV services posed by punitive laws and practices, threats to continued availability of HIV treatment and widespread stigma and discrimination. They also called upon governments to work increasingly with communities to ramp-up action to reach HIV goals.

The call to action was heard. By the end of the three-day talks, co-convened by UNAIDS and other UN partners, the nations present endorsed a framework to fast-track regional action on AIDS towards the achievement of global targets and commitments by 2015. Countries agreed to create ‘spaces’ for key affected communities—including people who use drugs, men who have sex with men, people who buy and sell sex, and transgender people—to be involved in the development of practical solutions to legal impediments and HIV service scale-up at the policy and programmatic level.

“It was recognized here that we have to find new ways to reach the maximum amount of people in the short time we have before 2015,” said UNAIDS Director of the Asia-Pacific Regional Support Team, Steven Kraus. “And there is no question; this must be done hand-in-hand with the community.”

Akkai, a transgender woman from Bangladesh, sings about the stigma and discrimination she faces.
Credit: UN ESCAP

In recent years, Asia and the Pacific has experienced significant progress in reduction of new HIV infections, increase on numbers of people receiving antiretroviral treatment and expansion of programmes to reach key populations most at risk.

Examples given by a number of countries at the Bangkok talks illustrated that scaled up HIV services coupled with intensive engagement of key affected populations, have led to declining epidemics. In Thailand for example, the transgender people-led initiative “Sisters”, which provides social services and support to transgender people in the Pattaya area reports that HIV incidence fell from 12 to 8% among people using its services in the last 5 years.

With such examples of progress, the importance of developing the next generation of community leaders is a central regional priority. The new Asia-Pacific framework for accelerated action underlines that young people from key affected populations must be heard, heeded, and have space at the policy and programme tables.

Emphasizing the readiness of young people most affected by HIV to take on a leadership role in the region’s future HIV response, Coordinator of Youth LEAD, the regional network for young HIV key affected populations, Thaw Zin Aye said: “Young people are taking ownership of the AIDS response and we are committed to carrying on the legacy. We urge governments to continue taking action with us.”

The endorsed regional framework emphasizes the need to share good practices and lessons learned in implementing the measures and commitments related to HIV. Asia-Pacific countries also requested UN ESCAP, UNAIDS and other cosponsors to support implementation of the road map.

24-year old Ayu Oktariani from Indonesia who is living with HIV is part of the Youth LEAD network for key affected populations.
Credit: UNAIDS

When Palitha Wijebandara from Sri Lanka found out he had tested positive for HIV, he was shocked and confused. He had been tested as part of a company policy at his work, without his specific consent or proper counseling, and he did not understand the implications of his test result.

Palitha is one of many thousands of people in Asia and the Pacific who have faced the challenge of discovering their HIV status in their youth. At only 23 years old, he was alone. He did not know how to face his family. He feared discovery of his status and of the fact that he had been having relations with other men.

In Asia and the Pacific, evidence indicates that 95% of all new HIV infections in young people in the region are among young people from key affected populations—young people who buy and sell sex, young men who have sex with men, young transgender persons and adolescent drug users.

Specific data on young people at higher risk of HIV in the region is sparse. But estimates that do exist give cause for concern. In some Asian countries, three out of five female sex workers, and almost half of all men who have sex with men, are younger than 25 years. In the Lao People’s Democratic Republic, 82% of sex workers are in that age group. In Nepal, half of all people who inject drugs start injecting in their late adolescence, when they are between 15 and 21 years old. By the time someone has been injecting for a year, there is a 33% chance that they will have acquired HIV.

Multiple challenges

Despite high vulnerability to HIV infection, young people at higher risk find it difficult to obtain information on HIV, sterile injecting equipment, or other services such as HIV testing and support. Across Asia-Pacific, programmes focusing specifically on young people most at risk are often scarce.

“Prevention campaigns don’t reach out to young female sex workers as often we do not come out to access the information, and if we do, it doesn’t speak to us,” said Ms Fulmaya*, a young sex worker from Nepal.

“As a young gay man, some things are hard to say openly and you worry that if you say those things, people will discriminate against you. The first time I wanted to get an HIV test, I had no idea where to get it and I was too scared to go to the hospital,” said Xiao Chen*, 21, from China.

Stigma, the criminalization of certain behaviours and other legal hindrances mean that young people from key populations at higher risk are often difficult to reach. In many countries, taking an HIV test, going on HIV treatment, or using reproductive health or harm-reduction services requires the consent of a parent or guardian.

“I can’t get the free HIV test because I don’t want my mother to know what I’m doing and so I cannot provide the clinic with parental consent. All I want is to know my HIV status,” said Bugoi a transgender sex worker from the Philippines.

Many adolescents find sexually transmitted infection clinics and HIV clinics intimidating, and feel uncomfortable talking about personal issues with clinical staff who are much older than them, and who can be judgmental. Harm-reduction programmes for drug users generally focus on male adults, despite statistics that show some young drug users start injecting as early as 12 years old and the fact that young women also need services.

“I have heard of organizations that give out needles but many are far and they only target the boys,” explained Payal, an 18 year old woman from Nepawho uses drugs.

An often-expressed frustration of young people from key populations at higher risk in Asia is that they often feel they are robbed of the voice to describe, discuss and alter their realities.

“Young people have plenty to say, but their voices aren’t heard. I think if people paid more attention to HIV and strengthened the voice of the community a bit, more people would learn about HIV and understand the issues and what we need,” Xiao Chen* said.

Time to lead

Some significant action is being taken to bring the voice of young key affected populations to the foreground –organizations and networks of young people from key populations at higher risk are gradually becoming strengthened.

Sri Lankan Palitha Wijebandara, who discovered his status through an unauthorized HIV test, drew strength from his involvement in peer support and, recently, from his efforts to promote the rights of young people from key populations at risk through Youth LEAD. This Asia Pacific regional network set up in 2010 is helping develop youth leadership in key populations at higher risk to strengthen their involvement in community, national and regional programmes. Representatives from Youth LEAD and other youth at risk organizations are increasingly being able to take their place at the table in regional policy arenas and debates.

From 6-8 February in Bangkok, Thailand, the need for increased focus on and involvement of young people from key affected populations in the Asia-Pacific AIDS response is one of the central areas of discussion at a high-level United Nations meeting. Young people from key affected populations are joining government leaders and senior officials from across Ministries of health, justice, law enforcement, social development and drug control agencies as well as their older civil society counterparts from key affected populations and people living with HIV to address legal and policy barriers that impede access to HIV services in the region.

According to UNAIDS Director of the Regional Support Team for Asia and the Pacific, Steve Kraus, the regional UN gathering on AIDS provides the ideal opportunity for young people from key communities to “Be loud, be heard and be honest about the critical things you need to make Getting to Zero a reality in this region.”

For 24-year old Ayu Oktariani from Indonesia who is living with HIV, and participating in the Bangkok meeting with Youth LEAD, the message is simple: “We need to be empowered and supported so that we can take ownership of AIDS. We are here to say please include us, listen to us, work with us and together we can achieve great things.”

 A longer version of this feature first appeared in the UNAIDS publication: HIV in Asia and the Pacific - Getting to Zero, August 2011.

* Some names have been changed on request to protect the identities of the interviewees

Resolution 67/9 on HIV was endorsed at the 67th UN ESCAP Commission held in Bangkok, Thailand from 19-25 May 2011. Credit: UN ESCAP

In the lead-up to the 2011 General Assembly High Level Meeting on AIDS to take place in New York from 8-10 June, the 62 Members and Associate Members of the United Nations (UN) Economic and Social Commission in Asia and the Pacific (ESCAP) have unanimously adopted a new Resolution on HIV. The resolution reconfirms commitment of countries in the region to reach universal access to HIV prevention, treatment, care and support and to address critical barriers hampering responses to AIDS.

Cosponsored by the Governments of Indonesia, Australia, Fiji, Thailand and Myanmar, the 67^th Commission Session, held at the ESCAP headquarters in Bangkok, Thailand, passed the Resolution on Wednesday 25 May 2011.

The HIV Resolution was developed following the Asia Pacific Regional Consultation on Universal Access held at the end of March, at which over 250 representatives from governments, international organizations, donors and civil society from nearly 30 countries agreed upon necessary actions from the region towards the vision of zero new HIV infections, zero discrimination, zero AIDS-related deaths.

“Thirty years since AIDS was first discovered, many countries have made progress in their HIV responses, but the agenda is unfinished. To ‘get to zero’ we need to unite as a region and redouble our efforts, making sure they are focused to reach those who need them most,” said Dr Nafsiah Mboi, Secretary of the Indonesian National AIDS Commission.

Recalling previously adopted Resolutions and commitments on HIV made by the Commission, ESCAP Resolution 67/9 calls upon members and associate members to further intensify actions to reach the unmet goals and targets of the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS.

The Resolution emphasizes members’ agreements to support the achievement of 80% coverage for populations at higher risk including people who use drugs, people who buy and sell sex, men who have sex with men and transgender people, with a view to achieving targets on universal access to HIV services.

“We welcome this strong endorsement by Members of ESCAP. With less than one month to go before the High Level Meeting on AIDS, this Resolution is timely and shows the commitment of the region to respond to HIV and particularly to removing barriers which can hamper progress,” said UNAIDS Regional Director, Steven Kraus.

The new declaration calls on governments in the region to ensure the commitment of a greater proportion of national resources to improve the programmatic effectiveness of the HIV responses. Resolution 67/9 also urges a review of national laws, policies and practices to enable the full achievement of universal access targets with a view to eliminating all forms of discrimination against people affected and infected with HIV. Finally, it underlines that to better address HIV, countries must continue to develop their national strategies to address all forms of gender-based violence, including sexual violence, particularly against women and girls.

UN ESCAP’s Social Development Director, Nanda Krairiksh underlined the significance of the Resolution endorsement for the region: "Governments in the Asia-Pacific region are moving forward to ensure greater effectiveness in national HIV responses. They are calling for greater financial sustainability, resource allocation and scaling-up of the full range of actions to ensure universal access to HIV prevention, treatment, care and support," she said.  

Steve Kraus, Director, UNAIDS Regional Support Team for Aisa and the Pacific, gives an overview on the epidemic and response in the region. Credit: UNAIDS / V. Dithajohn

Nearly 30 countries from Asia and the Pacific have unanimously committed to driving forward the region’s efforts to reach universal access to HIV services by 2015.

This commitment came as more than 250 representatives from government, civil society, people living with HIV, UN agencies and development partners from across the region met in Bangkok, Thailand from 30-31 March, to review progress made and to develop key actions to achieve universal access to HIV prevention, treatment, care an support.

Through a Resolution, unanimously adopted at the end of the review, participants underlined the need for an HIV prevention revolution focusing on key populations at higher risk. Also, the need to sustain gains made in the provision of HIV treatment and to take urgent action to address legal barriers, stigma and discrimination and funding gaps that block progress in the region’s response to AIDS. The Resolution will now be presented to the 67^th Commission of the UN Economic and Social Commission in Asia and the Pacific where it will be considered for official adoption by the entire Commission comprising 62 Member governments.

“This is a region showing it is serious about an effective Asia Pacific response to AIDS, and is willing to stand up for sex workers, people who use drugs, men who have sex with men, transgender persons and policies that uphold the human rights of people living with HIV,” said Mr Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific. “Commitment and energy have produced a strong and clear agreement on how to achieve universal access in Asia Pacific, giving a strong regional voice in the lead up to the UN High Level Meeting in New York in June,” he added.

Over the two-day meeting, hosted by UNAIDS in collaboration with the UN Economic and Social Commission in Asia and the Pacific, participants noted important progress in the region to date, including that HIV epidemics have significantly slowed or stabilized across the region and that a number of the countries are reaching high levels of coverage for antiretroviral treatment.

However, critical challenges were raised as no country in the region is reaching universal access to HIV prevention, treatment, care and support. One in three people in the region do not have access to HIV treatment; 60% of people living with HIV in the region do not know their HIV status; and key affected communities continue to be subjected to stigma and discrimination, punitive laws, policies and practices which obstruct access to HIV services. Many countries in the region—including those with or approaching middle-income status—rely heavily on international funding for their AIDS responses.

Speaking at the opening, Dr Siriwat Tiptaradol, Deputy Permanent Secretary from the Ministry of Health in Thailand urged countries to make health is a policy priority and to ensure a partnership response: “Progress on universal access can only be possible when different arms of the same government, together with civil society, join together with common goals.We must find ways to support each other, particularly at the regional level, to make AIDS funding a collective responsibility.”

Igor Mocorro, a member of ‘Youth Lead’, addresses the plenary at the Asia Pacific Regional Consultation on Universal Access. Credit: UNAIDS / V. Dithajohn

In times of fiscal austerity and competing development priorities, the need to sustain momentum on HIV was echoed throughout the Consultation. “The world’s most populous region cannot afford complacency on AIDS. Political leadership with civil society and the key affected communities as the cornerstone of the response requires fresh perspectives from the ground,” said ESCAP Social Development Division Director, Nanda Krairiksh.

Strongly emphasized was the critical importance of continued engagement and motivation of the region’s youth—particularly those from key populations at higher risk. Young leaders underlined the importance of the full involvement of young people in the HIV response and urged national leaders and partners to ensure their voices are equally heard and heeded.

“We have the passion for change and it’s time for leaders to take young people seriously as equal partners and key actors in society,” said Igor Mocorro, a member of ‘Youth Lead’, a programme to develop youth AIDS leaders from key affected populations. “We know the realities; we can make a difference.”

On Thursday, UNAIDS Executive Director Michel Sidibé (left) urged the Prime Minister of Thailand, Abhisit Vejjajiva, to lead an HIV prevention revolution in the Asia region, with the goal of zero new HIV infections, zero discrimination and zero AIDS-related deaths. Credit: UNAIDS/V. Dithajohn

On the final day of an official country visit to Thailand, UNAIDS Executive Director Michel Sidibé praised Thailand’s Prime Minister, Abhisit Vejjajiva, for his leadership and commitment on AIDS in the country and urged Thailand to redouble efforts—and resources—on HIV prevention.

Underlining the country’s current successes, including significant advances in the provision of antiretroviral treatment and increased access to services for the prevention of mother-to-child transmission of HIV, Mr Sidibé urged Thailand to lead an HIV prevention revolution in the Asia region.

“Thailand has an outstanding record in the AIDS response which now needs to be taken to the next level,” said Mr Sidibé, encouraging Thailand to take the lead and be the first country in the region to make a concrete impact on the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. 

Thailand is known for its effective, rapid and targeted HIV response. Currently 80% of people in need have access to antiretroviral treatment and nearly 97% of pregnant women living with HIV have access to services to prevent mother-to-child transmission of HIV. The Government of Thailand funds 83% of its national HIV response, but only 14% of the national HIV budget is allocated for HIV prevention.

Prime Minister Abhisit acknowledged that HIV prevention efforts in Thailand need to be rapidly intensified and that they should be clearly focused on key affected populations, such as sex workers, men who have sex with men, and people who inject drugs. He complimented UNAIDS’ bold goal of zero new HIV infections.   Stigma and discrimination was highlighted in the meeting as one of the critical barriers in the HIV response, particularly with regard to its impact on people living with HIV and the affected communities. Prime Minister Abhisit also called attention to Thailand’s newly developed harm reduction policy and said that he was taking action to ensure the policy’s implementation across the country, starting in ten provinces.
Underlining his continued commitment to lead on the issue of AIDS, the Prime Minister expressed his interest in playing an active role in the June 2011 UN General Assembly High-Level Meeting on AIDS.