World AIDS Day 2018
Message from Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region on the occasion of World AIDS Day 2018
The first ever World AIDS Day was observed thirty years ago today, on 1 December 1988. It was an unprecedented global event to raise awareness about the disease, show solidarity with those living with it, and commemorate persons who had died from AIDS-related illnesses. It has been commemorated every year since, in all corners of the globe, including in the WHO South-East Asia Region.
Between the first World AIDS Day and the present, significant progress has been made. Globally, in 2017, out of an estimated 36.9 million people living with HIV (PLHIV), around 22 million were receiving lifesaving Antiretroviral treatment (ART). Since 2010 the provision of ART to prevent mother-to-child transmission helped avert 1.4 million child infections. There has meanwhile been a 34% reduction in AIDS-related deaths compared to 2010, while global progress towards the 90-90-90 targets has been impressive: An estimated 75% of PLHIV know their status, while 79% of those who know their status are on ART. 81% of those on ART have suppressed viral loads.
Challenges, however, remain. As the theme of this year’s World AIDS Day – ‘Know your Status’ – highlights, the key to ensuring all PLHIV receive care and prevention services, as well as preventing new infections, is access to HIV testing. This is particularly salient in the South-East Asia Region, where 36% of estimated PLHIV do not know their status. Though AIDS-related deaths in the Region declined by 40% between 2010 and 2017, and new infections decreased from 318 000 in 2000 to 157 000 in 2017, an estimated 3.5 million people are presently infected with the virus, with around 51% receiving ART. This must be remedied as a priority.
Fundamental to ensuring all people have access to quality HIV testing is harnessing the many innovations now available. Novel approaches such as community-based testing by lay providers, community-led testing and HIV self-testing are vital tools to help people know their status and seek treatment as appropriate. To make this happen, countries must ensure WHO prequalified HIV self-test kits are registered with drug regulators and are readily accessible. They must also remove all structural barriers that presently exist to access testing, including the need for parental consent for adolescents, for example.
Communities themselves must be encouraged to embrace HIV testing. This can be done via communication campaigns that strive to eliminate the stigma and fear surrounding the disease, and which tailor messaging according to key populations. This is especially important given nearly two-thirds of new infections in the Region occur among key populations, who are at a significantly higher risk of contracting the virus than the general population, though often lack access to services and appropriate information. As recent regional think tank meetings have stressed, empowering key populations to harness ‘Aids Assets’ will help prevent, test and treat HIV, thereby keeping them safe and reducing the disease’s prevalence.
In championing the theme of this year’s World AIDS Day, it is indeed crucial that each and every person knows their HIV status, particularly among key populations. But as the WHO TREAT ALL guidelines make clear, knowledge alone will not solve the problem: All cases should be provided free treatment as soon after diagnosis as possible, especially given WHO removed limitations on the eligibility of receiving ART in 2016. It is to the credit of each of the Region’s Member States that the WHO TREAT ALL guidelines have been universally adopted, with each of them striving to reach the 90-90-90 targets by 2020.
As progress continues (even as international AIDS-related funding declines), health systems must go the extra mile to ensure all people everywhere know their status and can access treatment as part of the broader drive towards universal health coverage. While the number of new infections continues to come down, treatment coverage expands, and AIDS-related deaths reduce evermore, we must focus on sustaining what has already been achieved, accelerating our progress, and harnessing the full power of innovation to ensure all people know their HIV status, can access care, live healthy and protect others.
Dr Poonam Khetrapal Singh