The Eighth International Congress on AIDS in Asia and the Pacific (ICAAP) opened on Sunday in Colombo, the Sri Lankan capital, with speakers stressing the need for action to prevent a surge in the regional infection rate.
UNAIDS, co-sponsor of the congress, along with the AIDS Society of Asia and the Pacific (ASAP), recently revised its estimate of HIV-positive people in the region from 8.3 million to 5.4 million. Nevertheless, the epidemic in Asia and the Pacific is still increasing, with approximately one million new infections in the last two years.
J V R Prasado Rao, director of the UNAIDS regional support team in Asia, explained that the new figures were drawn from a combination of household and antenatal surveillance figures, whereas previous estimates had relied solely on tests of pregnant women.
"UNAIDS advocates looking at trends, not figures," Prasado Rao told delegates on Monday, "and the overall trends remain the same." Summarising these, he noted that HIV infections were rising in a number of countries, including China, Vietnam, Bangladesh, Nepal, Pakistan and Indonesia, but had declined in Thailand, Cambodia and several parts of India.
Pockets of despair
Economic growth and improvements in infrastructure have created greater wealth and mobility, but have also promoted HIV infections. Yet in most countries HIV infections remain largely confined to vulnerable pockets of the population, such as injecting drugs users, sex workers and their clients, and men who have sex with men.
"The challenge for Asia is to keep prevalence low," said Peter Piot, UNAIDS chief, in a statement read by his deputy director, Deborah Landey. Describing complacency by the region's leaders as misplaced, Piot cited dramatic increases in prevalence among men who have sex with men in China, and among married women in Papua New Guinea.
Sri Lanka, which is hosting the conference with its 2,500 delegates from 70 countries, has an HIV prevalence below 0.1 percent, one of the lowest in the region, but President Mahinda Rajapaksa said this was no reason "to pat ourselves on our backs".
Despite the presence of factors often conducive to fuelling epidemics, such as a large migrant worker population and a protracted conflict, the president described Sri Lanka's strict policies on illegal drugs and alcohol consumption as key to its success in keeping infections low.
Emphasis on universal coverage
About 235,000 people in Asia are receiving antiretroviral treatment: around 20 percent of those who need it. Given that most countries in the region have adequate resources and manageable numbers of people requiring treatment, Prasado Rao of UNAIDS challenged delegates to push harder to achieve the goal of universal coverage.
Prevention efforts were also lagging and, according to Prasado Rao, overly skewed towards the general population when the need was for programmes focused on the most vulnerable groups.
He also warned that over-dependence on external funding was likely to create problems for the future sustainability of anti-AIDS efforts in most countries.
While urging governments to expand their health budgets, Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, asked them to view HIV/AIDS not just as a health problem, but as a development issue requiring the mobilisation of all sectors.
"This conference is being held at a historic moment in the life of the epidemic in this region," Peter Piot said in his statement, "because there is still hope ... but we must seize these opportunities of hope."
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