By Susann Roth
The Asia Pacific region has scored many successes in its march to reverse the HIV and AIDS epidemic in a number of countries, starting with Thailand, Cambodia, and India. But the region still faces serious challenges with other countries like Pakistan, Philippines, and Indonesia reporting rising epidemic levels. Initial successes in scaling up treatment and prevention programs have left some political leaders and policymakers complacent.
New HIV infections in the region decreased by about 30% between 2001 and 2009, but that decline has stalled in recent years. There are still 4.1 million–5.5 million people living with HIV in Asia Pacific.
Over 98% of the people with HIV in the region live in only 12 countries—listed in decreasing order of epidemic size: India, the People’s Republic of China (PRC), Indonesia, Thailand, Viet Nam, Myanmar, Pakistan, Malaysia, Cambodia, Nepal, Papua New Guinea, and the Philippines. Some of these (Indonesia, Philippines and Pakistan) have experienced major increases in new infections in key population groups at risk—namely, men having sex with men (MSM), injecting drug users and sex workers and their partners.
But the most serious challenge to AIDS efforts is ensuring sustainable financing for national programs. With many countries in the region graduating to middle-income level, external funding is fast drying up.
In 2013, about 58% of the region’s AIDS response was funded domestically, accounting for $1.3 billion of the $2.2 billion allocated in that year. This represented a 30% increase in domestic funding in the region between 2010 and 2013 mainly in middle-income countries.
Malaysia, Thailand and PRC are leading in funding the HIV response from domestic resources, while Mongolia and the Philippines are at the tail end.
Most countries fund mainly HIV treatment but not prevention, which is often funded by donors through civil society organizations (mostly because key population groups at risk are in many counties still criminalized under law and governments don’t fund programs to reach them). This can cause a huge risk to the gains made.
A recent study by UNAIDS, Investing for results—How Asia Pacific Countries Can Invest in Ending AIDS
—says that if investments in HIV prevention are not sustained or increased, the region will experience a serious resurgent epidemic. Annual new HIV infections are expected to increase about 391,000 in 2020 and then keep growing, along with spiraling costs for providing HIV treatment.
It is unclear whether countries are prepared to step in to fill the gap with domestic resources. Without assured and increased funding over the next decade, there is a real danger of past gains getting wiped out, leading to a resurgence of the epidemic. People living with HIV who are leading healthy and productive lives could once again struggle with poor health.
In order to avoid the worst, ADB suggests developing differentiated approaches for its developing member countries:
• Lower Income Countries: need continued donor support to fund their HIV and AIDS response (treatment and prevention).
• Lower Middle Income Countries: need to take responsibility to fund HIV treatment form domestic resources, support policy change to stop criminalizing key population groups at risk, and boost funding of prevention measures. But they will need transition funding from donors to fund prevention. This could be in the form of grants or loans.
• Upper Middle Income Countries: need to fully transition to funding HIV treatment and prevention from domestic resources. They might need TA support to identify funding sources.
Development organizations such as ADB should continue to advocate for sustaining and increasing financing the response to HIV and AIDS and to fund regional activities such as the HIV data hub for regional HIV surveillance, risk prevention of migrant workers and tackling regulations to allow quick market entry of new affordable HIV medicine.
Asia and Pacific is at a cross road in the history of HIV. The region has the opportunity to end AIDS by 2030 or risk losing the gains made in recent years and see an increase in new HIV infections.