JAKARTA, 1 December 2014 – After almost three decades since HIV and AIDS first appeared in this region, varied pattern of disease transmission is seen across different countries.  Some countries are showing an increasing trend; remains stable in others, while a few countries have been successful in reducing the incidence of HIV. The World Health Organization (WHO) estimated that globally, by the end of 2013, 35 million people are living with HIV with 2.1 million people becoming infected with HIV in 2013 alone. WHO also estimates that globally by 2030, HIV will be the eighth leading cause of all deaths and the third leading cause of death due to communicable, maternal, perinatal and nutritionally related diseases and conditions.  It is clear that HIV will continue to remain a concern in the coming years. For this reason, the financing and provision of HIV and AIDS treatment and services should remain a major policy and programmatic issue in the development agenda. Whilst severe natural disasters, economic volatility, high levels of debt, and slow growth pose constraints to many ASEAN countries to invest maximally in human development, the gap between people’s expectations and government budgetary allocations need to be closed. Domestic spending on HIV and AIDS among ASEAN countries is increasing.

The UNAIDS 2013 Global Report stated that, where the HIV epidemic is mainly highlighted in Asia, the key populationparticularly affected by HIV are: sex workers (SWs) and their clients; men who have sex with men (MSM); and people who use drugs (PWUD). For these groups, they are estimated to be 13, 19 and 22 times, respectively, more likely to be living with HIV than the general population. These most-affected groups are also more likely to have difficulties accessing the health and support services. By 2013, approximately 1.7 million people are living with HIV and AIDS (PLHA) in Southeast Asia, close to a  third of these are women. Of the total PLHA, 46 per cent are adults eligible for antiretrovirals and only 57 per cent of them are receiving antiretrovirals (ARV).

This year,  the ASEAN theme for World AIDS Day is: “Getting To Zero through Efficient & Sustainable HIV Response”. As the world economic landscape changes, so does the HIV funding landscape. Donor funding has stagnated, and the limited resources available require more emphasis on value for money: funds spent for the greatest impact and in the most efficient way. The challenge posed by HIV/AIDS is further complicated by changing social patterns, weak health systems, high rates of tuberculosis, and increasing number of people engaged in high risk behaviors. Within this context, responses must take into account five key challenges which are :

  1. political commitment
  2. multisectoral support;
  3. public health surveillance and monitoring
  4. evaluation; prevention; care, support, and treatment;
  5. health services delivery.

The sheer scale of the HIV/AIDS epidemic will require ongoing, dynamic cooperation among a broad coalition of stakeholders.

Discussions during the 5th ASEAN Plus Three Health Ministers Meeting in Phuket in July 2012 signalled  a strong interest in Universal Health Coverage (UHC), when it requested the Senior Officials Meeting on Health Development to deliberate on the formation of an ASEAN Plus Three UHC Network (hereafter known as the Network). This is to allow “sharing and collectively building the national and regional capacity of its member countries to assess and manage equitable and efficient health systems to support UHC”.UHC’s tenets of universality and affordability make it as an important contributor to sustainable development. UHC should however not be measured by the robustness of the health systems and their financial sustainability alone, but also by a country’s ability to ensure truly inclusive and universal access, i.e. to meet the needs of marginalised populations to improved health conditions. HIV and AIDS is an example of a health condition that affects certain population groups disproportionately, in terms of its health impact, adverse socio-economic effects, and overall progress in development as well.  Equity is central to the concept of UHC, making it a crucial consideration if we are to make any further progress in stopping new HIV infections, achieving High Level Meeting targets and bringing an end to AIDS. 

Working closely with partners, ASEAN Member States must be able to implement evidence-based and cost-effective interventions that are allocated through fair and transparent process. There is a need for new financing mechanisms beyond the traditional concept of development assistance to move towards universal access to health care. Increased sense of ownership, as well as strong and effective involvement from goverments, civil society, communities, person living with HIV and health professionals are critical pre-conditions for an effective and efficient regional and global response.

Sustained financial, political and scientific commitment is key to ensuring that all relevant stakeholders play their part in coordinated efforts to expand HIV prevention and treatment interventions; integrate HIV/AIDS into broader health services; increase funding and improve human rights across vulnerable population, including reducing stigma and discrimination. In the fight against HIV and AIDS, historic gains have been achieved but key challenges remain. Only by responding to these challenges in an efficient and sustainable way can we “Get to Zero”.

ASEAN Task Force On AIDS (ATFOA) 2014