The year of 2018 marks the 30th anniversary of the commemoration of World AIDS Day. Each year, ASEAN Member State Governments, civil society and development partners unite to increase visibility, raise awareness and provide basic information on HIV and AIDS. For one day each year, ASEAN Member States and the world are united around a common World AIDS Day theme. This year the global theme is ‘know your status’. ‘Knowing your status’ begins with HIV testing, which is now well recognised as the entry point to accessing comprehensive HIV prevention, and treatment and care programmes. As ASEAN prepares to celebrate this year’s WAD, it is important that we take stock and reflect on our regions collective progress.
Since the establishment of the ASEAN Task Force on AIDS in 1992, AMS have worked to implement regional activities on health and HIV and AIDS, guided by multi-year ASEAN Work Programmes on AIDS (AWP). AWPs typically operationalize the various HIV and AIDS declarations of commitments (2016, 2011, 2007 and 2001). The AWPs are coordinated under ASEAN Health Ministers Meeting (AHMM) and ASEAN Senior Officials Meeting on Health Development (SOMHD). From 2011 through to 2015, AMS implemented the fourth AWP, which operationalised the ASEAN Declaration of Commitment: Getting to Zero New HIV Infections, Zero Discrimination, Zero AIDS-Related Deaths. The 4AWP, met the HIV targets contained within ASEAN Strategic Framework on Health and Development (2010-2015), which included a flagship initiative of ASEAN, to achieve zero new HIV infections, zero discrimination and zero AIDS-related deaths in Southeast Asia, ‘ASEAN Cities Getting to Zero’ (G2Z). Under Indonesia’s leadership, G2Z is now entering its third phase, with a total of 74 cities joining the regional initiative as of September 2018. The initiative began with 13 cities at the launch of the initiative in 2011.
The G2Z initiative was launched in 2011 with 13 cities and show cases ASEAN at its very best, through the practices of south-to-South cooperation, lessons sharing, documentation of good practices and cooperation with civil society, which along with individual Member State efforts has results in dramatic reduction in the HIV prevalence in many states. As of 2017, approximately 1.8 million people were living with HIV in the ASEAN region, which reported a 19% decline in HIV infections between 2010 and 2017. Almost a third of all HIV infection in ASEAN, are in women, with most ASEAN countries reporting largely concentrated epidemics among key populations, especially, in large cities and urban areas. The epidemic remains concentrated in men who have sex with men, transgender populations, people who inject drugs and female sex workers. ASEAN has shown great success with the steady decline in HIV prevalence among female sex workers, one of the great success stories of the HIV response in the ASEAN region. Such successes, would not have been possible without the political commitment of AMS coupled with the application of best practices such as same day diagnosis and treatment for people living with HIV- to reduce loss to follow-up, creation of ‘one-stop’ shop approaches that are targeted towards the needs of men who have sex with men and transgender people, the scale up of harm reduction strategies for people who inject drugs and geographically targeted HIV prevention and treatment interventions.
Despite the successes achieved by ASEAN Member States, challenges still remain. Some of these include stigma and discrimination, difficulties in scaling up programmes, lost-to-follow up for confirmatory testing and enrolment in ART, inadequate coordination and the need to enhance human resource challenges such as, capacity to implement newly proposed innovative strategies and shortages of health work-force available for the scale up efforts. In recognition of our challenges and building on the significant regional progress towards the 2011 Commitments, the Heads of State and Government adopted the ASEAN Declaration of Commitment on HIV and AIDS: Fast-Tracking and Sustaining HIV and AIDS Responses to End AIDS in ASEAN by 2030’, which is very much in line with the health aspirations outlined in the ‘ASEAN Socio‐Cultural Community Blueprint 2025’.
The 2016 Commitments, obligate Member States to focus, target, scale up and strengthen HIV and AIDS responses captured under ‘The ASEAN Strategic Framework on Health Development (2016-2020)’, which encompass 7 goals and 20 health priorities covered within 4 health clusters. HIV specific activities are addressed within the ‘ASEAN Health Cluster 2 Work Programme, (2016-2020), responding to all hazards and emerging threats’. Health Cluster 2 focuses on prevention and control of communicable diseases, emerging infectious diseases, and neglected tropical diseases, including HIV and AIDS. Regional HIV commitments aims to end AIDS in ASEAN with an outcome indicator of the ‘percentage of key populations who have received an HIV test in the past 12 months and know their status: the target is 90% by 2020’. The fifth ASEAN Work Programme on HIV and AIDS 2016-2020 (5AWP) was endorsed at the 13th Ministers of Health Meeting in Brunei, 6 September 2017, as part of the Work Programme of ASEAN Health Cluster 2 on Responding to All Hazards and Emerging Threats. AMS ‘HIV and AIDS Contact Points’ were identified to support the ASEAN Health Cluster 2 Country Coordinators in implementing HIV and AIDS project activities in the region. The ASEAN Task Force on AIDS has been dissolved and its functions assumed by the ASEAN Health Cluster 2 as part of the new Governance and Implementation Mechanism of the ASEAN Health Sector Cooperation.
In line with the 5AWP, a side-meeting of ASEAN HIV and AIDS Contact Points was held in September 2018, in Bagan, Myanmar alongside a broader ASEAN Health Cluster 2 meeting. ASEAN Member States representatives provided important HIV updates and highlighted common challenges facing the region. The meeting noted that there was a change in drug-use patterns in many AMS, with the advent of amphetamine-type stimulants (ATS), new psychoactive substances and other non-opioid-based drugs including pharmaceuticals. The meeting also noted that specific attention should be paid to these drug-use patterns, as there could be a link between the use of ATS, risk behavior, and HIV and STI infections. The meeting concluded that ASEAN Health Sector, through Myanmar, as current Chair of ASEAN Health Cluster 2, should develop a sub-theme for World AIDS Day 2018, which would elevate the issue of preventing the increased amphetamine-type stimulants use among youth.
The sub-theme for this World AIDS Day in ASEAN is “Young People’s Health Matters’. It is our commitment that all young people in every ASEAN country and community should have access to information and knowledge about HIV and AIDS, and also about drugs, in order to stay healthy and safe.
This World AIDS Day we highlight that according to the ASEAN Narcotics Cooperation Center (2015), the overall ASEAN drug treatment admission rate was 40.1 per 100,000 population, of which over 70% were metamphetamine users. ATS is ranked among the top 3 drugs used in the region, and in 2012, Cambodia, Lao PDR, Myanmar, Thailand and Viet Nam reported increasing methamphetamine use. These concerns were raised at the 5th Ministerial Meeting on Drug Matters held in 2016 in Singapore, where Ministers expressed concern about the widespread misuse of illicit drugs, including ATS, and encouraged Member States to step up preventive education activities and campaigns, spreading the message among youth and communities to be resilient against drugs.
AMS would like to highlight that in 2017, ASEAN developed a Youth Development Index (YDI), noting that young people are current and future leaders and the catalyst for economic, social and cultural development. ASEAN Member States agreed on the population age range of 15-35 years – equating to an ASEAN youth population of 213 million people in 2015 — and identified key domains of youth development, which include health and well-being, and in particular the importance of preventing years of life lost (YLL) due to drug abuse.
The theme of Young People’s Health Matters — in order to prevent HIV and AIDS and drug use, including ATS — is therefore relevant not only for the ASEAN response to HIV and AIDS, but also to the ASEAN response to drug use, and to development of ASEAN youth.
On the occasion of World AIDS Day 1st December, relevant stakeholders are called to commit to empower and support the young peoples of ASEAN to have access to information and knowledge about HIV and AIDS and ill-effects and negative consequences of illicit drug use, and to keep the young people of ASEAN healthy and safe. Multi-stakeholder and multi-sectoral coordination and collaboration should be enhanced in implementing the ASEAN Declaration of Commitment on HIV and AIDS: Fast-Tracking and Sustaining HIV and AIDS Responses to End AIDS in ASEAN by 2030’ particularly those involved in the sectors of health, youth, education, and drug matters.
There is a need to emphasise the importance of HIV testing as the entry point to prevention, and treatment and care programmes; and the commitment to the global theme of this year’s World AIDS Day to ‘know your status’. We encourage all young peoples in the region to take up the challenge, get tested for HIV and ‘know your status’ as a personal commitment to your own right to health. We challenge ourselves to realise the positive impact that ASEAN’s sub-theme of Young People’s Health Matters will have on our region as a whole. After all, the youth are our future.
ASEAN Members States and Government remain committed to our post-2015 principles of accountability, leadership, operational and resource efficiency, capacity building and positioning ASEAN in global health, which sets for us a strong collective foundation to ‘End AIDS in ASEAN by 2030’.
We wish everyone a happy, fruitful and safe World AIDS Day 2018 and we leave you with our hopeful themes of committing to Young People’s Health Matters and challenge each one of us to ‘know your status’.
- Link to ‘ASEAN Post 2015 Health Development Agenda (APHDA)’
- Link to Work Programme of HC2 with Annex on HIV (Work Programme 5 for HIV and AIDS; the ‘ASEAN Work Plan 5 (AWP 5) on AIDS 2016-2020’
- Link to ASEAN E-Health Bulletin — special issue for the Side Meeting for the UN HLM on Ending AIDS in July 2016 with documentation of the ASEAN Cities Getting to Zeros Project’
- Link to Publication on ASEAN Good Practices and New Initiatives in HIV and AIDS (ie. supported by HIV Alliance)
- Link to UNAIDS website regarding the WAD Theme
- Link to HIV Situation in ASEAN 2015, the Second Regional Report on HIV and AIDS 2011-2015
- Link to ‘ASEAN Declaration of Commitment on HIV and AIDS: Fast-Tracking and Sustaining HIV and AIDS Responses to End the AIDS Epidemic by 2030’
- Link to ASEAN WAD Message 2017
UNAIDS, Updated ASEAN slides, 17 AUGUST 2017, www.aidsdatahub.org
The ASEAN Secretariat, 2016, HIV IN THE ASEAN REGION: Second Regional Report on HIV & AIDS 2011 – 2015, ASEC, Jakarta.
UNAIDS, 2018 HIV Estimates, www.aidsdatahub.org