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Scoop
18 hours ago
- Health
- Scoop
Legalising Key Population Led Health Services In Thailand Is A Gamechanger
Article – CNS 'Key population led health services (KPLHS) is a bottom-up approach in providing healthcare. It speaks to the needs and willingness of the community which will increase the value of the effort as compared to some thing being given to them passively (top-down … Legalising key population or community-led health services has been a gamechanger in Thailand to protect most-at-risk people from getting infected with HIV, as well as to take evidence-based standard care to the people living with HIV in a person-centred manner so that they can lead normal healthy lives, said Dr Praphan Phanuphak, a legend who has played a defining role in shaping Thailand's HIV response since the first few AIDS cases got diagnosed in the land of smiles in 1985. Key populations are groups of people who are disproportionately affected by HIV (which may include men who have sex with men, transgender women and sex workers, among others). Dr Praphan Phanuphak is a distinguished Professor Emeritus of the Faculty of Medicine, Chulalongkorn University in Bangkok, Thailand. In February 1985, Professor Praphan diagnosed Thailand's first three cases of HIV/AIDS and has been involved in clinical care as well as in HIV prevention and treatment research since then. Together with late Professors Joep Lange and David Cooper, Prof Praphan co-founded HIV-NAT (the HIV Netherlands, Australia, Thailand Research Collaboration), Asia's first HIV clinical trials centre in Bangkok in 1996. Prof Praphan served as the Director of the Thai Red Cross AIDS Research Centre for 31 years (1989-2020) and is currently the Senior Research and Policy Advocacy Advisor of the Institute of HIV Research and Innovation (IHRI) in Bangkok as well as the Advisor of HIV-NAT. Dr Phanuphak was speaking with CNS (Citizen News Service) around 10th Asia Pacific AIDS and Co-Infections Conference (APACC 2025), 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases (POC 2025) and 13th International AIDS Society Conference on HIV Science (IAS 2025). When people lead, change happens Sterling examples of high impact key population or community-led health service deliver models come from Thailand. HIV key populations continue to play a major role in delivering Pre-Exposure Prophylaxis (PrEP for HIV prevention) to those who are at a heightened risk of HIV acquisition. Thailand has the largest PrEP rollout in Asia Pacific region, 80% of people using PrEP in Thailand receive it from a clinic led and staffed by members of the community that it serves. Key population led health services mean that community thinks, demands and does the work and manages the programmes, for the benefit of their own community members (and the country). This model has proven to help accelerate community-led responses towards ending AIDS with government's support, said Dr Praphan Phanuphak. 'Therefore, it is a collaborative effort with equal responsibility and equal importance [between key populations or communities and the government]. One has to respect the other. It is not that the NGOs are snatching the work or the territory of the government,' he said. 'Key population led health services (KPLHS) is a bottom-up approach in providing healthcare. It speaks to the needs and willingness of the community which will increase the value of the effort as compared to some thing being given to them passively (top-down approach). It fills the gaps that government cannot do and it is acceptable by the community they serve,' emphasised Dr Praphan Phanuphak. However, there could be some misunderstanding from the government side in some instances. For example, some may opine that 'government is getting blamed for not doing enough good work because of which NGOs are trying to compete with them'. Truth is that KPLHS or community-led models are only helping complement government's work. 'One has to show the evidence that KPLHS (key population led health services) can actually provide quality services to the populations that conventional healthcare providers cannot. Key population led health services will lead to ending AIDS and other sustainable health goals beyond HIV, such as mental health and NCDs, i.e., KPLHS is in accordance with government policy,' said Dr Phanuphak. He added: 'KPLHS or key population or community led health services is one arm of the holistic healthcare approach. They need to collaborate with the main stream public healthcare systems. Once the government accepts these facts, legal and financial supports will follow. However, key population led health services may be more expensive than conventional healthcare since the personnels and office facilities are not provided by the government. Therefore, they need enough financial support to ensure sustainability of the programme.' 95-95-95 HIV targets for 2025 Dr Praphan firmly believes that the 95-95-95 HIV goals can be achieved. We have science-based tools to deliver on these goals, he said. 95-95-95 goals refer to ensuring 95% of people living with HIV know their HIV positive status, 95% of them are receiving lifesaving antiretroviral therapy, and 95% of those on treatment are virally suppressed. According to the World Health Organization (WHO), there is ZERO RISK of any further HIV transmission from a person living with HIV whose viral load remains undetectable. That is why it is referred to as Undetectable Equals Untransmittable or #UequalsU. Dr Praphan Phanuphak stresses upon 'finding people with HIV early in all sub-groups of the population.' He calls for focussing on HIV key populations as well as general population too. 'General population is the group currently being left behind since we have rightly focussed on key populations now – but if we are to end AIDS by 2030, we need to reach out to everyone. Each individual – from general population or key population – should have at least one HIV test in their life – earlier the better (and repeat test as appropriate),' he said. 'Pre-Exposure Prophylaxis (PrEP) can prevent up to 99.9% HIV acquisition': Dr Praphan Phanuphak Pre-Exposure Prophylaxis (PrEP) is a medicine taken by those without HIV to reduce the risk of getting infected with the virus. 'PrEP can prevent up to 99.9% of HIV acquisition. One needs to scale up access to PrEP widely and rapidly. Once HIV cannot spread further and individual-at-risk cannot acquire new HIV infection with PrEP use, AIDS can be ended,' said Dr Praphan Phanuphak. Treatment is also prevention because when people with HIV are on treatment and their viral load is undetectable, then there is zero risk of any further HIV transmission. Thailand government rolls out PrEP under its universal health coverage since 2019 onwards. A majority of PrEP is being provided through key population led health services in Thailand. Eliminate legal and structural barriers Dr Praphan calls for eliminating all legal and structural barriers including stigma and discrimination that block access to existing HIV and other health and social support services – especially for HIV key populations. He not only calls for strong and sustained national political commitment which is essential to end AIDS by 2030 but also for accountability of political leaders if we fail to deliver on the promise to end AIDS by 2030. He acknowledges that USA President Trump's current policy decisions have severed research funding and development financing for a range of programmes including HIV in the Global South. 'This could pose to be a big obstacle for ending AIDS in many developing countries,' said Dr Phanuphak. Lot of progress towards ending AIDS but challenges remain Thailand has seen alarmingly high HIV rates in certain sub-national areas or key populations in late 1980s and early 1990s. But a strong community-led response to prevent HIV has turned the tide since then and brought down HIV rates significantly. Thailand today champions a HIV response which parallels only a few other nations in the Global South. And Thailand is on track to deliver on HIV goals for 2025 too. '100% condom use campaign to prevent HIV infection from commercial sex was a game changer. Establishment of HIV-NAT (the HIV Netherlands Australia Thailand Research Collaboration), the first HIV clinical trials centre in Asia to provide free up-to-date HIV treatment through clinical trials in 1996, was another major step forward,' said Dr Praphan Phanuphak. Helping children born to HIV positive parents are HIV free When world's first therapy was rolled out in the rich nations in 1994 to reduce the risk of vertical transmission of HIV (from mother to child), Thailand soon began its rollout two years later (1996 onwards). Zidovudine was the first available antiretroviral agent for reducing mother-to-child HIV transmission in 1994. 'Princess Soamsawali prevention of mother to child transmission of HIV (PMTCT) project was another gamechanger to provide up-to-date PMTCT drugs to all pregnant women in Thailand, free of charge, from 1996 to 2010,' said Dr Praphan Phanuphak. Thailand government took over and provided science-based triple antiretroviral therapy from 2010 to all HIV infected pregnant women so that no child is born of HIV. In 2016, Thailand became the first country in Asian region to eliminate mother to child transmission of HIV as well as syphilis. Another gamechanger which helped Thailand progress towards ending AIDS is generic manufacturing of lifesaving antiretroviral medicines from 2006 onwards. Thailand is a leading manufacturer of generic medicines in the region and also procures lifesaving medicines from other nations including India. Test and treat policy was rolled out in Thailand, a year before the WHO recommendation came in A year before the WHO recommendation came for 'Test and Treat' policy, Thailand had begun its rollout. WHO 'Test and Treat' policy meant that anyone diagnosed with HIV, regardless of their CD4 count or stage of infection, should be offered and immediately linked to lifesaving antiretroviral therapy. Strong scientific evidence showed that this approach maximises the benefits of early treatment for individual health and to prevent further transmission of the virus. What could have gone better in HIV response Dr Praphan Phanuphak reflects and shares that although 'Test and Treat' and PrEP was rolled out by Thailand but it has not been implemented to its full scale. To some extent, it lacks a sense of urgency, and frequent changes of policy makers also impacted the rollout. Flashback to 1980s: When first HIV cases were diagnosed in Thailand by Dr Praphan Phanuphak 'I was accidentally involved in HIV/AIDS arena. I am not an infectious disease doctor, but an allergist and clinical immunologist trained in USA. The first patient, an American gay man living in Thailand, was referred to me at King Chulalongkorn Hospital in October 1984 to investigate the cause of his recurrent muco-cutaneous infection. Immunologic investigations revealed that his T-helper cell numbers and T-cell functions were moderately low, but no diagnosis was made. In February 1985 the patient was admitted into the hospital with confirmed diagnosis of Pneumocystis carinii pneumonia (PCP) and his T-cell numbers and functions were further deteriorated. With the diagnosis of PCP and severe T-cell defect, AIDS was diagnosed at that time,' shared Dr Praphan Phanuphak. He added: 'During the same month, a Thai male sex worker was referred to Chulalongkorn Hospital because of multi-organ cryptococcal infection. His T-cell numbers and T-cell functions were also severely impaired. AIDS was diagnosed in this second patient since he had sexual contact with a foreign man who had sex with men. The girlfriend of this patient was asymptomatic but had generalised lymphadenopathy, Her T-cell numbers and functions were moderately impaired. This patient was counted as the third case. Sera collected from these 3 patients were tested for HIV in May 1985 when the anti-HIV test kit was available in Thailand. All were HIV-positive. These are the first 3 HIV/AIDS cases diagnosed in Thailand, all in February 1985. With the availability of anti-HIV test in Thailand, more and more patients were diagnosed. This accidentally drove me deeper and deeper into the HIV field, coupled with the fact that there were not very many infectious disease doctors in the early days who were willing to see HIV patients.' Dr Phanuphak's lifetime contribution and continuing guidance to shaping HIV responses in Thailand and worldwide is commendable. We hope community-led responses would steer the global AIDS response towards getting on track to end AIDS by 2030. Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights)
Scoop
4 days ago
- Health
- Scoop
To Be Or Not To Be? Daily Oral Versus Long-Acting Injectable Medicines For HIV Prevention
Scientific research has gifted us with a range of evidence-based options to protect ourselves from getting infected with HIV. In 2012, US FDA had first approved Pre-Exposure Prophylaxis (PrEP) daily oral medicines for HIV prevention. More recently, long-acting injectable options of PrEP are also approved. We at CNS listened to the experts on both of these PrEP options so that we can make an informed choice. A lively debate was organised at the recently concluded 10th Asia Pacific AIDS and Co-Infections Conference (APACC 2025) in Tokyo, Japan, on "Should Long-Acting Injectables (LAIs) Replace Oral Antiretrovirals for Biomedical HIV Prevention in the Asia-Pacific Region?" Also, 13th International AIDS Society Conference on HIV Science (IAS 2025) and 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases (POC25) will open soon. Arguments in favour of long-acting injectable PrEP dwelt upon the current dismally low use of oral PrEP in the Asia Pacific Region - as of end 2023, around 204,000 individuals were actively using PrEP - just 2% of the 8.2 million target set for 2025. Also a significant number of individuals discontinue PrEP within a relatively short period of time after initiation. For example, in Thailand, a programme serving over half of all PrEP users, saw 47% of clients discontinuing within 12 months, according to the Institute of HIV Research and Innovation (IHRI). "I don't fear the side effects. I fear the side eyes" Varied reasons were put forward by debater Jennifer Ho, a global health advocate from Thailand, included "Oral PrEP is not reaching those most at risk. Transgender women navigating stigma in clinics, sex workers who cannot safely carry pills; men who have sex with men and young men hiding their PrEP from family; persons who use drugs facing criminalisation - all of these find it difficult to take daily oral PrEP. Pill shaming keeps people from starting or leads them to quietly stop, because of 'I don't fear the side effects. I fear the side eyes.' On the other hand, long-acting injectables remove structural and behavioural barriers and can reach people outside formal systems. We need prevention tools that meet people's needs. Prevention works when it does not depend upon disclosure, disability or perfect routine. Oral PrEP stigmatises life because you have to take a pill daily. Long-acting injectables are discreet, there is no daily pill to remember, there is no need to hide. Long-acting injectables are a prevention strategy that is realistic, respectful and responsive." Dr Nagalingeswaran Kumarasamy, a well known infectious disease expert from India gave a doctor's perspective on the necessity of long-acting injectable PrEP. He serves as Chief and Director of Infectious Diseases Medical Centre at Voluntary Health Services Hospital in Chennai, India. He is also the Secretary General of AIDS Society of India (ASI) - a nationwide network of medical experts and researchers on HIV, co-infections and co-morbidities. Dr Kumarasamy said that daily PrEP pill is not a suitable or desirable prevention strategy for everyone. We need more options as well as expanded access or use by key populations (people who are at a heightened risk of HIV). Long-acting PrEP will likely be a very cost-effective improvement over standard PrEP but may require novel financing mechanisms that bring short-term fiscal planning efforts into closer alignment with longer-term societal objectives. Cost effectiveness is different from cost of sale. Long-acting injectables will be cost effective in the long run. It is too much to expect daily adherence from people who are not sick. Also studies have found that long-acting injectables like cabotagravir and lenacapavir to be superior to oral PrEP. It is not about 'either/or' but expanding options for HIV prevention While conceding that long-acting injectable PrEP is promising, Danvic Rosadiño, Co-Chair, WHO Guidelines Development Group on Long-acting Injectable Cabotegravir for HIV Prevention, firmly argued that replacing oral PrEP is premature, impractical and inequitable. Danvic heads programmes and innovations at LoveYourself in the Philippines. "It is not a question of 'either', 'or'. It is about expanding options, and not eliminating them. In a socially, economically and politically diverse region like the Asia Pacific, this will risk undermining progress. The three core reasons why oral PrEP should not be replaced is cost, convenience and confidence," he said. "Long-acting injectable PrEP is far more expensive than generic oral PrEP. How many governments of this region will be able to afford long-acting injectables? If we replace oral PrEP, we will be leaving the most vulnerable behind. We have been able to roll out PrEP in a very de-medicalised manner. We have built our systems which allow oral PrEP to be accessed in community clinics, in mobile clinics, in peer outreach facilities. It is easy, discreet and empowering, especially for those avoiding judgmental or stigmatising healthcare settings. However long-acting injectables might bring us to clinical dependence, and many of our clients do not feel welcome in clinical facilities. We set up communities for giving oral PrEP because the mainstream system was not built for us. It excluded and stigmatised the community. We have created alternate spaces where people could feel safe, respected and seen not just as patients but as people. If we shift HIV prevention back to clinical systems, we risk destroying those safe spaces. Long-acting injectables might require clients to go back to those places which they actively avoided. Granted that long-acting injectables are very promising, replacing oral PrEP with them would create barriers and not bridges. We must protect choice. Different people need different things-some will prefer pills, some will prefer injectables. Let us invest in building a system where these options co-exist and where everyone- no matter where they live - can access HIV prevention that works for them," said Danvic. Do not forget stigma, inequity and costs Dr Rayner Kay Jin Tan, an Assistant Professor at the Saw Swee Hock School of Public Health, National University of Singapore, supported Danvic. He opined that 'Stigma, inequity and costs are very important considerations when we think about PrEP and other HIV prevention products. Keeping these things in mind, we should not replace oral PrEP with long-acting injectables. Oral PrEP has been de-medicalised to a large extent and distribution is community driven, thus bringing access to communities. And the cost of long-acting injectables is still not known. No generic manufacturer has given any idea of what it would cost. And most of the HIV infections are in countries that will not be able to meet the high cost of long-acting injectables. Except for Australia, no other countries in the Asia-Pacific have approved any long-acting injectable PrEP. However, both sides agreed that not everyone needs the same prevention options, but everyone deserves what works best for them. Speed, scale, implementation, and equity must be at the core of translating exciting scientific tools into public health impact. Give real choices to people to choose from full range of HIV combination prevention options It is now for the readers to decide which premise do they support- long-acting injectables or daily oral PrEP -till science develops more exciting HIV prevention tools. And above all, expanding the range of prevention options to protect ourselves from HIV should always remain the mainstay - and trusting people to have real choices if all combination prevention options are offered to them. Oral PrEP or pre-exposure prophylaxis is an HIV medicine taken daily by HIV negative individuals that reduces their risk of acquiring HIV through sex by about 99% and from injection drug use by at least 74%. PrEP should be used with condoms when possible. There are newer approved PrEP options that also protect us against few STIs, like Doxy PrEP (which provides reasonable protection against getting infected with STIs like syphilis, chlamydia, and gonorrhoea). Know more about long-acting injectable PrEP Since 2022, one of the long-acting injectable PrEP has a medicine called cabotegravir which has shown high efficacy in protecting us from HIV. It involves injections administered intramuscularly, with the first two injections given four weeks apart, followed thereafter by an injection every 8 weeks. Studies have shown it to be safe and superior to daily oral PrEP (which uses medicines like tenofovir and emtricitabine) for HIV prevention among cisgender women, cisgender men who have sex with men, and transgender women who have sex with men. It offers a promising alternative to daily oral PrEP, particularly for individuals who may face challenges with adherence to daily medication. It was recommended by the WHO in 2022 as an additional HIV prevention option for people at substantial risk of HIV infection. However, its current high cost of US$ 22,000 per year per user jeopardises its potential for public health benefits. In July 2022, its manufacturer ViiV Healthcare announced a voluntary license with the Medicines Patent Pool, allowing 90 countries to buy generic versions of cabotegravir for HIV prevention. The cost of generic version is expected to be potentially around US$ 16-34 per person per year. However, generic versions will not be out before 2027. Long-acting Lenacapavir Long-acting lenacapavir PrEP given as a subcutaneous injection once every 6 months, has been found to be highly effective. In 2024, two landmark clinical studies- PURPOSE 1 and PURPOSE 2- showed it to be 100% efficacious in preventing HIV among cisgender women and 96% efficacious among men who have sex with men, transgender and gender non-binary individuals, and was found superior to oral PrEP. It is currently priced at US$ 42,250 per year per person in the US, but is expected to become much more affordable to around US$ 200-300 per year per person with the introduction of generic versions, that are expected to be available by 2027. Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights).
Scoop
5 days ago
- Health
- Scoop
Will We Rise To #endAIDS Challenge Or Stumble Withering Away The Gains In HIV Response?
Press Release – CNS The recent funding cuts by the US have further exacerbated the problems. UNAIDS projects that there would be an additional 6.6 million new HIV infections and 4.2 million deaths by 2029 just because of the shortfall created by US funding cuts. June 13, 2025 We have all the scientifically proven tools to end AIDS. It is about ensuring that these tools reach people who need them the most, through a sustainable HIV response, so said Dr Adeeba Kamarulzaman, the well known infectious diseases expert form Malaysia and a former President of International AIDS Society (IAS). She was speaking at the plenary of the 10th Asia Pacific AIDS and Co-infections Conference (APACC 2025) in Tokyo, Japan. The world is indeed at the crossroads, in terms of the global response to HIV today. The Asia Pacific region has 3/4 of the world's population and 6.7 million people living with HIV. The region accounts for almost a quarter of the annual new HIV infections globally (23%), making it the world's second-largest HIV epidemic after Eastern and Southern Africa. The recent funding cuts by the US have further exacerbated the problems. UNAIDS projects that there would be an additional 6.6 million new HIV infections and 4.2 million deaths by 2029 just because of the shortfall created by US funding cuts. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries is so unacceptable if we take into account the promise of SDGs by all governments worldwide. 'So, will the world rise to the challenge, to make the future response affordable, or will we stumble, throwing away the progress of the last two decades and creating a drain on future resources of countries?' wondered Eamonn Murphy, Regional Director, UNAIDS for the Asia Pacific and Eastern Europe and Central Asia. Speaking at APACC 2025, Murphy called for prioritising four other dimensions of sustainability- political leadership, enabling laws and policies, element of services and solutions and having proper systems in place, apart from financial stability. HIV prevention as cornerstone of sustainable HIV response UNAIDS leader Eamonn Murphy also stressed upon making prevention as the cornerstone of a sustainable HIV response. 'To end AIDS as a public health emergency we need a far stronger focus on prevention, and not just on keeping people living with HIV alive and well. New infections are like a leaking tap – 'every drop in the bucket' is another individual requiring a life on treatment. The only way to ensure a sustainable response is to stop this flow.' As per latest UNAIDS data, globally between 2010 and 2023, there was a 39% decline in new HIV infections. However, the rate of decline in Asia Pacific was three times slower than this by 13% during the same period. There were 300,000 new infections – one every two minutes -in 2023 in this region. Also, since 2010, the new HIV infections amongst gay men and other men who have sex with men across the region, have increased by 33%. Build more effective and efficient HIV programmes Eamonn laments that countries are investing too little in scaling up HIV prevention. 'While there is a high political commitment to fund treatment, there is limited will to invest in prevention.' 'Four out of every five new HIV infections occur among key populations. However, only one third of these communities have access to HIV prevention services. Key population led HIV prevention services are severely underfunded with less than 15% of HIV resources going into interventions for key populations,' he said. This is despite the proven evidence that key population led HIV service delivery model has been critical to bridge the gap between the public health services and those unreached. For example, 80% of PrEP (Pre-Exposure Prophylaxis for HIV prevention) is delivered by clinics run by key populations in Thailand. Thai PrEP rollout is the largest rollout in Asia Pacific region. Key populations or communities remain the largest provider and carer for those on PrEP even today in the land of smiles. Eamonn Murphy of UNAIDS added: 'PrEP related HIV prevention services largely remain donor dependent. PrEP, social contracting and other differentiated or innovative services mostly remain as pilot projects, and not continued at a scale to have impact on national or regional epidemics. For example, there is a 98% gap to the region's PrEP target of reaching 8.2 million people by 2025.' PrEP – Pre-Exposure Prophylaxis for HIV, refers to medicines used to reduce the risk of HIV acquisition for HIV-negative people. They were first approved by US FDA in 2012. Long walk to integrated health responses Even though financial sustainability is important there is need for improvements in the system integration, in legal and social environments, and in community engagement and leaderships, says Dr Adeeba. 'Addressing the legal and social environment, which the key populations find themselves in terms of coming forward for prevention, as well as treatment, is one area that requires much attention.' With legal barriers to HIV response existing in 39 countries of Asia Pacific, key populations are criminalised in many countries. These barriers include criminalising sex work or same-sex relations, or criminalising drug use, criminalising transmission of, or non-disclosure of HIV transmission, and restricting entry and stay of people living with HIV in the country. All these legal and social impediments have resulted in poor outcomes of HIV response in those countries. Dr Adeeba also advocates for community engagement and leadership by involving communities not only in the designing of programmes, but also community based monitoring through peer led interventions- like in Thailand, which has great examples of key population led clinics and anti retroviral treatment. Role of academia As researchers and scientists, we must continue to advocate and stand firm in terms of the importance of science. Otherwise how else are we going to get the breakthroughs, like the importance of lifesaving antiretroviral therapies for treatment as prevention. HIV treatment works as prevention because science has proven that there is zero risk of any further HIV transmission from those people with HIV who are receiving the treatment, remain virally suppressed and have undetectable equals untransmittable to be true in their lives. But the role of researchers does not end here. We then need to scale it up and the best way is through implementation research, says Dr Adeeba. PopART Dr Adeeba cited the example of one of the largest HIV implementation research studies- the HPTN 071 or PopART- a community-based, randomised study that was conducted during 2013-2018 across 21 high HIV burden, resource-limited urban settings in South Africa and Zambia, with a total estimated population of 1 million. The name PopART, stands for Population Effects of Antiretroviral Therapy to reduce HIV Transmission, because the study focused on evaluating the impact of a combination HIV prevention package, including universal test and treat, on community-level HIV incidence. The study aimed to determine how a community-wide approach to HIV prevention, including the use of antiretroviral therapy, could reduce the spread of the virus at a population level. This PopART intervention with lifesaving antiretroviral therapy reduced HIV incidence by 30%, achieved 90% testing coverage, and increased viral suppression at population level even in remote parts of Africa. It demonstrated feasibility of scaling community based universal test and treat and influenced WHO guidelines on test and treat. Dr Adeeba rightly insists that 'Another very important role of researchers and academicians is to not just advocate with political leaders but also with pharmaceutical companies in making all the new advances accessible to countries that need them most. For example, the price of Human Papilloma Virus (HPV) vaccine, which has been around for a long time, is still extremely high, and inaccessible to many parts of the world. So, this is another important role that we as scientists and researchers must play- advocate to ensure sustainability of the HIV response, particularly in this day and age where financial resources are limited'. Women with HIV are up to 6 times higher risk of HPV related cervical cancer. What next? With a decline in international donor support, it becomes all the more necessary for countries to transition to more sustainable domestic driven HIV financing. UNAIDS leader Eamonn cites some good practice examples from the Asia Pacific region to see what sustainable responses could look like. 'Thailand has shown the model of integrating HIV services, introducing universal health coverage, and scaling up social contracting to reach the community organisations. and we need to pick up on that to share with other countries. Thailand already covers 90% funding of their responses and is developing a sustainability roadmap for the remainder. India is another example of progressive public policy to uphold the human rights of people in the HIV key populations, and they fund over 95% of their funding. In Malaysia, we find an example of diversified domestic resource mobilisation that targets the private sector. We can learn from these and other examples that make the right mix in different countries. We know what to do, the time of cherry picking in sustainability strategies is over. We must act now to enforce all relevant best practices and to keep the hope of ending AIDS alive.' Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here
Scoop
5 days ago
- Health
- Scoop
Will We Rise To #endAIDS Challenge Or Stumble Withering Away The Gains In HIV Response?
June 13, 2025 We have all the scientifically proven tools to end AIDS. It is about ensuring that these tools reach people who need them the most, through a sustainable HIV response, so said Dr Adeeba Kamarulzaman, the well known infectious diseases expert form Malaysia and a former President of International AIDS Society (IAS). She was speaking at the plenary of the 10th Asia Pacific AIDS and Co-infections Conference (APACC 2025) in Tokyo, Japan. The world is indeed at the crossroads, in terms of the global response to HIV today. The Asia Pacific region has 3/4 of the world's population and 6.7 million people living with HIV. The region accounts for almost a quarter of the annual new HIV infections globally (23%), making it the world's second-largest HIV epidemic after Eastern and Southern Africa. The recent funding cuts by the US have further exacerbated the problems. UNAIDS projects that there would be an additional 6.6 million new HIV infections and 4.2 million deaths by 2029 just because of the shortfall created by US funding cuts. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries is so unacceptable if we take into account the promise of SDGs by all governments worldwide. 'So, will the world rise to the challenge, to make the future response affordable, or will we stumble, throwing away the progress of the last two decades and creating a drain on future resources of countries?' wondered Eamonn Murphy, Regional Director, UNAIDS for the Asia Pacific and Eastern Europe and Central Asia. Speaking at APACC 2025, Murphy called for prioritising four other dimensions of sustainability- political leadership, enabling laws and policies, element of services and solutions and having proper systems in place, apart from financial stability. HIV prevention as cornerstone of sustainable HIV response UNAIDS leader Eamonn Murphy also stressed upon making prevention as the cornerstone of a sustainable HIV response. "To end AIDS as a public health emergency we need a far stronger focus on prevention, and not just on keeping people living with HIV alive and well. New infections are like a leaking tap - "every drop in the bucket" is another individual requiring a life on treatment. The only way to ensure a sustainable response is to stop this flow." As per latest UNAIDS data, globally between 2010 and 2023, there was a 39% decline in new HIV infections. However, the rate of decline in Asia Pacific was three times slower than this by 13% during the same period. There were 300,000 new infections - one every two minutes -in 2023 in this region. Also, since 2010, the new HIV infections amongst gay men and other men who have sex with men across the region, have increased by 33%. Build more effective and efficient HIV programmes Eamonn laments that countries are investing too little in scaling up HIV prevention. 'While there is a high political commitment to fund treatment, there is limited will to invest in prevention." "Four out of every five new HIV infections occur among key populations. However, only one third of these communities have access to HIV prevention services. Key population led HIV prevention services are severely underfunded with less than 15% of HIV resources going into interventions for key populations," he said. This is despite the proven evidence that key population led HIV service delivery model has been critical to bridge the gap between the public health services and those unreached. For example, 80% of PrEP (Pre-Exposure Prophylaxis for HIV prevention) is delivered by clinics run by key populations in Thailand. Thai PrEP rollout is the largest rollout in Asia Pacific region. Key populations or communities remain the largest provider and carer for those on PrEP even today in the land of smiles. Eamonn Murphy of UNAIDS added: "PrEP related HIV prevention services largely remain donor dependent. PrEP, social contracting and other differentiated or innovative services mostly remain as pilot projects, and not continued at a scale to have impact on national or regional epidemics. For example, there is a 98% gap to the region's PrEP target of reaching 8.2 million people by 2025." PrEP - Pre-Exposure Prophylaxis for HIV, refers to medicines used to reduce the risk of HIV acquisition for HIV-negative people. They were first approved by US FDA in 2012. Long walk to integrated health responses Even though financial sustainability is important there is need for improvements in the system integration, in legal and social environments, and in community engagement and leaderships, says Dr Adeeba. "Addressing the legal and social environment, which the key populations find themselves in terms of coming forward for prevention, as well as treatment, is one area that requires much attention." With legal barriers to HIV response existing in 39 countries of Asia Pacific, key populations are criminalised in many countries. These barriers include criminalising sex work or same-sex relations, or criminalising drug use, criminalising transmission of, or non-disclosure of HIV transmission, and restricting entry and stay of people living with HIV in the country. All these legal and social impediments have resulted in poor outcomes of HIV response in those countries. Dr Adeeba also advocates for community engagement and leadership by involving communities not only in the designing of programmes, but also community based monitoring through peer led interventions- like in Thailand, which has great examples of key population led clinics and anti retroviral treatment. Role of academia As researchers and scientists, we must continue to advocate and stand firm in terms of the importance of science. Otherwise how else are we going to get the breakthroughs, like the importance of lifesaving antiretroviral therapies for treatment as prevention. HIV treatment works as prevention because science has proven that there is zero risk of any further HIV transmission from those people with HIV who are receiving the treatment, remain virally suppressed and have undetectable equals untransmittable to be true in their lives. But the role of researchers does not end here. We then need to scale it up and the best way is through implementation research, says Dr Adeeba. PopART Dr Adeeba cited the example of one of the largest HIV implementation research studies- the HPTN 071 or PopART- a community-based, randomised study that was conducted during 2013-2018 across 21 high HIV burden, resource-limited urban settings in South Africa and Zambia, with a total estimated population of 1 million. The name PopART, stands for Population Effects of Antiretroviral Therapy to reduce HIV Transmission, because the study focused on evaluating the impact of a combination HIV prevention package, including universal test and treat, on community-level HIV incidence. The study aimed to determine how a community-wide approach to HIV prevention, including the use of antiretroviral therapy, could reduce the spread of the virus at a population level. This PopART intervention with lifesaving antiretroviral therapy reduced HIV incidence by 30%, achieved 90% testing coverage, and increased viral suppression at population level even in remote parts of Africa. It demonstrated feasibility of scaling community based universal test and treat and influenced WHO guidelines on test and treat. Dr Adeeba rightly insists that "Another very important role of researchers and academicians is to not just advocate with political leaders but also with pharmaceutical companies in making all the new advances accessible to countries that need them most. For example, the price of Human Papilloma Virus (HPV) vaccine, which has been around for a long time, is still extremely high, and inaccessible to many parts of the world. So, this is another important role that we as scientists and researchers must play- advocate to ensure sustainability of the HIV response, particularly in this day and age where financial resources are limited'. Women with HIV are up to 6 times higher risk of HPV related cervical cancer. What next? With a decline in international donor support, it becomes all the more necessary for countries to transition to more sustainable domestic driven HIV financing. UNAIDS leader Eamonn cites some good practice examples from the Asia Pacific region to see what sustainable responses could look like. 'Thailand has shown the model of integrating HIV services, introducing universal health coverage, and scaling up social contracting to reach the community organisations. and we need to pick up on that to share with other countries. Thailand already covers 90% funding of their responses and is developing a sustainability roadmap for the remainder. India is another example of progressive public policy to uphold the human rights of people in the HIV key populations, and they fund over 95% of their funding. In Malaysia, we find an example of diversified domestic resource mobilisation that targets the private sector. We can learn from these and other examples that make the right mix in different countries. We know what to do, the time of cherry picking in sustainability strategies is over. We must act now to enforce all relevant best practices and to keep the hope of ending AIDS alive." Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here
