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Scoop
2 days ago
- General
- Scoop
Will We-the-Quails Unite To Lift The Net Or Wither Away The Gains Made In AIDS Response?
Let us refresh the old gold Buddhist tale of The Quail and the Net: 'Long ago a flock of quails lived in a forest. Everyday a hunter would cast a net and trap many of them. But eventually, a wise quail told the rest that if they worked together, they could lift the net collectively at the same moment and escape as one. Next time the hunter tried to capture them, quails moved in unison, raising the net and flying off together. Unity is strength,' said Eamonn Murphy, Director of UNAIDS for Asia Pacific and Central Asia and Eastern Europe regions around the world's largest conference on HIV science (13th International AIDS Society Conference on HIV Science). He continued narrating this tale of deep wisdom: 'For several days thereafter, quails were able to drop the net far from the catcher's reach. But soon some of them became annoyed – small quarrels started – one quail felt 'I am doing most of the work' the other felt 'I want to go in the opposite direction' - eventually they stopped working together. Next time the net fell, instead of flying, they argued. Then the hunter caught them all. This tale teaches us that the discord and breaking focus can lead to ruin.' AIDS response faces the ruin but would we – the quails – fight or unite? 'I would be blunt. Today, it is the AIDS response that faces ruin. We are all the quails – from advocates to academics, countries to communities, doctors to development partners - we worked together to lift the net of the disease that once threatened to devastate us. We even came up with a plan to cast it off for good. Some of us have grown tired, others are doing part of the work but not all they should – many are not pulling their weight – and now we risk being tracked by a disease we should be condemning to history,' said Eamonn Murphy of UNAIDS. 'Recent global funding cuts could send the world back to levels of HIV infections and AIDS-related deaths not seen since the early 2000s,' said Murphy while showing a 5-years projection of how new HIV infections and AIDS-related deaths globally can dangerously rise if the lost funding both this year and in recent years does not return. 'Many countries have reduced their investments and domestic funding is often inadequate to fully fund the AIDS response – which has been relying on external support.' Agrees Dr Jakkrapatara Boonruang, research physician at the Institute of HIV Research and Innovation (IHRI) and a Mark Wainberg Fellowship Awardee: 'There is more work which needs to be done for ending AIDS by 2030. The latest UNAIDS global AIDS update 2025 launched before IAS 2025 shows that along with US funding cuts, other international financing for HIV is also waning. The impact is more severe where HIV programmes were majorly funded by international donors.' 'Even though in Thailand where most of the HIV-related services have been included in universal health coverage of the government, there are some aspects like reimbursements that have not been covered. Salaries of service providers and utility courses are yet to be covered by the universal health coverage for instance,' added Dr Boonruang. 'While services are fully covered by tax payers money, service providers are losing jobs or facing salary reductions. For example, we at IHRI have lost 20% of our colleagues following the suspension of US funding.' Rising new infections, low treatment coverage and funding cuts in Asia Pacific 'Nine countries in Asia and the Pacific region have rising new HIV infection rates. 9 countries in the region have too low coverage of lifesaving antiretroviral treatments. Moreover, the region has been hit with funding crisis – and – overall HIV prevention crisis too,' said Cedriann Martin, UNAIDS Communications Advisor. Between 2010 to 2024, there were 9 countries in Asia Pacific which reported an increase in newly diagnosed people with HIV. Fiji has the world's fastest growing epidemic, new HIV infections increased by over 3091% in Fiji. Along with Fiji, other countries in Asia Pacific where there was an upswing in the number of people newly diagnosed with HIV between 2010-2024 are: * 942% rise in Philippines * 187% rise in Afghanistan * 84% rise in Papua New Guinea * 67% rise in Bhutan * 48% rise in Sri Lanka * 42% rise in Timor-Leste * 33% rise in Bangladesh * 16% rise in Lao PDR Between 2010-2024, there were 9 countries in Asia Pacific which are also treating less than half of the people living with HIV, such as Afghanistan (11%), Pakistan (16%), Fiji (24%), Philippines (40%), Bangladesh (41%), Indonesia (41%), Mongolia (41%), PNG (46%), and Maldives (48%). Cambodia treats most people with HIV (92%) in the region. Prevention crisis in Asia Pacific Compared to the decline in the number of people newly diagnosed with HIV between 2010-2024 worldwide (40%), the decline in Asia Pacific is far behind (17%). 'Asia Pacific has a prevention crisis. The reduction of new infections has flatlined. Every 2 minutes a new person contracts HIV in our region today. Every hour we have 35 new HIV infections including 9 among young people. Every single day, we have over 300 men who have sex with men, over 80 persons who inject drugs, over 50 sex workers, and over 15 transgender persons, newly infected with HIV in the region,' said Eamonn. 'It is like we are trying to empty the bowl but have not turned off the tap.' What is worrying for CNS (Citizen News Service) is that as per the Global AIDS Update 2024 (last year), these numbers were also almost the same. So, there is hardly any significant change when it comes to prevention, testing and treatment targets in the region. Rather on the contrary, challenges have gone up manifold this year. 79% of new HIV infections were among key populations and their partners: 43% among men who have sex with men, 7% among sex workers, 12% among persons who inject drugs, 2% among transgender peoples, among others. 'Criminalisation and marginalisation deepen their vulnerability making it harder for HIV key populations to access services – and less likely to engage with the services available,' remarked Eamonn Murphy of UNAIDS. Weak HIV response in Asia Pacific region in recent years: Why? Not just HIV prevention is flatlined in the region but also HIV testing and treatment have only increased marginally since 2023. 'This region is not speeding towards the finish line. At best, it is (too) slowly inching forwards,' said Eamonn Murphy of UNAIDS. '1 in every 5 people living with HIV still do not know their HIV status; 1 in 4 people are not on lifesaving antiretroviral treatment, 1 in 3 have not achieved a suppressed viral load,' said Murphy. Scientific research and WHO guidelines show that if a person living with HIV is on lifesaving antiretroviral therapy and viral load remains undetectable, then not only the person lives normal healthy lifespans but also there is zero risk of any further HIV transmission. So, treatment works as prevention too. Undetectable equals Untransmittbale or #UequalsU. That is why 2025 HIV targets call upon countries to ensure that at least 95% of people know their status, 95% are on treatment and 95% are virally suppressed. 'In Asia Pacific by end of 2024, 79% know their status, 69% of them are on treatment, and 66% of them have suppressed viral load,' said Eamonn. 'By the time we reach the end of 2025, we may have to diagnose an additional 1.1 million people with HIV and treat 1.5 million people with HIV in this region. So, realistically we are going to miss 2025 targets in Asia Pacific.' The latest Global AIDS Update 2025 of UNAIDS shows that when it comes to HIV targets for 2025, progress among children with HIV in the region is the worst. 70% of children (or their caregivers) know their status, 67% are on treatment, and 57% are virally suppressed. Among women with HIV in Asia Pacific, 83% know their status, 72% are on treatment and 71% are virally suppressed. Among men with HIV in the region, 77% know their status, 67% are on treatment and 65% are virally suppressed. 'By the time we should be realising the dream of AIDS-free generations we are dropping the ball for our future generations. Care for children begins with support for their families. Prevention of mother to child transmission of HIV services, are a critical starting point of early infant diagnosis and ongoing care. For many in our region they do not have access to early HIV screening and treatment and psychosocial support they need,' said Eamonn Murphy. He added: 'We should respond to gender dynamics for both men and women in this region. We have to work with partners to increase health seeking behaviour among men and to lower intimate partner violence for relevant countries and communities. Better HIV service results require a collective intersectional action. Let us learn the lessons from the Quail and the Net 'The world still has not learnt the lessons of the quails- we need to work together. We have a small window of opportunity to get it right. We know what central components of AIDS response are, we have the science, knowledge, evidence, and partnerships, yet we are continuing to rely too heavily on treatment approach. In Asia Pacific region, we need a HIV prevention revolution that is anchored in human rights,' said Eamonn Murphy of UNAIDS. 'If we are together focussed and unified, we can fly towards the end of this epidemic as a public health threat – we can end AIDS now. If not, we will all fail.' Shobha Shukla, Bobby Ramakant – CNS (Citizen News Service) (Shobha Shukla and Bobby Ramakant co-lead the editorial at CNS (Citizen News Service) and Shobha was the Lead Discussant on SDG-3 at UN High Level Political Forum 2025. Follow them on Twitter/X: @Shobha1Shukla, @BobbyRamakant)
Scoop
17-06-2025
- Health
- Scoop
Unite Health Systems With Community-led Health Services To Deliver On UHC
We cannot deliver on universal health coverage (UHC) unless we reach the unreached people with standard health services – with equity and human dignity. Uniting Health systems with Community-led health services should be the new lens to look at UHC. Despite mounting evidence of how key population or community-led health services have bridged the gap between public health system and those unreached, we are yet to optimally integrate community-led health service delivery model into public health system effectively, said Dr Nittaya Phanuphak. Dr Nittaya Phanuphak is the Executive Director of Institute for HIV Research and Innovation (IHRI), Governing Council member of International AIDS Society (IAS), and Convener of 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases. Sterling examples of high impact key population or community-led health service deliver models come from the land of smiles – 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 populations are groups of people who are disproportionately affected by HIV (which includes gay men and other men who have sex with men, transgender women and sex workers). 'On the ground, despite successes, we have faced challenges too over the last decade in our efforts to integrate community-led health service delivery model into the national public health system in Thailand. Key population lay providers are still the main providers and carers who are initiating and maintaining key population clients in PrEP services,' said Dr Phanuphak. Over two years ago, Thai government changed regulations which adversely impacted the community-led health services. For example, due to these regulatory changes by the government, PrEP medications were not allowed to be stocked at the clinics run by key populations. Key population service providers were only allowed to give PrEP if it was prescribed by government doctors (and not NGO doctors). 'These regulations are still there but, on the ground, we are upholding our core values of delivering health services in a people-centred way. Many public hospitals work closely with key population led clinics since more than a decade now. These hospitals have seen the impact of key population led health services at the provincial level. They too feel that the best way forward is to continue and maintain the original flow of having client come to the key population led clinics, get tested for HIV by lay providers, and then have the PrEP prescription made through TeleHealth by a government doctor. PrEP can be given out to the client within an hour of entering the clinic,' said Dr Phanuphak. Funding cuts have made community-led services even more vital Trump's decisions have snapped funding majorly to a range of health-related projects in the Global South. Dr Nittaya opines that with limited resources it becomes even more critical to ensure we are serving those most in need and most likely to be left behind. 'We need to continue integrating key population led health services into country's healthcare system and make sure that key population led clinics are receiving their reimbursements from the government in a fair way. We also need to ensure that the cadres of lay providers are recognised and endorsed at the country level,' said Dr Nittaya Phanuphak. Community-led services are not just limited to HIV 'Key population or community-led health services is not only limited to HIV services. It can also be expanded to services for sexually transmitted infections (STIs), mental health, harm reduction, among others. This would be a real game changer for public health in Thailand,' said Dr Phanuphak. Other countries in southeast Asian and western pacific region such as the Philippines, Viet Nam, Myanmar, and Laos, are also following Thailand-model by adapting community-led health services in their own unique in-country contexts and realities. Communities and countries need to learn from each other too, says Dr Nittaya Phanuphak. 'We learn from the Philippines that there are members of key populations within the healthcare providers including medical professionals. In Viet Nam, we are seeing a good role of private sector in developing key population led clinics – many of which are social enterprise models too.' End delays in translating scientific breakthroughs into public health impact Among the biggest breakthrough scientific announcements in 2024 was lenacapavir - a medicine (twice yearly injections) that showed 100% protection against HIV among women who took part in the study. The study called PURPOSE-1 had cisgender women as participants and lenacapavir demonstrated 100% efficacy in preventing HIV infection. PURPOSE-2 study enrolled a more diverse population of cisgender men, transgender men, transgender women and non-binary individuals who have sex with partners assigned male at birth. PURPOSE-2 study results showed that twice-yearly lenacapavir cut HIV incidence by 96%. Dr Nittaya Phanuphak shares her disappointment because when the HIV prevention medicine lenacapavir was announced last year, she was rightly hoping for a rapid rollout to protect many more people from HIV acquisition. But it has not happened so far. "Despite the progress over the last 2-3 decades in HIV response, we still had 1.3 million people who were newly diagnosed with HIV in 2023 worldwide. Around a quarter of these new infections occurred in Asia Pacific region. We have HIV prevention tools in our region but pace at which these are being rolled out is not acceptable. No one needs to get newly infected with HIV because we have the science-based tools to prevent the transmission. For example, PrEP rollout is barely 2% of the target rollout for 2025 (target was to ensure that at least 8.2 million people have used PrEP at least once in a year by end of 2025). This is a huge gap," she said. Unless all science-based new and old HIV prevention tools would not be offered to people to choose from, we would not be able to protect everyone from the virus. "When research and development of these new health technologies have taken place in our countries in the Global South so that we can have enough scientific evidence for approvals from US FDA or European Medicine Agency, then why cannot people of our own countries access these approved products?" asks Dr Phanuphak. "This is not fair." Deploying health technologies developed by the Global South equitably at the point-of-need Dr Phanuphak calls for uniting our community power in the Global South and leverage upon our regional purchasing power to negotiate lowest possible prices for quality assured screening and diagnostic tools and generic medicines - especially those developed in the Global South. She also underlines the importance of taking services for multiple diseases and health conditions to the communities in people-centred and rights-based manner. She says that when a health technology is approved by the regulators, it should be developed and made accessible to the people in the Global South without any delay. Not doing so, is not acceptable. 1st Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases was held in Australia. Dr Phanuphak was among those who worked hard to bring the 2nd POC 2025 to Thailand which will be held during 19-21 June 2025 with her being its convener. She rightly calls for deploying scientifically validated point-of-care health tools closer to the communities to strengthen multiple disease responses, such as for TB, HIV, STIs, vector-borne diseases like malaria or dengue, hepatitis, HPV, among others. She calls for accelerating innovations in developing more health technologies to serve the most-in-need communities in a rights-based, gender transformative and people-centred manner. "Point-of-care technologies is not only limited to testing for example, but also point-of-care sample collection tools too, so that sample collection not only gets enhanced but also it can be done in a way that it becomes self-care. We should not have to rely on people going to healthcare facilities for sample collection by healthcare providers, but if science-based tools become available, then sample collection can perhaps be done by the clients themselves and sent to the nearest testing centre." "We cannot talk about new point-of-care technologies without talking about game-changing health financing, policies and political commitment too. At the POC 2025, I hope that we can bring all these aspects together so that we can not only transition in deploying point-of-care health technologies where they are needed most in people-centred manner, but also how can we sustain the implementation," she said. Integration may not mean the same for everyone Dr Phanuphak reflects that integration may have different meanings for different people. "A programme manager may think of integrating services together, such as those for TB and HIV. For grant managers it may mean integrating testing platforms, such as those for TB and HIV. We have seen on the ground already that community-led clinics have naturally integrated HIV, hepatitis and STIs services to serve people better. Lay providers have also gone beyond the laboratory integration by integrating mental health, harm reduction, social and legal services." She calls for reimagining integration in a people-centred way so that we can deliver on WHO Multi-Disease Elimination Approach at the local level and scale up those that have demonstrated impact. 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
