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WHO today asked its South-East Asia Region member countries, including India, which are home to the second highest number of people with HIV, to undertake proactive action to prevent and treat the disease, especially in low and concentrated epidemic settings of populous countries. On the eve of World AIDS day tomorrow, WHO Regional Director for South-East Asia Poonam Khetrapal Singh said proactive action, backed by political will and innovative and sustainable financing will go a long way in fast-tracking the national HIV responses that would steer the region towards an AIDS-free world. The remarks come after the WHO released new guidelines on HIV self-testing to improve access to and uptake of HIV diagnosis. The WHO progress report said lack of a diagnosis is a major obstacle in implementing the organisation's recommendation that everyone with HIV should be offered antiretroviral therapy (ART). The report said more than 18 million people with HIV are currently taking ART across the world. A similar number is still unable to access treatment, majority of whom are unaware of their HIV positive status. She said although in the fight against HIV, the world has reversed the epidemic that was one of the Millennium Development Goals for 2015, "we have fallen short on our commitment of universal access to HIV treatment". "The South-East Asia Region of WHO, home to the second highest number of people with HIV after sub-Saharan Africa, has an estimated 3.5 million people living with HIV of whom about 1.4 million are on treatment. Expansion of HIV treatment has resulted in a 47 per cent decline in new infections in the Region in 2015 compared with 2010. "AIDS-related deaths, after impressive declines in the first 10 years of this century, have started to stagnate. One reason for this is late diagnosis and treatment initiation that also reduces the prevention benefit of early treatment," she said. She said stigma and discrimination continue to pose access barriers to key populations at highest risk of HIV and this must change if an AIDS-free world is to be achieved. "We need to be innovative and strike where it impacts the most.
Our focus and prioritization of interventions is critical, especially in low and concentrated epidemic settings in populous countries. This is all the more important in the scenario of receding resources," she said.
She said WHO has now embarked on a mission to end the AIDS epidemic as a public health threat by 2030 as part of Sustainable Development Goal 3.3. This is through an interim goal which aims to achieve the 90-90-90 targets by 2020--that is identifying 90 per cent of people living with HIV, putting 90 per cent of them on effective treatment and ensuring that 90 per cent of those on treatment have successfully suppressed the multiplication of HIV in their bodies. She said despite having political will, commitment and an active, engaging civil society that has steered the HIV response from the lanes of "despondency to the path of hope", only one in two people living with HIV know their status and of those that do know, only half are on treatment. "This is unacceptable. We cannot let go of the momentum and give up on a public health success that will go down in the annals of history as a shining example of public health success led by the public and enabled by governments in partnership with development partners and academia," she said. Providing HIV services within a universal healthcare framework reaps rich dividends as in the case of Thailand which achieved elimination of mother-to-child transmission of HIV and syphilis in June 2016, she said. "As treatment expands, people with HIV live longer and are at risk of diseases related to lifestyles and ageing, i. E. noncommunicable diseases (NCDs). "We know that people with HIV on lifelong treatment are at higher risk of NCDs, and non-AIDS illnesses are now major causes of mortality among people living with HIV. This calls for a chronic care model within a primary care approach," she said. She said the global health body has been updating evidence on prevention, testing, treatment, monitoring, including drug resistance, and service delivery approaches. The Global Strategy on Health Sector Response to HIV 2016-2021, endorsed by all member countries at the World Health Assembly in May 2016, provides the framework for effective and sustainable implementation of evidence-based interventions.