Question 5.
Your message to the government and civil society of Asia?

To quote UNAIDS Regional Director's plenary speech at the 8th International Congress on AIDS in Asia and the Pacific (ICAAP) in Colombo in August 2007, a message to the government and civil society in Asia would be the following:

Fighting denial and complacency:

Ever since it emerged nearly three decades ago, AIDS has faced skeptics- people who believe either that it is not a disease at all or does not pose much threat to human societies. That kind of response has already been countered with very obvious and dramatic evidence - just ask the families of the millions who have died in its wake. And yet the peculiar phenomenon of denying HIV persists. Moreover, the downward revision of HIV estimates in Asia has fuelled this trend, and has been twisted out of context to say there is no threat from the epidemic. Such arguments are confined to a few, but it is a dangerous trend that can cost a lot of lives due to negligence.

The counterpart to denial is complacency, that's to say the tendency in some countries that have achieved much in their battle against AIDS to rest on their laurels as if nothing more needs to be done. But there can be no let up in the effort against the epidemic which does not respect past glories but ruthlessly spreads on depending on what you do in the present and how well you have prepared for the future.

Promoting and sustaining continued AIDS activism:

Activism by individuals and lobby groups has all along played a key role in putting AIDS on the agenda of policy makers, forced drug companies to lower cost of treatment and empowered those affected by the epidemic. An important characteristic of countries that have done well in containing and even reversing the epidemic has always been the strong participation of civil society as well as popular 'champions' of HIV-related causes. There is an important lesson to be learnt from this for nations that are still struggling to cope with the epidemic: it shows they need to nurture and actively encourage such activism instead of mistakenly seeing it as a threat or 'troublesome' to those in authority.

Prioritizing resources for reducing new infections:

Although the resources available for dealing with AIDS in the Asia-Pacific region has gone up considerably in recent years , they are still not enough to be spent without considering priorities. From the experience of countries that have tackled the epidemic successfully we know that money needs to be spent on areas where it will have maximum impact, such as on prevention work among most-at-risk populations. Allocating scarce resources in a targeted way will produce better results instead of spreading these resources thinly over a wide area with little impact.

Universalising coverage of ART services:

Countries in Asia have struggled to provide ART to their affected populations and to meet the WHO's 3 by 5 targets for some time Barring a few Asian countries like India and Thailand, China and Myanmar which have a large number of infected populations, most countries have a manageable number of people requiring ART, for whom they can easily provide universal coverage.

Poor coverage to ART is partly attributed to the lack of investment of these countries in health care delivery itself. Asia ranks lower than Africa and Latin America in per capita investment in health.

The fact is Asian countries today have enough resources to provide universal coverage. They should learn from Thailand, a middle-income country which, as a result of its high per capita investment on health, has managed to reach its care targets. Another factor behind Thailand's success is that it has made the ART a part of general health services, as in developed countries and in line with the recommendation of health economists that countries should 'pool' risk of such high cost investment through cost sharing and integration with the health sector.

Promoting educational programmes on sex for young men and women:

Matters of sex and sexuality have always been taboo in many Asian societies that hardly debate these matters in private let alone in public. More than anything else ignorance of such matters remains the biggest threat to the health of our populations. Those who claim sex education is against their national culture are in some ways claiming that learning and knowledge are against their traditions. The choice is ours-what form of education do we want for our children on the process of growing up? Is it through a carefully researched adolescent education programme, or through pornographic movies and internet sites? Trying to shut off knowledge and information is like blocking the sunrise with your palm-it can't be done.

Orphans and vulnerable children as the hidden face of the Asian epidemic:

While a lot of attention has been rightly paid to the plight of those living with HIV, we are increasingly confronted in the region today by the tragic phenomenon of children losing one or more parents to the AIDS epidemic. These orphaned children need care, social support and also protection lest they too become vulnerable to the ravages of the epidemic. In the coming years we will need to focus a lot of effort on this growing population of AIDS orphans. Married monogamous women- most silent sufferer

The typical Asian epidemic follows a general progression from injecting drug users to sex workers; then to the clients of sex workers, who then transmit the virus to their wives, and finally to the children born of HIV-positive women. In this entire chain married housewives- who should normally be under little threat from HIV/AIDS- are the most silent sufferer . They are estimated to constitute nearly 25-40% of the total number of people infected, yet they are faceless. The time has come to give them a face, a voice, and to address their needs. According to one UNDP study in South Asia, 40% of women leave their in-laws house after their husbands' death due to AIDS, and 80% of these women, mostly infected by their husbands, are denied of property rights.

SCALE UP your interventions:

As far as our region is concerned the phase when countries were still tentatively trying out strategies and experimenting with what could be the best approach to AIDS is clearly over. Now it's time to bite the bullet and take the challenge of fighting the epidemic head on by scaling up interventions to appropriate levels. Such scaling up will require resources, technical support and, above all, political will at all levels of governance