* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Late diagnosis remains a major contributor to AIDS-related deaths – we need to invest in more community-led responses to HIV nowEamonn Murphy is UNAIDS Regional Director for Asia Pacific and Eastern Europe Central Asia regions
A person living with HIV has zero chance of passing it on if, through effective treatment, they suppress the virus to an undetectable level.
With today’s tools, people should not die due to AIDS or infect others. Instead, they can become aware of their status and start antiretroviral therapy right away. Then they must be supported to keep taking their medicines and getting viral load checks.
But it’s not always that easy.
Even where services are available and free, many people don’t use them. We have 21st century HIV prevention and treatment science, but 1980s attitudes. People still worry—often rightly—about being shamed or scorned in health facilities. So even when they know they are at risk or need help, they stay away. Late diagnosis is a major contributor to AIDS-related deaths.
The discrimination or exclusion people experience in their homes, neighbourhoods and workplaces can make them despondent. This too affects treatment adherence. In 2023, fear and prejudice are fuelling avoidable deaths and transmissions.
The challenge is acute in Asia and the Pacific, where more than 95% of new HIV infections are among some of society’s most stigmatised groups, known in the AIDS response as “key populations”.
These are the people who are most likely to be mistreated anywhere from a clinic to a police station because they use drugs, sell sex, are gay or transgender. Youth is also a risk factor.
In Cambodia, Indonesia, Myanmar, Lao PDR, the Philippines and Thailand, young key populations between ages 15 and 24 make up around half of new infections.
In some countries the HIV epidemic among gay men is growing. Since 2010, new HIV infections among MSM doubled in Lao PDR, tripled in Cambodia and increased by six times in the Philippines. The dynamics vary from place to place, but among the contributing factors are the relative lack of prevention education and gay friendly sexual health services.
The 2023 UNAIDS World AIDS Day report, “Let Communities Lead”, highlights the role communities play in ensuring HIV services reach those who need them most. By communities we mean organisations of people living with HIV, the key populations and other civil society groups.
Globally, funding for communities has fallen by 35% in the last 10 years. We should instead be increasing financing for the community-led initiatives that reach the populations mainstream health services can’t.
Across the region organisations serving men who have sex with men are using social media to not only raise prevention awareness, but also increase HIV testing. The Asia Pacific Coalition on Male Sexual Health (APCOM) came up with a unique approach through testBKK, a social media campaign that has been adapted in four countries.
Peers from communities of people living with HIV and key population groups can also drive demand for HIV treatment, increasing uptake of conventional health services. In the Philippines, a trans woman living with HIV named Zoe Black is one of the volunteers with LGBTQ+ organisation Loveyourself, which has been instrumental in encouraging newly diagnosed people to start treatment.
This kind of intervention can help save the 16% of people living with HIV in the region who are aware of their status but not accessing treatment. It also helps more people to achieve a suppressed viral load.
Communities can also deliver services themselves including pre-exposure prophylaxis (PrEP), a prevention method in which HIV-negative people take antiretroviral therapy to avoid getting infected if they are exposed.
A Thai study found that more people use PrEP when it is offered by key population-led organisations - more than half of the people on PrEP in the nation access them through community health services.
The feeling of acceptance these organisations can give makes all the difference between someone consistently accessing prevention education and support, or disappearing into the shadows with all its risks.
This World AIDS Day we recognise the contributions that communities make to HIV responses, everywhere, but more than that, we are calling for increased support to communities doing this important work.
This is not a new request. Through the 2021 political declaration on HV and AIDS, the community of nations agreed to invest more in community-led service delivery, peer-led interventions and community-led monitoring.
In most places governments have committed to financing HIV treatment. To end the AIDS pandemic as a public health threat, we must also increase domestic financing of community-led work. This is not just a nice thing to do. Community leadership ensures that HIV programmes achieve the highest possible impact.
This story is part of a series supported by HIVOS's Free To Be Me programme.
