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13 countries from APAC plan scale-up of PrEP and HIV self-testing; challenges remain

Most countries in the region do not have policies in place to implement PrEP or HIV self-testing at scale.  However, a handful of countries are taking the lead and have included these innovative interventions into their national HIV strategies.

People from 13 countries across Asia and the Pacific gathered in Bangkok, Thailand to develop road maps to implement and expand pre-exposure prophylaxis (PrEP) and HIV self-testing in the region. 

PrEP reduces the risk of acquiring HIV by more than 90 percent, and HIV self-testing can significantly increase the number of people who find out their status, particularly among those at highest risk and least reached by existing services.  This means that adequate use of these products is set to revolutionize HIV prevention across Asia and the Pacific.  In China, Indonesia, Malaysia, Pakistan and the Philippines for example, infections among men that have sex with men (MSM) continue to rise, and HIV prevalence has hit 25.8 percent in Indonesia and 21.6 percent in Malaysia.  MSM could make up at least half of all new HIV infections in Asia by 2020.

But most countries in the region do not have policies in place to implement PrEP or HIV self-testing at scale.

Also, while a handful of countries are taking the lead and have included innovative interventions into their national HIV strategies, more countries have challenges re PrEP access that remains extremely limited to the well-off; while self-testing is not even discussed yet. This includes the Philippines, where PrEP access is deemed elitist; and self-testing is basically non-existent.

“The numbers say it all.  We cannot stop new HIV infections in men who have sex with men and other key populations if we stick to business as usual,” said Eamonn Murphy, UNAIDS Regional Director for Asia and the Pacific.  “PrEP answers an unmet need and expands the prevention options for people at substantial risk of HIV.  We need to scale up PrEP as an additional effective HIV prevention intervention”.

According to Rachel Baggaley, WHO’s coordinator of HIV testing and prevention, WHO first recommended HIV self-testing in 2016; and 59 countries now have policies. However, only 28 are implementing.

“HIV self-testing needs to become more widely available, affordable and accessible to reach the 90-90-90 targets.  WHO has also recommended PrEP since 2015.  If we are going to scale up PrEP, if we are going to reach levels of coverage that translate into public health impact, we need to engage and support key populations to deliver PrEP in Asia,” she concluded.

Participants discussed roadblocks to scale-up, including lack of political commitment, investments, national guidance; as well as stigma and discrimination towards key populations. They also emphasized the need to integrate PrEP and HIV self-testing into national programs, work with the private sector, and to further involve communities to increase demand and improve service delivery.

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The meeting was coordinated by Unitaid, UNAIDS, and WHO. Attendees included representatives from Ministries of Health, country and regional partners and networks working on PrEP and HIV self-testing, civil society representatives from Bangladesh, Cambodia, China, Indonesia, India, Lao PDR, Malaysia, Myanmar, Pakistan, Papua New Guinea, Philippines, Thailand and Viet Nam, WHO and UNAIDS country and regional HIV focal points and representatives from civil society including APCOM and APTN as well as other partners such as PEPFAR, CDC, FHI360 and the Global Fund for AIDS, TB and Malaria.

Outrage Magazine reached out to the organizers of the Bangkok gathering to ascertain: 1) who the countries representatives are; 2) how they intend to do the scale-up; and 3) if they have a timeline for the scale-up.
No responses have been received to date.

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