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Grey: Facing each day as a miracle unfolding

Contributing HIV-positive writer Grey of Cagayan de Oro City says that knowing one’s status may not be easy, but it’s the first step to empowerment. In his case, “I am better and better every day. Every day is a miracle. I am now ready to face this battle.”

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This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 as a move eyed to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”.  More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

By Grey of Cagayan de Oro City

Call me Grey (not my real name). I am from south of the islands of the Philippines – Cagayan de Oro. I am HIV-positive. It’s been two months since I knew my result.

I call it as my Dark Age or simply “restless days”. I had a wonderful and simple life here in the province but I chose to work in a big city for better opportunities. Financially, my family can provide for me and my brother the things we ask for; but young as I was, I wanted more – I wanted freedom and to live independently. And so I had a very different life, and yes, I loved it. But while I enjoyed it so much, I forgot the things that matter. It was then that I got really depressed, so that I clung to short-term happiness. I became promiscuous. I enjoyed the ‘short times’ with some random guys. I had several flings and it became a pattern… a pattern of my life that I never wish happened, though it did happen and not that I ever regretted it happening.

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In October 2011, I decided to come home. I was having the best and worst days of my life then. I needed to learn to love myself and to embrace the people who matter to me. I got sick most of the time then – from fever to coughing, until I was diagnosed with shingles. My self-denial did not help me. I was sick on and off until November 2012, and my family was starting to worry. I kept my composure and never thought of having the virus. In fact, I was still active in my sexual life – and, worse, I remained unsafe even then. I continued living my my life as if it’s the last day of the world for me.

Earlier this year, I got ill again, and I lost weight – around 10% of my body weight. It was the turning point in my life. I realized that I was indeed sick and that it may be something serious.

I remember earlier, on February 2012, when I got mild TB and confined in a private hospital in CDO, where I was enrolled to DOTS for free meds for TB – that moment in my life, I learned to value my family more as they were there when I was about to quit life. They did not judge me, just cared for me and gave me unconditional love. My tita, who is like my second mom, was always hands-on during those awful times. My nurse cousin was there to check on me. My mama was always there praying for my recovery. My best friends who knew my situation were there too.  God became my refuge during those times. He was there and together with my family. I disconnect myself from the world for five months then, and I celebrated each day as if my last.

READ:  Unlawful HIV and AIDS information confronted

By mid-May, I got better and better each day. Loving yourself more is my weapon in that fight. I recovered so fast and it was amazing. A second life, indeed.

On May 28, I contacted my peer counselor from the city health department. I told him that I will take the HIV antibody test. I took it as God’s grace and courage to take the risk of getting tested. It was a risk I knew I would carry for a lifetime. In the afternoon of that same day, I got the result. I expected for it to be positive – I somehow knew I am positive. And my suspicion was proven right. As the doctor was discussing with me about my case, I just listened and thought of the things I did. I told him I needed to accept my status because I made a choice. No regrets for me now. I am now ready to face what life has brought me. This is a rebirth for me; a call for service.

It is true that one of the most difficult situations I ever dealt with is accepting my status day by day. But I became better eventually, and more loving of myself. I was indeed whole now. I dealt with this with openness and I embrace it unconditionally and with God’s grace.

My family still matters to me now. My best friends and my new friends from the advocacy molded me to become strong. I now need to choose the people who I want to share my life with.

Blaming doesn’t help at all. Dealing with it with open arms and continuing living and stopping worrying do. Yoga helped me a lot, too, and being with optimistic people.

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And now I hope to somehow become a voice to my fellow PLHIVs, advocating for love and for inner peace.

Yes, it may not be always easy – it took me two months to write this! But to other PLHIVs, remember that you are loved. I am praying for all of us. Let us join together and build a new “us”.

Last week, I had my CD4 count, and the result was too low – it’s only 56. I know it’s just a number. I will start taking my medications this week and I know this will help me. But already, I am better and better every day. Every day is a miracle. I am now ready to face this battle.

POZ

Phl now has 32 new HIV cases per day, up from 22 HIV cases per day in 2015

From January 1984 to October 2018, the Philippines already had a total of 60,207 HIV cases. It is worth noting that 9,605 of that figure was reported from January to October 2018 alone.

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October highlighted the continuing disturbing worsening HIV situation in the Philippines, with an estimated 32 new HIV cases now happening in the country every day. For October, there were 1,072 new HIV cases reported to the HIV/AIDS & ART Registry of the Philippines (HARP).

It was in September when this number (i.e. 32 new HIV cases per day) was first reported. Prior to that, the country “only” had 31 new HIV cases reported daily, though even this figure was already considered high compared to figures from past years. In 2009, the country only had two new HIV cases per day. By 2015, the number increased to 22; and in the early part of 2018, the number was 31.

From January 1984 (when the first HIV case was reported in the country) to October 2018 (when the latest figures were belatedly – as usual – released by the HARP), the Philippines already had a total of 60,207 HIV cases. It is worth noting that 9,605 of that figure was reported from January to October 2018 alone.

MALES IN FOCUS

Those newly infected continue to be male – in October, of the 1,072 newly infected, 1,016 (95%) were male. The median age was 28 years old (age range: 2 – 67 years old). Half of the cases (50%, 537) were 25-34 years old and 29% (306) were 15-24 years old at the time of testing.

GEOGRAPHICAL DISTRIBUTION

Based on where those who tested HIV-positive originated, one third (32%, 343) were from the National Capital Region (NCR). Region 4A (17%, 187 cases), Region 3 (11%, 121), Region 7 (8%, 82), and Region 6 (7%, 76), round off the top five regions with the most number of newly diagnosed cases for the month, together accounting for 75% of the total.

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Sexual contact remains the main mode of transmission (97%, 1,044). Among this, 86% were males who have sex with males (MSM). Other modes of transmission were needle sharing among injecting drug users (1%, 15) and vertical (formerly, mother-to-child) transmission (<1%, 2). There were 11 cases that had no data on mode of transmission.

Among the newly diagnosed females in October, eight were pregnant at the time of diagnosis. Five cases were from NCR and one case each from Regions 3, 4A and 7.

ACCESSING TREATMENT

In October, there were 831 patients who were initiated on antiretroviral therapy (ART). This is close to the figure registered in September, when 804 patients were initiated on ART. To date, a total of 32,324 people living with HIV (PLHIV) are on ART as of October; and this figure is still only a few thousand over the total number (60,207) of those who reported to have HIV in the country.

FOCUS ON THE YOUNG

Those getting infected continue to be also younger.

In October, 306 (29%) cases were among youth 15-24 years old; 94% were male. Almost all (98%, 300) were infected through sexual contact (31 male-female sex, 197 male-male sex, 72 sex with both males and females). There were six cases that had no data on mode of transmission.

There were also 41 newly diagnosed adolescents 10-19 years old in October. Almost all (95%) were infected through sexual contact (3 male-female sex, 31 male-male sex, and 5 had sex with both males and females); two had no data on mode of transmission. There were two newly diagnosed child less than 10 years old, and both were infected through mother-to-child transmission.

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OFWs IN FOCUS

Even among overseas Filipino workers who tested HIV-positive, more were infected from male-to-male sexual contact.

Eighty-one people who worked overseas within the past five years of diagnosis, whether on land or at sea, were diagnosed HIV-positive in October. They comprise 8% of the total newly diagnosed cases for the month. Among them, 89% (72) were male. Almost all were infected through sexual contact (27 male-female sex, 32 male-male sex, and 21 sex with both males and females). The ages of male OFWs ranged from 23 to 55 years (median: 32 years). More than half (57%) of the cases belonged to the 25-34 year age group. Among the female OFWs diagnosed in October 2018, four cases were from the age groups 25-34 and 35-49; and one case was from 50 years old & older age group. The age range among diagnosed female OFWs were 28 to 61 years (median: 35 years).

ENGAGEMENT IN TRANSACTIONAL SEX

In October 2018, 14% (147) of the newly diagnosed engaged in transactional sex. Ninety-five percent (140) were male and aged from 20 to 64 years old (median: 30 years). More than half of the males (57%, 80) reported paying for sex only, 31% (43) reported accepting payment for sex only and 12% (17) engaged in both. Among the female cases who engaged in transactional sex, majority (71%, 5) were reported accepting payment in exchange for sex and 29% (2) reported paying for sex only.

READ:  Reach the people

Reporting on people who engage in transactional sex – or those who reported that they either pay for sex, regularly accept payment for sex, or do both – was only included in the HARP starting December 2012.

PREGNANT AND HIV-POZ

In October 2018, eight newly diagnosed cases were reported to be pregnant. Five were from NCR and one each from Regions 3, 4A and 7. The age of diagnosis ranged from 19 to 34 (median age: 23).

Reporting of pregnancy status at the time of testing was included in the HARP from the year 2011.

DEATHS AMONG PEOPLE WITH HIV

In October 2018, there were 30 reported deaths due to any cause among people with HIV. Ninety-seven percent (29) were males. One case (4%) was less than 15, four cases (13%) were 15-24, 12 cases (40%) were from 25-34, 10 cases (33%) were from 35-49, and three cases (10%) were 50 years and older age group. Almost all of the cases were reported to have acquired the infection through sexual contact (97%) (3 through male-female sex, 19 through male-male sex, and seven through sex with both males and females); while one case (3%) was infected through vertical transmission.

The 30 deaths are lower than the number reported in August, with reached 159 HIV-related deaths. But the figures are still believed to be be higher because of under- or non-reporting.

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Interventions needed to reach older adults and ethnic minorities to address HIV testing, beliefs

Many barriers already prevent people from getting tested for HIV. But researchers now argue that interventions are urgently needed to also reach older adults and ethnic minorities to address HIV testing and beliefs.

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Photo by Nicholas Kwok from Unsplash.com

As it is, many barriers already prevent people from getting tested for HIV, including lack of knowledge, competing priorities during medical visits, and stigma associated with the test on the part of both the patient and provider. But researchers now argue that interventions are urgently needed to also reach older adults and ethnic minorities to address HIV testing and beliefs.

Brandon Brown, an HIV researcher at the University of California, Riverside’s School of Medicine, is the lead author of “Indicators of self-reported human immunodeficiency virus risk and differences in willingness to get tested by age and ethnicity: An observational study”, which was published in the journal Medicine.

The researchers argued that “not much is known, however, about what impact age and ethnicity have on HIV testing.”

Brown and colleagues explored data on self-reported HIV risk and willingness to be tested. They focused on age and ethnicity in the Coachella Valley in the US using the 2014 Get Tested Coachella Valley Community Survey. The team collected data from nearly 1,000 participants related to demographics, sexual history, HIV testing history, thoughts on who should get tested, and future preferences for HIV testing.

“We found stigma, education, provider recommendations, risk perceptions, and cost are among major factors contributing to accepting HIV testing and intention to receive HIV testing,” Brown said.

The study also found:

  • Most untested participants did not believe they are at risk.
  • Men were more likely than women to have been tested.
  • Significantly fewer participants aged 50 or older said they are at risk of HIV compared to participants younger than 50.
  • Participants aged 50 or older were less likely to be tested for HIV compared to participants between the ages of 25 to 49.
  • Compared to younger participants, significantly fewer participants aged 50 years or older accepted HIV testing when it was offered by a health care provider.
  • Older adults tend to underestimate their HIV risk and severely delay HIV testing or forgo testing altogether.
  • Older adults are more likely than younger adults to be diagnosed with HIV later in the disease course.
  • Many participants claimed they would get tested if their health care provider offered testing.
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“Our recommendations to health care providers are that they talk directly with their patients during clinical visits about HIV prevention and HIV risk, and that they routinely offer HIV screening as part of primary care,” Brown said.

Brown added that interventions are needed to “debunk beliefs among physicians that older adults are not sexually active, and beliefs among older adults that only others are at risk of HIV.”

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‘Life for a poz is an ongoing struggle. Face it.’ – @pozzieblue

Contributing writer @pozzieblue tested HIV-positive in July 2013, while working as a nurse in the Middle East. He now writes how life has been after he was detained and then deported.

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This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”.
More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

Photo used for illustration purpose only; by Jason Schjerven from Unsplash.com

BACKGROUND: While working as a nurse in Abu Dhabi, United Arab Emirates, @pozzieblue tested HIV-positive in July 2013. He was placed in an isolated facility in the middle of a desert, and then deported to the Philippines. Months after trying to get his life back together, he shared his story to Outrage Magazine in November 2013. This is a new contributed article from him, sharing how life has changed for him after he tested HIV-positive; and the lessons he hopes others like him learns from life.

After being detained and deported, life was not easy. I felt I’ve went back to zero. I grieved a lot, and sometimes I thought I’ve reached the acceptance phase but the anger and sadness fluctuates every now and then. There was even a time that I went to RITM from my hometown by myself, and I was still struggling from my pneumonia and ARV allergic reaction. I needed to go back to my hub so I could refill my new ARV. I was on MRT train when I felt I was fainting so I’ve decided to sat on the floor to gain my strength and to avoid falling. It felt so terrible and lonely because as a nurse who used to take care different people, nobody cared to approach and ask me if I’m okay.

@pozzieblue: The HIV-positive OFW

This is the reason why I realized that I need to focus on one of the most important aspect of my life, my health. Later on, I discovered twitter. I am grateful because this social media became a great support system to me because the of the fellow poz who have their account there. They have been very encouraging to my PLHIV journey, so I’m truly thankful to them. In fact, I have found some of my true best friends.They were there in supporting me in different ways, specially to my mental health.

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When my health became stable, I started working from different fields. I hopped from the BPO industry, teaching International students and doing online jobs. I was upset because it was hard to start a clean slate. Maybe because deep in my heart, I hold this faith that there is still another world waiting for me, but this virus in my blood inhibits me, as well as the trauma I’ve had. Then I promised myself that my life will not end this way and just like the long-time drama anthology says “Ikaw ang bida ng buhay mo.”

I tried enriching my neurons by finishing my Master’s Degree and improving my English skill. I was spending my earnings in different classes and dealing my thesis. During that time, I was also rekindling my relationship to God. There was a time that I felt He left me, but I realized that during those lowest lows of my life, he was there all through out, but I couldn’t see him because I was blinded with frustration, anger and regrets.

After going through with my Master and passing my English test. I’ve received an information from another PLHIV that he knows a nurse who was accepted to work in UK to practice his profession, despite being a poz. That simple online conversation ignited a hope in my heart. Hence, I started applying for an overseas job again. I can still remember how much worry it caused me whenever I needed to disclose my HIV status to my prospective employers but I’m grateful that they don’t mind it.

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To make the story short, I’m now in UK and I just passed my final exam to become a Registered Nurse here few weeks ago. It wasn’t an easy journey, but with perseverance, good health and divine intervention; I was able to fulfill this dream. I remember what Pope Francis said, “When you lose the capacity to dream, you lose the capacity to love, and the energy to love is lost.” This is my new mantra now.

To all my fellow PLHIV out there: life may seem to be a continuous struggle but continue learning and enriching yourself. Ask for help if you think you need one. Pain and sorrow is subjective. I may not know what you are going through but I sincerely wish everyone well.

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Study links individual HPV types to HIV infection

Persons with any HPV type, more than one HPV type, or high-risk HPV are more likely to test HIV positive.

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Image used for illustration purpose only; photo by lucas clarysse from Unsplash.com

Individual types of the human papillomavirus (HPV) that are specifically linked to HIV infection have – for the first time – been identified.

In a study published in the journal PLOS ONE, a person with any HPV type, more than one HPV type, or high-risk HPV is more likely to acquire HIV. The study found the following HPV types are linked to HIV: HPV16, 18, 31, 33, 35, 52, 58.

“Although most studies have shown a general link between HPV and HIV co-infection, our findings illustrate the strong relationship between individual HPV types and HIV infection,” said Brandon Brown, an HIV researcher and associate professor in the UCR School of Medicine and lead author of the study. “Some HPV types are more linked to cancer and others to warts. This further illustrates the potential utility of HPV vaccine for men who have sex with men and trans women, not only for HPV prevention but also possibly for HIV prevention.”

Brown, a member of UCR’s Center for Healthy Communities, was joined in the study by Logan Marg of UCR; Segundo Leon at Socios En Salud, Lima, Peru; Cynthia Chen and Junice Ng Yi Siu of the National University of Singapore; Gino Calvo and Hugo Sanchez of Epicentro Salud, Lima, Peru; and Jerome T. Galea of the University of South Florida.

Previous research has shown that HPV, in general, was linked to HIV infection, but the new research team looked at infection with 37 HPV types and found that individual types are linked, “which is more specific than saying HPV is linked.”

READ:  Chance of HIV-positive person with undetectable viral load transmitting the virus to a sex partner is scientifically zero

The study investigated the relationship between HPV types and incident HIV infection among men who have sex with men (MSM) and transgender women in Lima, Peru. There were 600 participants recruited at a local community-based health center, bars, clubs, volleyball courts, and via social media. The researchers started with two groups, one with genital warts and one without, and followed participants over two years to see who contracted HIV. Of the 571 participants who completed at least two study visits, 73 acquired HIV in two years – a 6% HIV incidence rate.

Brown has been working in Peru for more than 10 years and has conducted preliminary work on HPV vaccine acceptability in MSM. In his previous work with female sex workers, he found that the HPV vaccine still provided protection to high-risk groups.

According to Brown, the results of the study are “absolutely applicable beyond Peru, and synergize with recent results of studies outside Peru.”

“The fact that our study took place in Peru is irrelevant,” Brown said. “It was simply convenient to do it there with our strong community connections and a high interest in this research.”

Regarding prevention and treatment, Brown recommends the HPV vaccine, widely provided to everyone, regardless of sex, gender, or sexual orientation, before sexual debut, as well as genital wart treatment.

“Even if the vaccine is not provided before sexual debut, there can be strong benefit if given at any time to prevent HPV-associated disease and also HIV,” he said. “We know that HPV is the most common STI, and we know that HPV vaccine works to prevent chronic HPV infection. What we need now is to implement the vaccine in a better way.”

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Study stresses negligible risk of transmitting HIV during sex when viral load is suppressed

Stressing U=U with a new research stating that there is a negligible risk of transmitting HIV during sex when a person living with HIV is on antiretroviral therapy and maintains a viral load under a specific threshold.

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U=U; undetectable=untransmittable.

A newer study found – and backed – the already-established fact that there is a negligible risk of transmitting HIV during sex when a person living with HIV is on antiretroviral therapy and maintains a viral load under a specific threshold. In “Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review”, published in CMAJ (Canadian Medical Association Journal), the Public Health Agency of Canada conducted a systematic review that relied on 11 studies and one previously published review to determine the absolute risk of HIV transmission when preventive measures are in place.

Chance of HIV-positive person with undetectable viral load transmitting the virus to a sex partner is scientifically zero

“Our findings show that there is a negligible risk of sexually transmitting HIV when an HIV-positive sex partner adheres to antiretroviral therapy and maintains a suppressed viral load of less than 200 copies/mL on consecutive measurements every four to six months. The risk of sexual HIV transmission is low when an HIV-positive sex partner is taking antiretroviral therapy without a suppressed viral load of less than 200 copies/mL, condoms are used or both,” the researchers – which included Rachel Rodin from the Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada – stated.

The findings are of particular relevance, according to the researchers, in the drafting of laws.

Because Undetectable = Untransmittable

In Canada, for instance, based on the findings of this study, as well as relevant case law and other factors, the Department of Justice Canada concluded that “the criminal law should not apply to people living with HIV who maintain a suppressed viral load of less than 200 copies/mL.”

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Justice Canada also concluded that the criminal law should generally not apply to those who use condoms, among others.

Previous studies found that antiretroviral therapy and condoms can reduce HIV transmission. This study includes evidence from newer studies that have influenced clinical practice and could affect criminal law.

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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.

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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”.

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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.

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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