This year the World AIDS Day theme remains the same as that of 2011, "Getting to zero: Zero new HIV infections. Zero discrimination. Zero AIDS related deaths". And the same, big question hangs over it: “Is this too ambitious?”

The latest UNAIDS report[1] gives encouraging news that a 50% reduction in the rate of new HIV infections (HIV incidence) has been achieved in 25 low and middle-income countries – more than half in Africa, the region most affected by HIV – between 2001 and 2011. Africa has cut AIDS-related deaths by one third in the past six years.

It also shows that in the last 24 months alone, the number of people around the world accessing life-saving antiretroviral (ARV) treatment has increased by 63%, a feat that took a decade to achieve previously

Despite such great progress however, it may be too early to conclude that the end of the epidemic is near.  The fight is far from over. Although there are 8 million people receiving ARV treatment to date, another 7 million people still don’t have access to this life-saving treatment. With the new World Health Organization (WHO) guidelines expected to be released in 2013, encompassing the latest science on treatment as prevention, the gap will widen again. The expected target of people in need of ARV treatment according to the new expanded treatment criteria will increase to 23 million[2].

In addition, there is mixed progress on new HIV infections and substantial variations in the way the epidemic hits different countries and parts of countries. In Asia for example UNAIDS report a 25% decrease in new cases in India, Nepal and Thailand between 2001 and 2009 but a comparable increase in Bangladesh and Philippines for the same time period.  The epidemic also has a different face, depending on where you look. And that demands different solutions. In Asia, HIV remains largely concentrated among injecting drug users, men who have sex with men and sex workers; while in most of Africa, heterosexual sex remains the dominant mode of HIV transmission.

But HIV is not the only enemy here.  Tuberculosis (TB) with HIV is a deadly combination and each disease process fuels the epidemic of the other.  Although the brunt of TB/HIV mortality is bourne by Africa, other developing countries are far from immune.  Of the 41 high HIV/TB burden countries ranked by WHO[3], seven are in the Asia Pacific region, namely Cambodia, China, India, Indonesia, Myanmar, Vietnam and Thailand. In many of these countries, TB is the most common presenting illness among patients living with HIV and is the leading cause of death among them. In 2011 alone, 25 percent of all AIDS-related deaths worldwide were caused by HIV-associated TB disease.

Médecins Sans Frontières(MSF) has been providing HIV/AIDS and TB care in the Asia Pacific region for the past 20 years. In India and Myanmar for example, MSF activities have expanded into Multi-Drug Resistant TB care.  In Myanmar alone, MSF provides over 60% of lifesaving antiretroviral therapy (ART) in country. In India, MSF runs clinics to provide treatment and counselling to patients living with HIV/AIDS, TB and MDR-TB in Manipur and Mumbai. The complexity of the medical issues and the cost of the treatments are challenging even with the organisation’s internal resources, let alone those of over-stretched public health systems.

The ambition of “getting to zero” may, even so, be achievable.  Collaboration between those fighting HIV and TB is increasing. The emphasis on treating to prevent is a powerful response to the epidemic. But without persistent efforts, political will and mobilization of resources as well as an increased commitment to making treatment universally available, HIV, with TB, will continue to spread in many areas. Zero is still a distant target in too many places and the means to reach it are not yet in place.

Dr. Maria Guevara

Regional Humanitarian Representative (ASEAN)

Médecins Sans Frontières (MSF)

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