Editor's note: Recently, at the 9th Asia-Pacific AIDS& Co- Infections Conference 2024 (APACC 2024), Dr. Brigitte Quenum, UNAIDS Regional Office for Asia and the Pacific, delivered a speech entitled "Challenges & Success in the Region" and in an interview with Infectious Disease Frontier,she introduced the challenges and solutions of HIV/AIDS prevention and treatment in the Asia- Pacific region, with particular emphasis on breaking the "isolated island" model of government or community fighting alone and achieving the integration of multiple resources.Infectious Disease Frontier: What are the major challenges in HIV prevention and treatment in the Asia-Pacific region? What effective strategies are being adopted? In your opinion, which areas need to be further improved?
Dr. Brigitte Quenum：We have a number of challenges around access to services. If people don’t access prevention or treatment services, it will be really difficult to overcome the fight against AIDS. One of the main reasons people don’t access services is stigma and discrimination, human rights barriers, and gender barriers. People in vulnerable situations are being stigmatized in different settings, such as health and community settings, which keeps them away from services. In the Asia-Pacific region, this epidemic is driven by key populations. The most affected are key populations, and due to stigma and discrimination, they cannot access services adequately.
When you look at the investment allocated to HIV programs for key populations, there is a mismatch; the level of investment is quite low compared to the needs. About 80% of the key populations are impacted and affected by HIV/AIDS. We also need to put communities at the center of the response. Community-led organizations can help people access services. Services shouldn’t only be facility-based but also community-based. Communities are key to bringing people to services and must play a role in the response. They need to be included in the governance of the HIV response and supported to build institutional capacities, allowing them to drive and lead the response.
Infectious Disease Frontier: In order to improve the efficiency of HIV prevention and treatment, how do you think the integration of healthcare and community resources should be optimized?
Dr. Brigitte Quenum：It’s very important to understand that we need to work out of silos. The government alone and the communities alone cannot succeed. It requires collaboration, partnerships, and all stakeholders in the HIV response working together. Programs should be coordinated, implemented in synergy and complementarity, rather than in isolation, to reduce program inefficiencies. This collaboration and partnership need to happen from the beginning and continue in the long run for sustainability.
For instance, when addressing TB and HIV, people living with HIV should be tested for TB, and TB patients should be tested for HIV. This integration is crucial. Similarly, STIs and HIV services need to be integrated. Tools for prevention, such as PrEP and condoms, must be offered as a combination prevention strategy, tailored to individual needs. The needs of a young MSM are different from those of a female sex worker, and services must reflect these differences.
Prevention and treatment go together, exemplified by the U=U (Undetectable = Untransmittable) campaign. When people are on treatment and their viral load is undetectable, they no longer transmit the virus. Integrating STIs, HIV services, mental health, and HIV is essential. A multi-sectoral approach involving education, gender, and other sectors is required. Integration is challenging but vital, necessitating a strong health and community system to sustain the response.
