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Prevention of HIV infection: How effectively are countries responding to changing epidemics in the Asia Pacific Region?. HIV epidemics in Asia Pacific. Most new HIV infections will result from unprotected sex with female, male and transgender sex workers and their clients,

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Prevention of HIV infection: How effectively are countries responding to changing epidemics in the Asia Pacific Region?

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HIV epidemics in Asia Pacific

  • Most new HIV infections will result from unprotected sex with
    • female, male and transgender sex workers and their clients,
    • people who inject drugs and
    • men who have sex with men.
  • Significant numbers of ostensibly‘low-risk’ women who are the wives/intimate partners of these men are exposed to HIV.
slide3

How effective are country responses?

  • There are two sides to HIV prevention in Asia.
    • First, where there has been a systematic, national approach to prevention.
      • HIV prevalence has been reduced by up to 30–50%.
    • At the same time, there are important gaps in the aggregate coverage of HIV prevention services for all sex workers and their clients, men who have sex with men and people who inject drugs, and the wives/intimate partners of all of these.
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Funding scaled up national prevention

  • The Commission on AIDS in Asia Report urged Governments to prioritize programs with a high-impact, whether they are low-cost or high-cost.
  • Modelling and analysis in the report showed that the cost of funding a priority response in Asia varies from USD 0.50 per capita to USD 1.00per capita for most countries in Asia, depending upon the stage of the epidemic in each country.
  • If countries committed resources to the response of the order of USD 0.50–USD 1.00 per capita range, HIV epidemics in Asia could be reversed
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Barriers to scale up effective prevention program

  • Leadership: Many governments remain reluctant to support prevention interventions that focus on changing the high-risk behaviours driving new infections.
  • Legal, social and politicalbarriers to implementing and funding such programs.
  • Financial resources:
  • Limit involvement of civil society/community groups including key affected populations.
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Partnership with communities

  • National HIV responses are strengthened when community-basedand non-governmental organizations participate in policydevelopment, program planning, and implementation.
  • But the opportunities for genuine community participation inHIV responses in Asia remain mixed.
conclusion
Conclusion
  • Prevention which is focused on key affected populations is still the most cost-effective way stop HIV epidemics in the region and to reduce future treatment costs;
  • there has been some good progress with scale up of prevention services but coverage – especially for MSM and IDU – are well below the threshold level needed to halt epidemics;
  • scaling up will require a partnership between the health and the public security sectors;
  • civil society and community groups need to be even more centrally involved – from policy, planning to programming and implementation;
  • we must give more attention to prevention of intimate partner transmission, from high risk men to ‘low-risk’ women but less clear that we know what programmes work