This year’s International Congress on AIDS in Asia and the Pacific (ICAAP), held in August in Colombo, Sri Lanka, focused on scaling up policy and programmes and generated the following key messages: - As a minimum standard, civil society must engage in and influence the universal access process, especially the development, rollout and monitoring of national plans and AIDS resources. Universal access to treatment must include treatment for tuberculosis and hepatitis C and effectively link to comprehensive and intensive prevention.
- The Indian Harm Reduction Network was launched at ICAAP. A range of presentations demonstrated that self-organising and leadership in communities, especially among key populations at higher risk, can deliver HIV prevention, care and stigma reduction benefits.
- Scaling up HIV prevention, treatment and care is happening in the region, but coverage, saturation and quality are still inconsistent. Experience from large-scale prevention programmes demonstrated that communities are key to scale-up. The frequently cited gaps in many prevention interventions were the underdeveloped links with care, treatment, and support.
- Coverage and quality are critical for achieving impact. For example, when evidence-based harm reduction is expanded to 60% coverage, it can produce dramatic prevention benefits.
- Many opportunities to effectively link prevention with care and treatment to deliver comprehensive programmes were being missed. For example, positive prevention and other evidence-based sexual and reproductive health services, including antiretroviral therapy, should be expanded.
- Weak, under-resourced health systems are the rate-limiting factor in scale-up. As the Cambodia antiretroviral example showed, HIV resources can be used to strengthen health systems.
- Criminalisation, shame, stigma and violence hamper efforts to achieve and sustain scale-up. Protection against stigma, discrimination and marginalisation, and appropriate legal reform, especially for key populations, were seen as critical to scale-up. State-sponsored stigma, which denies access to essential services such as sex education and sexual and reproductive health services for young people, acts as a barrier to scale-up. More efforts need to be made to plan, fund and roll out stigma-reduction interventions at a national scale.
- Even though there are more data available now on key populations in the region (e.g., men who have sex with men), there is a need for better data and more nuanced analysis in the design of key population programmes.
- In general, programmes must move beyond reporting on outcomes and start measuring impact.
- Gender and sexuality should be understood as fluid concepts in effective programming. Alongside addressing the needs of women, male involvement and ownership are crucial.
- Economic impact in Asia and the Pacific is small, with a mild effect on growth of gross domestic product, but HIV has a substantial impact on economic welfare at household level.
- Cost-effectiveness discussions should be guided by the need to invest urgently in areas where new infections are rising rapidly (i.e., in key population groups). Cost-effectiveness cannot be about the cost-effectiveness of prevention versus the cost-effectiveness of treatment: both are essential for an effective response.
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