Enhancing HIV/STI prevention and treatment in the Western Pacific

MANILA, 24 October 2013 – While the number of new HIV infections in the Western Pacific Region has stabilized, the World Health Organization (WHO) warns against complacency. The WHO Regional Committee for the Western Pacific, currently meeting in Manila, urges Member States to continue scaling up antiretroviral therapy (ART) and strengthen surveillance for sexually transmitted infections (STIs).

“With the introduction of antiretroviral therapy, HIV has become a chronic disease condition,” says WHO Regional Director for the Western Pacific, Dr Shin Young-soo. “It requires a change of approach from an infectious disease to a chronic disease condition. HIV must be considered in ongoing planning for health financing in the short- and long-term as part of universal health coverage schemes.”

In 2011, there were 1.3 million people living with HIV in the Western Pacific Region. Approximately 50% of people in need of antiretroviral therapy (310 000) received treatment in 2012, a 16% increase from the previous year (261 000 in 2011). Among the Region’s middle- and low-income countries, only Cambodia reached more than 80% coverage of antiretroviral therapy while Papua New Guinea reached more than 60% coverage. The other countries had ART coverageslower than 50% in 2011.Effective implementation of programmes to halt mother-to-child transmission resulted in a 36% decrease in the number of children born with HIV in the Pacific between 2009 and 2011. In Asia, there was a 12% decrease in new HIV infections among children over the same period.


In June 2013, WHO released Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, which encourages all countries to initiate treatment in adults living with HIV when their CD4 cell count falls to 500 cells/mm³ or less—while their immune systems are still strong.


The new recommendations also include providing antiretroviral therapy—irrespective of their CD4 count—to all children with HIV under five years of age, all pregnant and breastfeeding women with HIV and all HIV-positive partners where one partner in the relationship is uninfected. WHO continues to recommend that all people with HIV with active tuberculosis or with hepatitis B disease receive antiretroviral therapy.


WHO based its recommendations on evidence that treating people with HIV earlier, with safe, affordable, and easier-to-manage medicines, can both keep them healthy and lower the amount of virus in the blood, which reduces the risk of infecting someone else.


Another issue in the Region is rising HIV prevalence among men who have sex with men (MSM). In Ulaanbaatar, Mongolia, HIV among MSM has increased from 1.8% in 2009 to 10.6% in 2011. In Chengdu, China, it rose from 0.6% in 2003 to 16% in 2012. Inadequate HIV prevention for MSM is also a challenge, with low coverage of MSM reached by HIV prevention programmes (including access to HIV testing and provision of condoms and lubricants) in the Philippines and Viet Nam at 25%. Although China reported more than 75% coverage of such programmes, and a survey of Singaporean and Vietnamese men who have sex with men revealed a high rate of condom use (75%), HIV infection among MSM continues to grow, requiring governments to re-assess the effectiveness and quality of existing interventions.


A training package called “The Time Has Come” was jointly developed by WHO and the United Nations Development Programme. The package provides support for access to services for MSM and transgender people. Initial steps to address the health needs of transgender people included the preparation of a technical brief, Regional Assessment of HIV, STI, and other Health Needs of Transgender People in Asia and the Pacific.


Moreover, sudden “outbreaks” of HIV can occur. A recent survey showed a prevalence rate of 54% in Cebu City, Philippines, among injecting drug users, compared to 0.59% in 2009. China and Malaysia have expanded harm reduction programmes for injecting drug users, resulting in a decrease of new HIV infections. Efforts are under way to address the HIV and hepatitis C outbreaks among injecting drug users in Cebu City. Among countries with detention centres for people who use drugs, Malaysia and Viet Nam were the first to phase out compulsory detention in 2012.


The Western Pacific Region also has the highest number of new cases of curable STI in the world. STIs are major contributors to HIV transmission, pelvic inflammatory disease, infertility and cervical cancer. There were 127 million new cases, including 42 million people infected with gonorrhoea, 40 million with chlamydia, 600 000 with syphilis and 46 million with trichomoniasis. Syphilis is prevalent in more than 1% of pregnant women in at least seven countries in the Region.


Efforts are under way to strengthen STI surveillance in China, Mongolia and Pacific island countries and areas. Several countries in the Western Pacific Region have begun to consider a combined approach for the prevention of paediatric HIV infections and congenital syphilis. China and Viet Nam are including their hepatitis B control efforts as part of a triple (congenital syphilis, paediatric HIV and hepatitis B) elimination initiative with the support of WHO, to benefit from integrated strategies for increasing uptake of screening and interventions.




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