HIS EXCELLENCY RATU EPELI NAILATIKAU
CF, LVO, OBE (Mil), OStJ, CSM, MSD
PRESIDENT OF THE REPUBLIC OF FIJI
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LEADERSHIP FORUM ICAAP 11
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Bangkok Sunday,17thNovember, 2013
THAILAND
1330hrs
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A WORLD WITHOUT AIDS: GLOBAL DEVELOPMENTS AND ASIA AND THE PACIFIC LEADERSHIP FOR ENDING AIDS


 The Chairperson of the Leadership Forum for ICAAP 11
 Distinguished Participants
 Ladies and Gentlemen

"I have walked that long road to freedom. I have tried not to falter; I have made missteps along the way. But I have discovered the secret that after climbing a great hill, one only finds that there are many more hills to climb. I have taken a moment here to rest, to steal a view of the glorious vista that surrounds me, to look back on the distance I have come. But I can only rest for a moment, for with freedom come responsibilities, and I dare not linger, for my long walk is not ended.”
― Nelson Mandela

Leaders, what is our freedom? Is it a freedom to a world without AIDS? An Asian Pacific region with zero new HIV infections, zero AIDS related deaths and zero discrimination?

Over the past decade since the evolvement of HIV & AIDS in the Asia Pacific region, countries have mounted vigorous and innovative responses to the epidemic.

These responses have not only been implemented by the health sectors, but also by other support organizations, with its vision linked to the Millennium Development Goal 6 - “combat HIV/AIDS, malaria and other diseases” - and the target to halt and begin to reverse the spread of HIV & AIDS by 2015.

The birth of a bold vision three years ago by the UNAIDS Programme Coordinating Board (PCB), to zero new HIV infections, zero discrimination and zero AIDS-related deaths, has inspired hope, changing the impossible to the possible in the response, and also inspired renewed action and results. This vision has now become a global AIDS movement.

The HIV epidemic is posing a very serious health and developmental problem in the Asia Pacific region especially when the potential for epidemic growth is real.

Since the extensive spread of HIV began at the end of the 1980s, statistics show that there are 4 900 000 people living with HIV, 350 000 new infections and an increase from 80 000 deaths as reported in 2010 to 270 000 deaths to date.

Close to 35% of people living with HIV are women and 7% of new infections are children. The HIV epidemic has also expanded rapidly across urban areas amongst men who have sex with men.

Although the region is still behind the global trend with antiretroviral therapy, 1.25 million people in need of treatment are receiving ART. There is 19% coverage of prevention with parent to child transmission which is still 62% below the global average.

Financially, AIDS spending is domestically sourced in 20% of the region’s low and lower middle income countries and in 87% of the upper middle income countries.

Looking back over the past decade, the region has made significant progress in the AIDS response.

National guidelines for implementing provider-initiated testing and counseling, including HIV testing and counseling for the key affected populations is in place.

The number of sites providing HIV testing and counseling services has increased by over 260% between 2007 and 2010, from 7008 to 18 539 sites and this number is still increasing.

Implementation of prevention intervention for key populations is an essential component of national HIV control efforts.

Scaling up and implementation of targeted interventions such as peer education and outreach programs, accessibility and availability of condoms or the 100% condom use program (100% cup), has contributed to the containment of the HIV & STI epidemic, not only in female sex workers but also with other key affected populations in the region.

There has been an increase in the number of people receiving ART as compared to a total of 203 000 people in 2010 including pregnant women with HIV for the prevention of mother to child transmission (PMTCT).

Although Antiretroviral Treatment for the prevention of mother to child transmission varies considerably among reporting countries in 2010, it stood at 88% and 89%, respectively in Malaysia and Fiji.

While we are still challenged with the control of chlamydia and gonorrhea infection especially with asymptomatic cases, a gonococcal antimicrobial resistance surveillance programme is in place in several Asia-Pacific countries with results that has led the region to use third–generation cephalosporins to address the high rates of antimicrobial resistance.

With the support from the World Health Organisation, most Asia Pacific countries have improved their surveillance systems in the past five years, and we now have more reliable data on the extent, trends and determinants of the HIV epidemic in the region.

We are also able to measure the impact of interventions and to properly guide public health decisions concerning HIV & AIDS.

I have no doubt in my mind that if we continue to use that knowledge to select the most appropriate interventions, we can make a difference.

Other health programmes such as TB, STIS and NCDS (to name but a few) are now linked with HIV to strengthen and enhance the coverage, promote uptake, optimize program management so as to ensure sustainability in the link of HIV services. This allows the key affected population to access appropriate health care services for optimal treatment, monitoring and management.

Very few countries with limited resources have been able to reduce HIV transmission, but, where activities have been successful, they have been guided by adequate epidemiological knowledge.

The above achievements to name a few, reflect the synergistic efforts of diverse stakeholders – the leadership and commitment of national governments, the solidarity of the international community, the innovation by programme implementers, the historic advances achieved by the scientific research community and the passionate engagement of civil society, most notably people living with HIV themselves.

As a result of working together, many countries within the region are now within reach of achieving several of the key targets outlined in the 2011 UN Political Declaration on HIV and AIDS, and they are thus making clear progress towards MDG 6.

Leaders, we cannot rest at the moment with our response to the epidemic. We can only reflect back at the successes that we have made together as leaders with the engagement of programme implementers, civil society and people living with HIV. These successful steps also come with missteps along the way which we need to strengthen and improve.

We need to strengthen strategic health communication strategies in our preventative programmes, and also continue with our treatment and the continuum of care services, especially to our targeted population to further reduce the number of new HIV infections.

As HIV testing and counseling services progresses, there is a need to strengthen the linkages between HIV testing and counseling and other established services to maximize uptake of prevention and treatment interventions. For example, what proportion of those tested positive have access to care and treatment.

Achieving zero discrimination and target 8 in particular – quote “eliminate stigma and discrimination against people living with HIV and affected by HIV, through promotion of laws and policies that ensure the full realization of all human rights and fundamental freedoms” unquote – is a subject that is close to my heart, and no doubt in your hearts as well.

Stigma remains a major impediment to the provision of effective prevention, treatment and care responses across the region.

The people who are most vulnerable to HIV often experience multiple levels of stigma due to their status as a sex worker, drug user, or as a man who has sex with other men, as well as a perception that these groups are a vector for diseases such as HIV, sexually transmitted infections (STIS) and hepatitis.

HIV-related stigma is a major disincentive to people presenting for testing and treatment and drives people away from prevention and care services.

Strong political and community leadership including from people living with HIV/AIDS can play a critically important role in tackling stigma and discrimination.

Pacific Island Countries have a history of leadership in the AIDS response, and Fiji has risen to the challenge of removing legal barriers to effective HIV programmes and tackling stigma and discrimination through legal reform.

In Fiji, we saw that the constant threat of arrest conviction and incarceration faced by men who have sex with men increased their vulnerability to HIV and made them hard to reach.

Fiji became the first Pacific Island country with colonial-era sodomy laws to formally decriminalize sex between men when the Fiji National Crimes Decree was passed in February 2010.

In February 2011, the Government of Fiji enacted the Fiji HIV/AIDS Decree. This was internationally compliant in addressing human rights violations that acted as barriers to the HIV response. The Decree was amended six months later in August, and removed HIV-related restrictions on entry, stay and residence, adding Fiji to the growing list of countries that are aligning national HIV legislation with international public health standards. The Decree also removed HIV-specific criminal offences for HIV transmission or exposure.

The benefits of these legal changes have materialized with improved access to services for those in our population most at risk of HIV.

Our work in Fiji is not done, but the Decree was a significant starting point in harnessing the protective power of laws to tackle stigma and discrimination head-on and to bring our country closer to the goal of an end to AIDS.

As a region, we have learnt a few lessons worth emphasizing in our work in addressing target 8.

First, evidence is showing that increased investment in the programmes to monitor and reduce stigma and discrimination and to increase access to justice is critical for the achievement of broader HIV investment goals.

Second, the number of governments in Asia and the Pacific that acknowledge that HIV-related stigma and punitive legal environments are holding back progress is growing.

Third, those countries that have taken bold action on stigma and discrimination report better results in achieving the 10 targets.

As leaders, we must not turn a blind eye to the global economic downturn that limits the availability of resources from donor partners, potentially putting additional strains, to cover for any domestic shortfalls within our domestic budgets.

This decade will bring a greater pressure to national programmes that are affordable and sustainable within a government funded context.
Health system strengthening is essential in the scaling up of HIV related services. There is a need to employ evidence-informed policies and guidelines to ensure the optimal use of resources and a more sustainable response to HIV & AIDS.

We need to continuously review and renew our efforts and our commitments as leaders and partners on our response to HIV & AIDS, especially to our commitments in achieving and sustaining universal access to antiretroviral treatment.

As leaders and policy makers, we need to recognize the importance of sustaining funding for ART to protect our current achievements, and also to enhance treatment and prevention outcomes.

We need to learn from Cambodia’s success story, in achieving universal access, through the adoption of a continuum of care approach that links testing, care, treatment and community based support.

The global HIV/AIDS epidemic is an unprecedented crisis that requires an unprecedented response.

Nelson Mandela once said and I quote - “when the water starts boiling, it is foolish to turn off the heat” – unquote.

The gains on our response to HIV & AIDS are still fragile and sustainability on these gains is crucial to breaking the epidemic trend.

Paving a pathway to end AIDS and reaching the 2015 MDGS and High Level Meeting (HLM) targets, is only possible if we lay out a comprehensive approach to meet the challenges of the epidemic.

In these few minutes, we have looked back on the distance we have come through and the journey we have taken in the response to HIV & AIDS.

And I say this as an appeal to leaders: our journey has not ended. We cannot rest because we still have many more hills to climb.

Let us be reminded as leaders, that HIV & AIDS are no longer merely domestic or humanitarian, but also global and strategic.

We need to work together to prevent the epidemic from further undermining the social, economic, and political systems that underpin our nations and our entire region.

With the AIDS movement, human rights, public health, national security, sustainable development and leadership need strengthening. Leadership must be strongest among them.

It is my hope that through this mutual dialogue, we can drive sustained action to further progress and achieve the results to get the Asia Pacific region to the ultimate vision of - zero HIV infections, zero discrimination and zero AIDS-related deaths.

Distinguished participants, ladies and gentlemen, thank you for your attention.

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