Shamshad Akhtar and Michel Sidibé | 25 January, 2015

South China Morning Post - This century opened with the Aids epidemic at its peak. Now, 15 years later, new HIV infections are down significantly worldwide, while access to treatment has cut the number of Aids-related deaths by more than a third. These achievements are no accident.

In 2000, governments committed to the Millennium Development Goals, which addressed the greatest challenges of our time, including halting and starting to reverse the spread of HIV. The progress since then fulfils a promise and proves that strong leadership and sustained engagement deliver results.

Still, much more remains to be done. This year, the international community will need to again show bold action in charting a path forward on HIV. In September, as the deadline for achieving the millennium goals approaches, governments will decide on a new set of sustainable development goals.

To help define the future of the HIV response, governments across the Asia-Pacific region, together with civil society and other partners, are gathering in Bangkok this week at a major regional meeting.

Since HIV first emerged, the region has been a leader in demonstrating political commitment and investing resources to address the epidemic. Initiatives like Thailand's programme to promote safer sex have been widely replicated. However, if the region is to continue to be a pioneer, governments must urgently confront several challenges head-on.

Perhaps the biggest is ensuring sustainable financing for HIV programmes. More than US$2 billion has been mobilised for Asia and the Pacific, but international donors account for nearly 40 per cent of the funding. This is not sustainable.

Clearly there is scope for greater domestic spending, given the region's economic dynamism. China is an example of what is possible. Between 2006 and 2013, it increased spending on HIV programmes seven times. Now, China has made the transition to full self-reliance, even in the face of one of the most serious Aids epidemics in the region.

While some low-income countries will continue to need support from international donors, governments must share responsibility and invest significantly. Otherwise, they risk losing the gains they have worked so hard to secure.

It is equally important to get more value for money. As member states of the UN Economic and Social Commission for Asia and the Pacific (Escap) have recognised in past resolutions, the populations most affected by the HIV epidemic include sex workers, men who have sex with men, transgender people, and people who inject drugs.

Yet, despite this knowledge, many countries are underfunding precisely those programmes which would make the most impact. Only an estimated 8 per cent of overall Aids spending is for HIV prevention among high-risk populations.

To get results, health authorities must work with civil society to promote community-based HIV services for the people who need them most. Two-thirds of key populations don't know their HIV status. It is important to offer simple but effective tests in communities.

However, ensuring a full return on investments doesn't only depend on funding. Stigma and discrimination prevent people living with HIV and key population groups from accessing essential services.

Almost every country in the region has laws, policies or practices that hinder the Aids response. For example, 42 countries criminalise some aspect of sex work and 21 countries prohibit same-sex sexual relations. Such laws and policies are unjust and increase risky health behaviour. They must be reversed.

Some 1.5 million people living with HIV in Asia-Pacific are accessing life-saving treatment. While this is a big success, it poses a challenge for the sustainable funding of the Aids response. To compound the problem, millions more still need treatment. Governments will need to meet demand in the coming years, including new and more expensive antiretroviral treatments.

The region has the potential to meet this challenge. It is a hub of entrepreneurial and scientific innovation which makes affordable HIV treatments and other commodities on a large scale. Indian manufacturers, for example, already provide the bulk of the generic antiretroviral treatments used in low- and middle-income countries.

Ending the Aids epidemic in Asia and the Pacific is possible, as long as countries have the courage and wisdom to take the right kind of action. Governments must invest significantly more in their response and refocus their efforts on higher-risk groups. Finally, they must promote scientific innovation and affordable access to life-saving medicine. Such bold action will help propel the world to end the Aids epidemic, once and for all.

Shamshad Akhtar is a UN undersecretary general and executive secretary of Escap. Michel Sidibé is a UN undersecretary general and executive director of the Joint United Nations Programme on HIV/AIDS

Source: http://www.scmp.com/comment/insight-opinion/article/1690067/ending-aids-epidemic-battle-asia-can-win