A fast-track to end the AIDS epidemic
J.V.R. Prasada Rao
The Jakarta Post
Home to the third-largest number of people living with HIV in Asia and the Pacific, Indonesia is a country critical to ending the AIDS epidemic in the region and on this World AIDS Day we are at a defining moment.
Only three decades since HIV arrived in this country, we can begin to close the chapter on one of modern history's worst epidemics. In September, Indonesia was one of 193 United Nations member states to adopt the Sustainable Development Goals and commit to ending the AIDS epidemic as a public health threat by 2030.
This goal is certainly ambitious but it is achievable. Even without a vaccine or a cure, we know how to stop HIV. Indonesia can pride itself on being a pathfinder in the AIDS epidemic on the global stage.
In 2013 the Indonesian government launched the Strategic Use of AIDS (SUFA) policy ' a pioneering strategy that made antiretroviral treatment available immediately for any person diagnozed with HIV. Providing early treatment has the double advantage of keeping people living with HIV healthy and stopping further transmission of the virus. Last month, the World Health Organization endorsed a similar policy for all countries.
The program has now been rolled out in 75 districts. The number of ART sites has more than doubled since 2008 and more than 50 000 people were accessing HIV treatment in 2014, compared with less than 2 500 in 2005. The program is a good indication of how the Indonesian government has sought new and innovative approaches in responding to HIV, and is one of the first in Asia to use treatment as prevention in reducing HIV transmission.
At the end of 2014, just a year and a half after the SUFA program was launched, HIV testing has reached slightly more than 1 million people, which is more than five times the number tested in 2010. There has been a massive expansion of prevention services, including condom distribution in key locations and harm reduction programs for people who inject drugs.
This scaling up of prevention and treatment services has been possible because of Indonesia's investment in its AIDS response and the commitment made to fund HIV treatment for its citizens, which has reached more than US$60 million in 2014. The partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria and other international partners has also provided very critical support during the early stages of the epidemic.
Thanks to the rapid expansion of prevention and treatment programs between 2004 and 2014 nearly half a million new HIV infections have been averted, saving Indonesia billions in treatment costs and avoiding the devastating social, economic and personal impact of the disease on many families and communities.
While the country has implemented a pioneering policy on HIV treatment for everyone living with HIV, its treatment coverage is far lower than the global average.
If Indonesia is to meet its commitment to end the AIDS epidemic by 2030, it needs to urgently intensify and scale-up its HIV response.
It is one of 35 countries that UNAIDS has identified as a priority country which must adopt a Fast-Track approach, by front-loading investments and initiating efficient and innovative approaches over the next five years in order to reach critical HIV prevention and treatment targets.
Jakarta is at the heart of Indonesia's AIDS epidemic, and although it has only 6 percent of the country's population, Jakarta accounts for almost 17 percent of the total number of people living with HIV living in Indonesia.
A month ago the Governor of Jakarta, Basuki 'Ahok' Tjahaja Purnama took the bold step of committing to the UNAIDS fast-track approach by signing the Paris Declaration, which has garnered support from city leaders around the globe. He has also formally instructed the mayors of the five Jakarta municipalities to develop their work plans and budgets in line with the fast-track targets.
Jakarta has taken many key measures to promote HIV testing, devoting a month a year to encouraging companies to conduct tests.
All city residents can access free HIV testing. Jakarta province is developing a roadmap that will ensure that all its six municipalities allocate resources in a coordinated fashion, setting ambitious targets for testing and treatment, and clear milestones to monitor progress.
Time and time again, we have seen that investing in the AIDS response brings huge rewards. Implementing the fast-track strategy in Jakarta and throughout the country carries a big price-tag ' more than $500 million over the next five years. At the moment the country shoulders 57 percent of its AIDS budget but as the economy grows, international donors will increasingly withdraw.
Indonesia must set out a clear strategy for transitioning to a largely domestically funded response. Provinces and districts will need to assume a greater share of the cost of local responses, and will need to come up with clear plans for mobilizing resources and to already start developing their transition plans, just as Jakarta has begun to do.
Of critical importance will be ensuring that the new national health insurance (JKN) covers the cost of the bulk of HIV-related services. There is also scope for making service delivery more cost-effective, both through better integration of HIV services in the health sector and by strengthening coordination between health facilities and community-based organizations (CBOs) on HIV testing, care and support.
While funding is a concern, I am even more concerned by the frequent calls by certain religious and public figures to close down brothel complexes in the country.
Such action can only undermine existing programs in brothel settings, which we know have been effective in promoting condom use and reducing transmission of HIV. Closing brothels will not stop sex work and will instead create a situation where HIV will find a favorable environment to spread among sex workers and their clients.
As we commemorate World AIDS Day, we have a precious window of opportunity to make a difference and build on the foundations which have been put in place during the past 10 years.
We have the opportunity to set more ambitious targets for treatment and prevention and invest more domestic resources on the AIDS response just as the Jakarta governor has committed to do.
By investing in the AIDS response the government will prevent HIV from impacting hundreds of thousands of lives and ensuring that those already living with HIV can lead healthy, productive lives. These benefits impact not only the individuals concerned but promise a better future for their families and communities as well.
The writer is the UN secretary-general's special envoy for AIDS in Asia and the Pacific.
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