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ince 2011, the theme for World AIDS Day has been '€œGetting to zero: Zero new HIV infections. Zero discrimination. Zero AIDS related deaths'€. This year is no exception but what has changed is the new '€œtest and treat'€ guideline by the World Health Organization (WHO) on getting HIV treatment to more people.

But what is worrisome is how to make it happen in the current economic crisis and in the face of Free Trade Agreements (FTAs), such as the Trans-Pacific Partnership (TPP) agreement, that threaten public health interest especially in countries already struggling to meet the gap to treatment for people living with HIV/AIDS today.

While UNAIDS reports an encouraging increase of 2.2 million people placed on antiretroviral therapy (ART) as of June 2015 over the previous year, totaling 15.8 million people to date, the challenge will be in achieving the global goal of reaching 30 million people with treatment by 2020. This means 3 million new people on treatment each year.

The experience of Médecins Sans Frontières (MSF, Doctors Without Borders) teams piloting '€œtest and treat'€ in Swaziland shows that starting people on HIV treatment whose immune systems have not yet significantly deteriorated is accepted among this group and also feasible in resource-limited contexts.

Uptake was 82 percent among the group with a CD4 cell count above 500, which was comparable to the group with a count lower than CD4 500. MSF also implements '€œtest and treat'€ in South Sudan, a country facing precarious health situation, and are hoping to do so in other countries where it treats HIV patients as in Asia.

In order for countries to upgrade and implement the WHO guidelines, there must be a mobilization of political will and financial support, especially for countries with low HIV treatment coverage that otherwise risk being left behind.

In Asia, where awareness, stigma and access to diagnostics and treatment still pose huge challenges in meeting that coverage, it is a daunting task. In the Philippines, the state of the HIV epidemic is alarming with one newly-diagnosed case every hour; while in Malaysia medicines for HIV opportunistic diseases, for example Hepatitis C, is priced high and unaffordable. In the face of the continued medical challenges in the region, economic crises topped with restrictive free trade agreements, countries who may have signed this would be especially challenged.

The TPP trade pact, for example, is set to grant big pharmaceutical companies to prolong patent monopolies and delay access to life-saving and price-lowering generic medicines. Where generic competition had been the impetus for the great leaps in access to antiretroviral treatment in the early 2000s, thereby allowing the gains we see today, continued access to the growing necessary arsenal of needed antiretrovirals and treatment for comorbidities as tuberculosis and its resistant strains or hepatitis C '€” two of the most common diseases affecting HIV patients in Asia '€” would be endangered.

For Malaysia and Vietnam, two countries who have signed TPP from the region, it may be too late but not for those wanting to join. Indonesia, Thailand and the Philippines '€” three countries in the region at the forefront of protecting its people'€™s public health interest by implementing safeguards in their national patent laws '€” must reexamine their choices.

The success of '€œtest and treat'€ hinges on helping as many people as possible reach undetectable levels of HIV as early in their disease progression as possible. Governments must not risk the health of their people. Market gains should not trump public health interest. Signing the TPP as it is today is pushing back from commitments of ending the HIV epidemic '€” and we may never get to zero.
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The writer is Asia'€™s regional humanitarian representative of Médecins Sans Frontières.