ASIA: Testing, Counselling Key in Coping with HIV, AIDS

By Lynette Lee Corporal

BANGKOK, Jun 11 (IPS Asia-Pacific) - Reduced prices of AIDS drugs and increased global funding will be useless if countries do not get their acts together in implementing prevention programmes for the pandemic properly and efficiently.

There is much to be done on the country level in order to dramatically decrease the spread of the disease, according to experts who attended a three-day technical consultation on the expansion of HIV testing and counselling services held in Cambodia this week. The dialogue, coordinated by the World Health Organisation (WHO), the United Nations Children's Fund (UNICEF), and the United Nations Programme on HIV/AIDS (UNAIDS), was held on Jun. 4 to 6.

"The resources are there and are adequate enough. What we lack is a good programme in the country level. Countries need to improve upon their managerial and technical capacity to implement these programmes," Dr JVR Prasada Rao, UNAIDS Regional Support Team for Asia and Pacific regional director, said in a phone interview from the Cambodian capital Phnom Penh.

The meeting looked at existing testing and counselling policies and practices among countries in the Asia-Pacific. Global guidelines and expansion schemes for effective testing and counselling were also discussed.

Figures show that some 8.5 million people in the Asia-Pacific region were living with HIV as of 2006. In the same year, about a million more became infected with half a million dying of AIDS-related ailments in the region. Worldwide, there are about 40 million people suffering from the disease.

Global funding for HIV/AIDS has increased to 8.3 billion U.S. dollars, from a mere 2 billion dollars in 2001, according to Medicins Sans Frontiers (Medicines without Borders).

"This is just the beginning of a long process. We're not trying to provide ultimate answers and there won't be a single recipe for the issue as it would be impossible. The solution can only be defined at the country level," Dr Massimo Ghidinelli, WHO/Western Pacific Regional Office' HIV/AIDS and STI unit regional advisor, explained in an interview,

The lack of access to the testing and counselling services has been a major obstacle for a huge number of people. Depending on the countries, experts say that voluntary testing sites are already in place, while provider-initiated testing and counselling (PITC) services are now being expanded. But poor infrastructure and inadequate human resources, they say, prevent the said services from being introduced and applied.

Unfortunately, noted Dr Rao, discrimination and stigma still persists. There is still that misperception that the disease is a "one-way ticket" and that there's no way out. "But today, thanks to available treatment, infected people can live long and healthy lives. They need to know that it's something that people can cope with," he added.

"The Philippines, for example, has good anti-discrimination laws but there are other countries that need improvement on this matter. In India, for instance, there are many anti-discrimination bills presented by lawmakers but most of these still hasn't gone through or passed in parliament," he said.

Voluntary testing and counselling services can easily be accessed through stand-alone stations, health facilities as well as outreach and mobile services. The most recent type is the PICT, which is recommended by health care providers in the communities. Though different in approach, both types strictly adhere to the '3 Cs' — (informed) consent, counselling and confidentiality.

"The PICT has only been implemented in limited areas before they are scaled up nationwide," said Shiba Phurailatpam, coordinator of the Asia-Pacific Network of People Living with HIV/AIDS Thailand.

Unfortunately, said Shiba, many people still have no access to both the PICT and readily available treatment.

"This dialogue is useful as it brings attention to the resources, especially for those who are not aware that such approaches exist. But as for implementation, we need to go back to the country level. There's a lot of things to be discussed and we have to make sure that care and treatment programmes are already in place," he explained.

Thailand has more than 600,000 people living with HIV, and 300,000 have died from AIDS. In May 2007, the country decided to invoke global trading rules to break patents on expensive drugs for AIDS, which resulted in an uproar among powerful pharmaceutical companies.

The services are especially crucial to children living with HIV. "It's good news that there are now more services provided for children, which have different needs because of their legal status, varying maturity levels, and special skills needed to do the tests," said UNICEF Cambodia representative Dr Suomi Sakai.

According to Sakai, dealing with children require a great balancing act as there are legal issues to consider especially when it comes to getting informed consent to do the testing. "For example, how do you deal with the issue of kids who have no parents or guardians, especially streetchildren?

"We also have to remember the child's right to express his views, to be heard and be part of the decision-making process based on their levels of maturity," said Sakai, who added that there is no right or wrong answer to this very challenging issue. "This needs to be discussed carefully in the society on the country level."

As for counselling, Sakai said that 50 percent of Cambodian children living with HIV have already received counselling. Unfortunately, the other half has been hampered by the lack of awareness and access.

"Physical access to the services is constrained in many parts. Children have to be accompanied by adults. There are multi-faceted reasons why children don't have access, but it's improving and that's good news," she said.

Ghidinelli urged the public and private sectors to join hands, he said. "We must look at this in the long-term. Donors will always be there but what we need are domestic resources and the commitment of everyone," said Rao. (END/LC/070607)