Pro­tect those most vul­ner­a­ble to HIV

China Daily (Canada) - - COMMENT -

Mon­day isWorldHealth Day. As the day ap­proaches, we should rec­og­nize the huge progress the world has made in the re­sponse to HIV. Glob­ally, newHIV in­fec­tions have fallen by one-third since 2001. AIDS-re­lated deaths have fallen to 1.6 mil­lion, com­pared with 2.3 mil­lion in 2005. More and more people liv­ing with HIV are leading long, healthy, pro­duc­tive lives.

In China, the cov­er­age of life­sav­ing an­tiretro­vi­ral treat­ment has in­creased more than ten-fold dur­ing the past 10 years; newin­fec­tions among people who in­ject drugs have fallen; and the num­ber of women re­ceiv­ing treat­ment to pre­vent mother-to-child trans­mis­sion of HIV has in­creased dra­mat­i­cally.

But de­spite these suc­cesses, we must con­tinue to strengthen our ef­forts. In China there are still ap­prox­i­mately 48,000 newHIV in­fec­tions ev­ery year, with sex­ual trans­mis­sion ac­count­ing for more than 80 per­cent of all newin­fec­tions. As is the case in many coun­tries, these are con­cen­trated among the most vul­ner­a­ble mem­bers of so­ci­ety, in­clud­ing men who have sex with men, sex work­ers, and people who in­ject drugs, pop­u­la­tions which are heav­ily stig­ma­tised and, in many cases, crim­i­nal­ized or other­wise sub­ject to ad­min­is­tra­tive ar­rest and de­ten­tion.

HIV test­ing rates among these pop­u­la­tions are low. Data from 2013 show that less than 40 per­cent of sex work­ers and people who in­ject drugs came for­ward to have them­selves tested, and only 45.6 per­cent of men who have sex with men had re­ceived an HIV test dur­ing the past 12 months. As a re­sult their risk ex­po­sure re­mains high. There is an ur­gent need to ex­pand cov­er­age of vol­un­tary coun­selling and test­ing, preven­tion, treat­ment and care ser­vices among these most vul­ner­a­ble pop­u­la­tions.

Ev­i­dence and in­ter­na­tional best prac­tice demon­strate that in so­ci­eties where those most vul­ner­a­ble to HIV are pro­tected and can ac­cess preven­tion, treat­ment and care ser­vices, more people do, and newin­fec­tions and deaths fall. While there is no sil­ver bul­let, a cru­cial first step is of­ten find­ing the de­ter­mi­na­tion to deal with laws or reg­u­la­tions that fuel stigma and dis­crim­i­na­tion, and drive those most vul­ner­a­ble un­der­ground, thereby fuel­ing the spread of HIV. Also key is build­ing the ca­pac­ity of com­mu­ni­ty­based or­ga­ni­za­tions to deliver ser­vices to pop­u­la­tions which are hid­den and dif­fi­cult to ac­cess.

In re­spond­ing to HIV and sex­u­ally trans­mit­ted in­fec­tions among sex work­ers, men who have sex with men and people who in­ject drugs, we have seen that holis­tic in­ter­ven­tions, such as com­mu­nity em­pow­er­ment ap­proaches, which seek to re­duce vul­ner­a­bil­ity and risk of in­fec­tion have proven most ef­fec­tive.

China has al­ready made strong progress in its re­sponse to HIV among vul­ner­a­ble pop­u­la­tions. In 2011, China be­gan scal­ing up “harm re­duc­tion” ap­proaches for people who in­ject drugs, and newin­fec­tions among drug users have fallen. China has also been suc­cess­ful in strength­en­ing the com­mu­nity re­sponse to HIV among men who have sex with men.

But chal­lenges re­main in scal­ing up ser­vices tar­geted at sex work­ers. Sex work­ers, par­tic­u­larly low-paid sex work­ers and other highly vul­ner­a­ble sex work­ers, ex­pe­ri­ence mul­ti­ple risk fac­tors, in­clud­ing high preva­lence of sex­u­ally trans­mit­ted in­fec­tions, low HIV risk aware­ness and vul­ner­a­bil­ity to vi­o­lence. In ad­dress­ing HIV among sex work­ers, there is a need to pro­mote greater com­mu­nity en­gage­ment and ex­panded cov­er­age of preven­tion, treat­ment and care ser­vices. This will re­quire stronger guar­an­tees for the rights of sex work­ers to health, dig­nity and free­dom from dis­crim­i­na­tion, com­bined with ef­forts to­ward de­crim­i­nal­iz­ing sex work and the re­moval of laws and reg­u­la­tions which hin­der the HIV re­sponse. One par­tic­u­lar area of con­cern is China’s sys­tem of “cus­tody and ed­u­ca­tion for sex work­ers”, un­der which sex work­ers can be de­tained for up to two years with­out ju­di­cial process.

Health ser­vices, in­clud­ing HIV and sex­u­ally trans­mit­ted in­fec­tion preven­tion ser­vices, which meet the spe­cific needs of sex work­ers should be made avail­able, ac­ces­si­ble and ac­cept­able. Vi­o­lence against sex work­ers is also a risk fac­tor for HIV that must be pre­vented and ad­dressed in part­ner­ship with sex work­ers and sex worker led or­ga­ni­za­tions.

In its re­sponse to HIV, China has con­sis­tently demon­strated a strong com­mit­ment and a will­ing­ness to do the things that work. Through work­ing to build an in­clu­sive so­ci­ety where the most vul­ner­a­ble can ac­cess ser­vices freely and eas­ily, China will be able to achieve ac­cel­er­ated progress in its re­sponse to HIV. This piece is is­sued by UNAIDS China, UNFPA China, UNWomen China, UNDP China and ILO China.

LUO JIE / CHINA DAILY

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