I was fortunate to be the first WA AIDS Council employee to benefit from collaboration with the Australia Federation of AIDS Organisations (AFAO) to take part in a three month secondment in Bangkok, from March to June 2015.
While based in Bangkok I had a role in working on a number of projects in various countries/regions such as Pacific Islands, Myanmar, Malaysia and Laos. During this time I went on country visits to both Myanmar and Malaysia, to work directly with Men who have sex with Men (MSM) and Transgender national networks.
In order to keep an international focus and connection, I returned to Bangkok later that year to participate as a rapporteur in a Regional Pre-Exposure Prophylaxis (PrEP) Consultation - which explored feasibility of PrEP pilot programmes in cities around South East Asia.
In the first half of 2016 I have been dedicating some of my time from the Perth office to follow up with eleven countries in the region to report on their progress toward PrEP pilot programs in their major cities. The goal of this work can broadly be described as strengthening and supporting civil society (both individuals and community based organisations/networks), to actively participate in their country’s national HIV strategies.
Strengthening civil society is crucial work, as in many contexts the voices of those most impacted by HIV have been ignored due to stigma and discrimination. As a result, strategies to prevent and treat HIV have proven less successful, because of a lack of consultation and engagement with the people requiring services. A solution to this issue is to have informed, empowered civil society advocates involved in every aspect of the HIV response- from treatment to prevention, spanning strategies in planning, implementation and evaluation. To achieve this, it is important for advocates and civil society across regions and countries to come together, and support each other through sharing information, strategies that work, and ways to adapt various solutions/strategies to each unique cultural context.
This process is best viewed as one of mutual respect and learning, in which everyone can share their expertise for the purpose of advancing civil society influence in each region. There is no “teacher” or “student” in such an exchange, rather powerful mutual learning and innovative brainstorming to overcome barriers which previously may have seemed insurmountable. This is the benefit and power of solidarity and partnership between regions, standing together we are much stronger than if we are separated and alone.
Apart from the benefit to the civil society of countries in the Asia Pacific Region, it also makes good strategic sense for Australia to focus some of its resources, including workforce, on our nearest neighbours. West Australia is a good example of how HIV epidemics in our region impact on our own. Epidemiology consistently demonstrates that a significant proportion of HIV diagnosed each year is linked to overseas epidemics. We have been innovative and proactive in engaging with this reality through excellent programmes like “Sex in Other Cities”, which aims to inform travellers and ex-pats about additional risks they could encounter in countries with higher prevalence of HIV. These efforts need to be maintained. However, it is also wise and ethical to consider how we can assist these countries to respond to their HIV epidemics. Reducing priority groups risk and marginalisation in country, is both the right thing to do ethically, as well as strategically, if we want to have an impact on the role the region’s HIV epidemics play in our own.
Furthermore, taking a more regional approach in our work also aligns to global strategies aimed at ending HIV as an epidemic by 2030. For this goal to be achieved, resources and focus needs to be efficient and targeted to those most in need and in ways that will have the maximum impact. In many South East Asian countries, while HIV rates are reducing amongst the general population due to more access to treatment and services, MSM and transgender women continue to be disproportionately represented in HIV epidemiology and in most cases rates are rising, especially in the large city centers. This discrepancy can be seen as the result of a lack of human rights and unequal access to essential resources. It is unacceptable and must be addressed if we are to successfully end HIV as an epidemic and achieve equality for all.
Most at-risk populations need enabling environments which include access to: combined and comprehensive prevention methods (from condoms to PrEP): friendly testing services which ensure results are received; linkages to care if diagnosed; support to cope with diagnose; early access to treatment with focus on retention to care; opportunity to maintain undetectable viral loads; and the right to live productive lives free from HIV-related stigma and discrimination. In many contexts this is a tall order and can appear a long way off, which is why pooling resources, expertise and support across regions is crucial.
We cannot and should not focus exclusively on our own backyard, when there is substantial need so nearby.
To further illustrate how important meaningfully contributing to supporting affected communities to respond to the HIV epidemic in some of our nearest neighbours are, we can look to current epidemiology and trends. Indonesia, Myanmar and Viet Nam are listed in the UNAIDS 2016-2021 strategy as amongst the 35 “fast-track” countries, which are recommended to be particularly focused on as collectively they account for over 90 per cent of people acquiring HIV, and 90 per cent of people dying from AIDS-related causes worldwide. If resources are applied to these epidemics in efficient ways (which we know can only happen if key populations are informed, empowered and participating), we could avert 28 million HIV infections and 21 million AIDS-related deaths between 2015 and 2030. Furthermore, other countries in South East Asia require support and resources to respond to epidemics amongst MSM and transgender women in their large urban centers such as Bangkok, Hanoi and Jakarta, where prevalence ranges from between 15 to 25 per cent and is rising.
Finally, particular attention is warranted for middle-income countries in the region, such as Malaysia, which face a potential HIV funding crisis. The ineligibility of middle-income countries for assistance from international donors threatens gains made, especially for programs focused on key populations such as MSM and transgender women, due to a lack of political good-will within the country. New funding strategies and strategic partnerships for civil society organisations which address complex socio-political and religious barriers are urgently required.
I felt privileged to work with AFAO International in Bangkok and am excited to have been able to continue this work beyond the three month secondment. It has been personally and professionally rewarding and I have gained a great deal. I also hope that through this short article I have demonstrated that this initiative is more important than one individual’s experience, and one secondment period. |
We stand at a precipice in the global response to the HIV epidemic, with more opportunities than ever before to make meaningful differences and end HIV within two decades. This can only be achieved if civil society scale up our responses and truly pull together, standing in solidarity with all of our resources and expertise honed in on the same goal. This targeted approach must consider the resources available and how to make them count the most.
I believe this secondment initiative between the WA AIDS Council and AFAO is an important, innovative step in that direction.
This article features in the STYLEAID 2016 TAROT Magazine and featured in our monthly eNewsletter. Subscribe here.