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Candlelight Memorial 2012: Towards Zero AIDS-related Deaths
Source: | Author:hkb980dd | Published time: 2012-05-18 | 213 Views | Share:
Since its initiation in 1983, the International Candlelight Memorial, which falls on the third Sunday of May, has served as an occasion to remember colleagues, family and friends who have died of AIDS. This year, people worldwide will come together on 20th May to light candles, remember those lost to AIDS, and call on governments and individuals to take action to prevent further AIDS-related deaths.
 
Today, as a result of strong government commitment to the AIDS response, and increased public awareness, more than 120,000 people are receiving life-saving antiretroviral treatment (ART) for HIV in China. Moreover, China has set out ambitious new targets in its new Five Year Action Plan (2011-2015) to reduce AIDS-related deaths by 30%, and  cut new HIV infections by a quarter by 2015. For China to succeed in achieving these ambitious goals there is a need to rapidly increase coverage of HIV testing, treatment, and HIV prevention services particularly among populations at increased risk of HIV.
 
Testing: Opening the Door to Treatment
 
Despite a significant increase in ART coverage witnessed in 2011 (increasing from 65,481 treatment recipients in 2009 to 126,448 in 2011), the fact remains that only 42% of Chinese PLHIV requiring ART are accessing it. One of the key reasons is that the majority of those living with HIV in China are still unaware of their HIV status due to low uptake of testing. While coverage of testing has increased dramatically in recent years - with over 84 million HIV tests carried out in 2011 - HIV testing rates amongst those most at risk remain low. In 2011, for example, only around 40 percent of people who inject drugs, and less than 40 percent of sex workers accessed testing and were aware of their test result.
 
Currently, many people are being diagnosed with HIV too late, most often after seeking treatment following the onset of symptoms. By this point, their immune system has already been considerably compromised, reducing the potential for effective treatment and leading to higher mortality.
 
The importance of testing was underscored by Zhang Lan, Program Officer at WHO China. “There is an urgent need to scale up testing, particularly amongst those at higher risk of HIV infection, such as sex workers, people who use drugs and men who have sex with men,” explained Zhang. “If those who are already infected do not receive treatment and gain access to other preventive interventions, there is potential for many more people to be infected.”
 
Findings from research carried out in 2011 showing that people receiving ART are 96% less likely to pass on their infection to others further highlighted the importance of early diagnosis and treatment. “This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
 
Promoting testing amongst marginalised populations such as men who have sex with men (MSM), people who inject drugs (PWID) and sex workers (SW) can be a challenging undertaking, but there are a number of key steps which have been shown to be effective. Firstly, there is a need to promote the involvement of community based organisations (CBOs) in testing. CBOs are often able to access marginalised populations more easily, and provide convenient services in the community.
 
Secondly, concrete action is required to eliminate the stigma and discrimination regularly faced by PLHIV and those at increased risk of HIV. In China, as in many other countries, discrimination remains a serious problem. In China it is estimated that more than a quarter of people living with HIV  have experienced discrimination from medical staff, and more than one-third  had experienced discrimination from government officials; Almost one in ten said that their children had been forced to leave school, despite not being HIV positive themselves; such discrimination, both from the public and in institutional settings such as hospitals, schools and workplaces, drives those at risk underground and prevent them from seeking testing.
 
Thirdly, it is essential to ensure that all HIV testing is carried out on a voluntary basis, and that confidentiality of test results is guaranteed. Such privacy protections allow those seeking testing to do so free from fears that their status may be made public, and increase willingness to test.
 
Optimised Approaches to Treatment: The Key to Reducing Mortality
 
While China has managed impressive scale up of ART in recent years, there is a need for greater optimization of treatment regimens and delivery models to improve access and treatment adherence.
 
One important step forward will be the wider provision of first-line treatment regimens based on the antiretroviral medication Tenofovir (TDF), which China has included in its latest treatment guidelines. TDF-based first-line regimens, which are set to be introduced nationwide, are known to cause fewer side effects than other medications currently used in China, and are used in a number of countries, including the US, UK and most of Western Europe, as well as being recommended by the World Health Organization (WHO).
 
Addressing barriers to treatment access will also be key. Currently, PLHIV are often required to return to their place of residence registration (hukou), to access treatment, which can present a significant obstacle to migrant workers and other people living away from their place of hukou.
 
In terms of managing treatment, action is needed to simplify delivery of diagnostic procedures and testing. Currently various procedures such as viral load testing and CD4 testing are often carried out in different locations, and those accessing testing may have to wait long periods of time to collect results, making it hard to modify treatment regimens in a timely manner based on the current physical condition of the treatment recipient.
 
Adherence counseling and treatment monitoring need to be strengthened and fully integrated with treatment provision, to ensure that treatment recipients are adhering to treatment regimens and managing their condition effectively.
 
Thomas Cai, Director of AIDS Care China, a CBO which provides treatment to over 30,000 PLHIV in southern China, gave more detail. “China’s Four Frees, One Care” policy guarantees access to treatment to those who require it, but for many, the practicalities of accessing treatment can be quite challenging. By exploring optimized, integrated approaches, where a range of services are provided together with treatment, we are able to improve treatment adherence and generate better treatment outcomes,” said Cai.
 
Community Participation: An Irreplaceable Component
 
Promoting stronger CBO participation in China’s AIDS response is an essential step for improving coverage of prevention and treatment services. CBOs act as a channel for feedback and transmission of information between service recipients and policy makers, leading to stronger policies based on realities on the ground. CBOs also have an important role to play in raising awareness and generating behaviour change. Gao Fei, a member of staff at the Beijing Sunshine Community Organisation, outlined the importance of this role. “Usually, before we give our clients the facts, we need to fix their misunderstandings,’ said Gao. ‘For example, some people think that by delaying their initiation onto treatment, they can delay the progress of AIDS.’
 
Ma Guihong, from Hebei’s Half the Sky Women’s PLHIV Support Group described how her organisation promotes testing and treatment adherence. ‘First of all, we provide counseling to familiarize those who seek from help from us. Secondly, we encourage those who are eligible for treatment to get on ART as soon as possible, and remind them to take pills on time by sending them text messages.”
 
To be able to participate effectively, CBOs need to be able to register easily, and gain access to funding. Ensuring full participation of CBOs in all stages of policy making is also critical to ensure that policies respond to the needs of those they seek to serve. “Grassroots organizations face two major obstacles: one is lack of financial assistance, the other is registration,” Gao Fei told UNAIDS. “Getting our organizations registered remains too difficult.” Ma Guihong emphasised the value of CBO participation. “Sincere partnership between government and CBOs is of fundamental importance. Together we can bring more benefits for PLHIV and the AIDS response as a whole.”
 
Working Together to Achieve Progress
 
As people gather to commemorate this year’s Candlelit Memorial, it is important that we remember the impressive progress which has been achieved in the response to HIV. But at the same time, we must also continue to ensure that efforts are not diminished in the face of these successes.
 
Through continuing to explore new and effective approaches to HIV prevention and treatment, and by ensuring that all sectors of society are participating in the response, China will continue to make progress towards achieving the UNAIDS vision of Zero New Infections, Zero Discrimination and Zero AIDS-Related Deaths.