Have political commitments to end AIDS driven improvements in women’s sexual and reproductive health in Asia?

A major commitment to end AIDS is evident in the Association of Southeast Asia Nations' (ASEAN) declaration with its focus on the three Zeros: getting to zero new HIV infections, zero discrimination and zero AIDS-related deaths.

A major commitment to end AIDS is evident in the Association of Southeast Asia Nations’ (ASEAN) declaration with its focus on the three Zeros: getting to zero new HIV infections, zero discrimination and zero AIDS-related deaths.

Adopted in 2011, the declaration reaffirms to “accelerate progress in achieving Millennium Development Goal 6 which specifically refers to halting and reversing the spread of HIV and AIDS, and other related MDGs by 2015; and the 2010 High Level Plenary Meeting of United Nations General Assembly on MDGs entitled Keeping the Promise: United to Achieve the Millennium Development Goals.”

But Jet Riparip, the International HIV/AIDS Alliance’s regional representative for Asia, observed at the Women Deliver conference currently going on in Malaysia that this is typical of “an amazing document that is a well-kept secret” among the political leadership of the Asian countries that made the commitments. These countries include Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam.

Riparip noted that the three zeros are still far from being realised as long as specific actions geared towards the realisation of efforts to combat HIV through eliminating barriers and accelarating progress on regulations and policies are not made.

“Key affected women are going into health facilities in these countries and do not get the services they need.  Women living with HIV are scared because they could be subjected to sterilisation, while women who want to undertake abortion fear and may choose to go to illegal facilities hence put their life at risk.”

She went on to suggest a focus on advocacy.  “In parliament we should be there and make sure that our budget is not cut and on policy, we have to choose and prioritise our message for the people we are talking to and those we are talking for – let us choose a message and deliver it.  Let us not confuse messages.  All of us should be speaking the same language and as often as possible and we can make our message come alive through advocacy”.

Myanmar’s Integrated HIV response

In Myanmar, where Marie Stopes International operates in 39 townships and covers 15% of the population, there is streamlined intervention at organizational and national level service delivery.  This strategy is leading to a decreasing trend in the concentrated HIV epidemic with 15 – 28% of men who have sex with men (MSM) having been reached together with 40% of injecting drug users (IDUs) and 50%  of female sex workers.

But Hlaing Min Swe, MSI’s technical advisor in Myanmar, observed that “although there are strong community based organizations that have played a role in the HIV response in processes like the national strategic plan development and implementation, laws criminalizing sex workers and injecting drug users still exist and there is inadequate access to maternal, neonatal and reproductive health services.

“There are still challenges of integration like exclusively vertical programmes; a lack of technical personnel, client friendly services and male involvement; and the existence of stigma and discrimination”.

The case of Malaysia

The greatest challenge in Malaysia also lies within the concentrated epidemic for the most at risk populations (MARPS), including injecting drug users, men who have sex with men, sex workers, clients of sex workers and transgender people. There are also efforts to address the sexual and reproductive health and HIV needs of adolescents and young people, street children, undocumented migrants and refugees, and the children of sex workers.

Dr. Raj Abdul Karim, president of the Malaysian AIDS Council and the Asian Regional director for Women Deliver, expressed some optimism.  “In Malaysia now, HIV is very much part of the reproductive health of the population, an achievement that has been made despite many challenges including budget constraints and power play.”

But where achievements are being realised like religious leaders opening up, there are also challenges she said, like the need for “strengthening political commitment to achieve greater harmonization and coordination and sustain high levels of financing to continue the provision of affordable treatment.  But some of the MARPs organizations are still underground groups that have not come out because of the stigma associated with them. The ministry of health should provide more money so that NGOs can go to such organizations and provide more and better services.”

Young people in the Philippines

The HIV and the sexual and reproductive health situation in the Philippines is quite unique because the country is the third most disaster prone country in the world. According to Aiza Baldonado, a peer educator from the Youth Peer Education Network:

“There is little access to sexual and reproductive health (SRH) and HIV information as well as a lack of employment which can lead to selling sex, engagement in risky behaviour such as unprotected sex and young people having multiple sexual partners.”

Structurally there are also challenges, “SRH is not a priority of the local government and there is weak implementation of the AIDS law which needs amendment, yet condom distribution is banned in some disaster relief camps.  This is in addition to the lack of coordination of the referral system, the lack of trained personnel and the sustainability of SRH programming.”

Aiza Baldonado called for more investment in SRH and HIV programing in the Philippines, especially in the context of a humanitarian situation with comprehensive information, education and in behaviour change and communication strategies.