Civil society networks, United Nations agencies and other partners in Asia and the Pacific are urging a rapid increase of voluntary confidential community-based HIV testing and counselling for key populations at higher risk in the region – including men who have sex with men, transgender people, sex workers and people who use drugs – to help ensure more people in need are able to access life-saving antiretroviral treatment.
Low levels of access to HIV testing and counselling for key populations remains a serious cause for concern in Asia and the Pacific. Across the region, less than half of the key populations know their HIV status, which can lead to late diagnosis, late initiation to care and treatment services, and can result in unnecessarily high morbidity and mortality for people living with HIV. This also means the benefits of the prevention impact of antiretroviral therapy (ART) are not being fully maximized.
Although countries have made significant strides to expand coverage of ART in recent years, in 2012 only around half of people eligible for ART were receiving it. If access to antiretroviral treatment is to be increased, there is an urgent need to change current approaches to HIV testing and counselling. This can only be achieved by ministries of health partnering with community organizations who are trusted by their peers to provide life-saving HIV prevention, care and support, and who understand how to deliver services that are ethical, convenient, acceptable and effective.
Access to HIV testing of any kind has been low among key populations in Indonesia, for example. Between a third of female sex workers and three quarters of transgender people have tested. Earlier this year, the Minister of Health signed a circular distributed to health departments in all provinces and districts in the country, as well to the directors of every hospital. The circular recommended that people from key populations living with HIV should be started on ART regardless of their CD4 cell count. This is “Test and Treat” for key populations; a major step forward in increasing access to treatment. Even the most conservative estimates for Indonesian key populations are 800,000 people. A major barrier to them exercising their right to health was removed with the stroke of the Minister’s pen.