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Equalise prevention and treatment of HIV to end AIDS in Kingdom

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A tuk-tuk with a banner about World AIDS Day drives past pedestrians in Phnom Penh. Hong Menea

Equalise prevention and treatment of HIV to end AIDS in Kingdom

Every day in Cambodia, three new people are infected with HIV.

It might be a baby whose mother did not receive HIV treatment during pregnancy. Or a young gay man who hasn’t yet learned how to protect himself.

And every day three people die due to AIDS-related causes.

Maybe it’s a transgender woman who was afraid to get tested. Or a child living with HIV who never received treatment.

In 2022 these cases are not only avoidable, but unacceptable.

Inequalities in access to HIV prevention, testing, treatment and care are slowing the final sprint to the 2025 finish line of ending AIDS as public health threat as per the commitment of the Royal Government of Cambodia. On December 1, World AIDS Day, we call upon all partners in the HIV response … be it the government, civil society organizations, development partners, communities, and individuals affected or infected by HIV … to work together to end these inequalities once and for all.

The good news is that Cambodia’s HIV response has already built incredible momentum. Last year 84per cent of the estimated 74,000 people living with HIV in Cambodia were aware of their status. An incredible 99 per cent of diagnosed people were on treatment. And 97 per cent of treated people achieved viral suppression, making them unable to transmit the virus to others.

This means that the health system and community services leading the HIV response have mastered the science and art of connecting diagnosed people to health services, keeping them in care and treating them successfully. It is entirely feasible for Cambodia to accelerate toward 95 per cent testing and treatment targets for 2025.

But to do so we must target those being left behind with laser focus. We must work to reach the 16 per cent of people living with HIV who do not know their HIV status and empower people vulnerable to HIV infection with combination HIV prevention options and differentiated services.

One of this country’s most stark inequalities is in access to treatment for children. Just over half (56 per cent) of Cambodian children living with HIV have been diagnosed and are on life-saving treatment. By contrast, 85 per cent of all adults living with HIV are receiving antiretrovirals. To close the treatment gap for children, we need to address inequalities and structural barriers that hamper access to early infant diagnosis and paediatric AIDS care.

Existing prevention, health and community interventions have contributed to a 50 per cent decline in new HIV infections since 2010. Cambodia has been a trailblazer with respect to the national roll-out of pre-exposure prophylaxis or PrEP. (PrEP is daily medication taken by an HIV negative person to avoid contracting the virus.) Community engagement in the design, delivery and expansion of PrEP services has been critical to success. As the HIV response matures, we must now build on these gains, using strategic investments and interventions to reach those still without access.

Australia and UNAIDS remain strong partners to Cambodia’s HIV response, through jointly supporting increased efforts and investments to HIV prevention among key populations. In the last year alone, Australia and UNAIDS collaborated with government and communities to bolster community-led demand generation for PrEP and HIV self-testing. This resulted in impressive linkages to services among key populations, with nearly 2,000 people taking PrEP to prevent HIV infection. Together we worked to, strengthen the accessibility and approachability of HIV services for key populations and the most marginalised, and increase the engagement of community-led organisations to provide greater reach of quality services into communities most in need of HIV services and HIV-related services.

The key populations – gay and other men who have sex with men, transgender women, people who use and inject drugs and female entertainment workers – remain a priority. There are good reasons why the prevention approaches that work for the general population aren’t as effective with the most marginalized and vulnerable among us. For a member of one of these communities, services that others take for granted – going to the clinic, requesting social support or making a police report – often seem unwelcoming. Laws, policies and practices can fuel the stigma and exclusion faced by key populations. We need to work together to ensure friendly access to HIV services and eliminate barriers that cause HIV-related stigma and discrimination.

Through the ASEAN Leaders’ Declaration on Ending Inequalities and Getting on Track to End AIDS by 2030, we have a fresh commitment by the government of Cambodia and other southeast Asian leaders to take concrete steps toward ending inequalities; strengthening, supporting and sustaining community-led responses; and financing the AIDS response. Supporting this effort – Australia will host the 12th International AIDS Society (IAS) Conference in Brisbane in 2023.

We congratulate and thank the Government of Cambodia for its regional HIV leadership. And we stand prepared as partners to support the work to equalize access to HIV prevention, testing, treatment, and care services, close the gaps in the first 95 and treatment gap between children and adults, remove discriminatory and punitive laws and ensure that the AIDS response is fully resourced with sustainable financing. Inequalities are obstructing the end of AIDS, but they are not fate. With courage, and cooperation, we can tackle them.

Patricia Ongpin is UNAIDS country director for Cambodia, Laos, and Malaysia.

Pablo Kang is Australian ambassador to Cambodia.

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