Track B report by Jason Brophy
Dr.Linda-Gail Bekker of the Desmond Tutu HIV Centre in Capetown spoke about the challenges of caring for adolescents living with HIV. Two major populations of HIV-infected adolescents exist – those who were perinatally infected and have survived (with the roll-out of effective therapies) to adolescence, often unaware of their diagnosis and with significant treatment experience and residual effects of HIV disease; and those who acquired their infection later in life through sexual or other exposures, treatment naïve and aware of their diagnosis. Both these groups, with their different needs, require transition to adult care. While many position statements advocate for coordinated, collaborative approaches to transition, there is little evidence to inform best practices and improve outcomes. A number of transition clinic approaches and group-based support & skills-building programs have been implemented, and measurement of the impact of these programs is needed. National programs and UNAIDS have been calledupon to create mechanisms to track perinatally and non-perinatally infectedyouth who transition in order to evaluate their treatment outcomes in adultcare, and ensure that they are not “lost in the crowd”.
Track D report by Elvin Geng
At the opening of the second day of the 2013 IAS conference, Dr.
Mean Chhi Vun, who directs the national response to HIV/AIDS in Cambodia,
described the remarkable success of the Cambodia’s response to HIV – a story which
provides insights into strategies for successful implementation. During this time, Cambodia has invested in a
strong structural response: laws were revised to address human trafficking, a unified
and centrally coordinate response was formulated, multisector engagement and
community involvement were emphasized. This
strategy has led to impressive statistics in the macroscopic processes of
health delivery: high levels of condom use, high ART coverage
for eligible patients (87%) and very high retention in care (89% at one year). Strong
structures and processes have led to remarkable improvements in health
outcomes. In the last 20 years, Cambodia has seen a 10-fold reduction in
incidence (from > 20,000 infections /year to < 2000) and in the last 10 years, a 3 fold reduction
of annual AIDS related deaths. Although
each national response is unique, Cambodia’s successes offer proof of concept
that a post-conflict, low income country with a generalized epidemic can turn
the tide, and offers hope for the future of the global response.
Community Advisory Group report by Kevin Nicholas Baker
The aim of the ambitious goal in Cambodia is the virtual
elimination of new HIV infections by 2020. Three domains – population prevention, treatment as
prevention and boost care services.
Cambodia will look to sharper epidemiological targeting to
include more specific community groups.
MARP prevention and links to health services – try to
reach the hidden population. Rapid
response mechanism will be introduced for these groups.
Want to simplify the referral systems and introducing the
figure prick testing. Make test
and treat easier.
Challenges include reaching key affected populations and fragmented health
The mobilizing of the community under a single command and
control strategy is possible in a socialist state, but no less bold and remarkable
for it. Focusing on speed, the Cambodian government has a target to eliminate
HIV infection by 2020. They recognize that they face tremendous challenges, in
particular to reach all segments of key affected populations (MSM, TG,
grownups – falling through the cracks
Looking at health care for teens and the specific situation
in relation to HIV. 6 critical
steps to help transition from child to adult health care. Plans should be developed with patient
and family. Barriers include the health systems not wanting to let go. The adult provider may not feel they
have the relevant expertise. This
means it is not done very often – just 16% of adolescence in one study had a
3.4 million under 19-year olds are living with HIV today.
2 groups – perinatally infected youths and behaviorally infected youths.
The pediatric HIV legacy who have grown up with ARV in
resource rich settings have experienced up to 7 types of ARV.
Coverage needs attention. There are high levels of lost to follow-up and therefore leads
What is the impact of HC transition on HIV care – health
What does the health care facility need to provide – be
more friendly and accessible.
Transition needs to continuous…often can happen quite
late. Should consider the maturity
of the patient and start early.
Planning required participation by patient, family and health care
provider. It should also consider
peer led services being available and services relating to the sexuality and
gender identity of these adolescents.
What happens to HIV positive adolescents as they become more aware of
Concept – Lost in the crowd – lost to follow-up and how
many children do actually transition.
There is a value to support and solidarity. Clinicians should make transition attractive to adolescents. Should be flexible. Allow adolescences to express at their
There are currently 180,000 children (<15 years) in the
Asia Pacific region infected by HIV – do we know who they are and what they
Laws were created in fear of those who have HIV. Looks at
the role of the law and how is can best be used and support the HIV response.
Criminal law as a barrier to health care service and
delivery is a reality – it stops the delivery of much needed heath services and
instead marginalizes and stigmaties PLHIV. Laws that criminalise transmission target PLHIV – over 60
countries worldwide criminalise transmission.
Criminal laws on sex work also demonstrate and have
consequences on the health of sex workers. Over 116 countries have such laws. Anti-trafficking laws also create barriers to HIV care and
programming. Criminalising the
clients of sex workers are also not helpful and in fact make life more
difficult for sex workers.
Laws that crimialise same sex sex and gender identity also
impedes HIV work.
Laws that criminalise drug use also negatively affect HIV
initiatives. People who use drugs
often suffer from the negative impacts of punitive laws and suffer stigma and
Often HIV workers also suffer from the negative impact of
the law – staff are under threat of arrest of harrassment. This does not enable HIV services.
Woman and girls are also affected by the law – e.g. sexual
and reproductive health rights suffers from abortion and other such laws. Age of consent laws also negatively
impact on health services for young people.
Laws also govern research and programming on HIV and the
political and self-censorship that is linked to funding is ‘chilling’ – e.g.
PEPFAR discriminated sex workers and drug users. Anti-prostitution loyalty oath is another example of policy
negatively impact on HIV programming.
This has now been struck down in US Supreme Court.
Stigma and discrimination beyond the law – enforced
sterilization is an example of this and happens in many settings around the
world. According to Malaysian
community young, unmarried girls are denied access to condoms and SRH services –
this needs further action.
Examples of laws being disabled – India anti-sodomy laws