Jhabindra Bhandari

Globally, HIV still continues to be a major public health challenge. We are far behind in preventing new HIV infections. A new report by UNAIDS shows remarkable, but highly unequal, progress, notably in expanding access to antiretroviral therapy. Because the achievements have not been shared equally within and between countries, it is less likely to achieve the global HIV targets so far. Ending AIDS as a public health threat by 2030 requires an accelerated expansion of HIV services alongside rights-affirming and enabling environments for those services. Progress against the fast-track targets has been still slow. Some countries are on track or nearly on track to achieve the ambitious global targets.
Sufficient political will, financial resources and meaningful community engagement are critical to accelerating the progress. More people living with HIV than ever before know their HIV status, are accessing antiretroviral therapy and are virally suppressed, reflecting strong progress towards the 90–90–90 targets. This implies that 90 per cent of people living with HIV know their HIV status, 90 per cent of people who know their HIV-positive status are accessing treatment and 90 per cent of people on treatment have suppressed viral loads by 2020.

Gain
The UNAIDS report - 2020 reveals that there have been gains across the HIV testing and treatment cascade. At the end of 2019, 81 per cent of people living with HIV knew their HIV status, more than 67 per cent were on treatment, and almost 59 per cent had suppressed viral loads. The report further suggests that HIV infections in Asia and the Pacific have declined slightly, with reductions in Cambodia, Myanmar, Thailand and Vietnam offset by sharp increases in Pakistan and the Philippines. Key populations and their partners accounted for an estimated 98 per cent of new HIV infections, and more than one quarter of new HIV infections were among young people (aged 15 to 24 years).

Community-led services
Despite progressive civil society engagement, community-led services are still not available at sufficient scale. As a complex reality of HIV epidemics, more HIV responses are sharpening their ability to identify gaps and develop strategies to reach out key populations who are being left behind. However, very few countries are taking sufficient actions to reach interim milestones and sustain the progress. In Nepal, the first HIV case was detected in 1988. The epidemiological data shows that heterosexual transmission is largely dominant, and HIV prevalence among adult populations is below 1 per cent. Over the decades, there has been significant progress in scaling up prevention, treatment, care and support services for key populations across the country.
In coordination with National Centre for AIDS and STD Control (NCASC), the partners such as UNAIDS, WHO, UNICEF, Save the Children, The Global Fund, EpiC/FHI 360, AHF and few others are providing technical assistance to enhance the capacity of civil society networks in planning and implementation of targeted interventions for key populations and their networks at all levels. In addition, their support in evidence-based policy making, strategy development, updating treatment guidelines and related protocols have been instrumental in delivering quality HIV services from the health facilities.
However, there are still critical needs to increase access to treatment services in particular across all provinces. The service coverage, for example, migrants and their families is still low, and more community-led HIV services need to be expanded in order ensure access to prevention and treatment services for those who are still left behind. On the other hand, more focus is needed to strengthen resilient health systems as well as community systems in order to ensure continuum of prevention, treatment and care.
Recent review of national HIV strategic plan (2016-2021) has recommended that national HIV response needs accelerated actions to enhance the capacity of provincial and local governments in participatory planning, implementation, monitoring and evaluation of community-based HIV interventions in the context of federal governance and COVID-19 pandemic. Additional priority actions include scaling up prevention, testing and treatment services. Similarly, strengthening supply chain management, strategic information, capacity building of provincial health laboratories and adequate trained human resources for HIV at province and local levels. The health system issues during the COVID-pandemic have been more prominent which is likely to slow the progress in HIV response.
Undoubtedly, HIV is a global health issue. In this context, a high-level meeting (HLM) on HIV and AIDS will be convened from 8 to 10 June 2021 in New York. The HLM will specifically undertake a comprehensive review of the progress on the commitments made in the 2016 Political Declaration towards ending the AIDS epidemic by 2030, and how the response, in its social, economic and political dimensions, continues to contribute to progress in the context of Sustainable Development Goals (SDGs).

Recommendations
More importantly, it will provide practical recommendations to guide and monitor the HIV and AIDS response beyond 2021, including new concrete commitments to accelerate action to end the AIDS epidemic by 2030 as well as to promote the renewed commitment and engagement of a range of partners to accelerate and implement a comprehensive universal and integrated response to HIV/AIDS.
In this context, civil society networks recently convened a series of consultations to draw the attention of stakeholders by raising practical issues and priority agenda in HLM. These basically include recommendations for adequate funding, community-led advocacy, integrated service delivery approach, advancing human rights, reducing inequalities, prevention of gender-based violence, responding to COVID-19 and social protection services for key and vulnerable populations.

(Bhandari is senior research fellow in global health and health systems)