Regional Overview

HIV Testing and Counselling

13
th
Philippine National Convention on AIDS (PNCA)
Key Themes of New Recommendations
New HIV infections in Asia-Pacific:
S & SE Asia 8% ; Pacific 16% (2005-2013);
Children 16% (2009 2013)
Adolescents (ages 10 19) 17% of all new infections
(2012)
# AIDS-related deaths in Asia-Pacific:
Adults - 37% (2005 2013)
Adolescents - 300% (2001 2012)
MSMin China, Malaysia, Myanmar,
Indonesia, Thailand, Vietnam
IDUs in Indonesia, Malaysia and Philippines
Asia-Pacific
HIV Trend
Source: 1) Global Report: UNAIDS Report on the Global AIDS Epidemic 2013 2) UNICEF New York estimates
Underlying coverage assumptions for zero new HIV
infections, including children and pregnant women
Key Themes of New Recommendations
Infants born to HIV+ mothers not tested
East Asia and Pacific 70%
South Asia 98%
Do not know HIV status
60% of young SW (inc MSM and TG)
75% of young IDUs
Test & Treat Strategy now drives PPTCT
Option B/B+ and HIV prevention in
general
HIV
Testing
and
reporting
HIV infecting younger age cohorts in Asia
0.7%
3.0%
7.1%
9.8%
11.0%
12.1%
10.7%
10.5%
0.7%
1.7%
2.8%
4.0%
9.1%
11.0%
11.3%
10.2%
<5 1519 2024 2529 3034 3539 4044 4549
AGES
Uganda (2011)
Females Males
3.7%
5.2%
17.9%
25.5%
36.8%
31.0%
26.6%
21.4%
2.1%
1.2%
5.6%
16.8%
23.1%
24.2%
15.7%
16.2%
0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
AGES
South Africa (2012)
Females Males
0.6%
1.3%
0.8%
0.7%
0.3%
1.0%
0.1%
0.2%
0.6%
1.2%
1.3%
0.7%
1.3%
<5 1519 2024 2529 3034 3539 4044 4549
AGES
Cambodia (2005)
Females Males
0.1%
0.2%
0.3%
0.5%
0.2%
0.2%
0.2%
0.0%
0.2%
0.4%
0.6%
0.5%
0.4%
0.5%
<5 1519 2024 2529 3034 3539 4044 4549
AGES
India (2006)
Females Males
HIV prevalence from ages 10-15 on
?
?
Adolescents the missing faces of HIV
Adolescents neglected in national AIDS response.
Adolescents at higher risk of HIV: hidden and
invisible
purchase sex or sell sex to peers or adults
boys and men who have sex with other males
those who inject drugs
Adolescent boys and girls sexually exploited -
fewer access to HIV/STI testing, counselling &
treatment
Underlying coverage assumptions for zero new HIV
infections, including children and pregnant women
HTC HIV and adolescents: Guidance for HIV testing and
counselling and care for adolescents living with HIV
Compulsory or mandatory HIV testing of individuals on public
health grounds or for any other purpose is a violation of human
rights
All forms of HTC must adhere to the five Cs: Consent,
Confidentiality, Counselling, Correct test results and
Connections to treatment, care and prevention services.
All services must be provided within a robust human rights
framework.
A supportive and conducive legal and policy environment is
essential for effective and acceptable service provision.
For those under 18 years of age, testing and counselling services
need to consider the best interests of the child as well as
appropriate and safe referrals to child protection services when
children have been abused and are at risk of abuse
Philippines: Significant challenges remain
Acceptability, values and preferences
Community Adolescent participants report strong desire to test,
motivations to test and awareness of responsibilities and
benefits of testing
Health-Care Providers Offering effective HTC services and encouraging adolescents
to access is high priority . Services and policies around HTC
are not often geared towards adolescents. Their needs are
underserved.
Other Legal issues and barriers exist in some settings and need to
be considered e.g. compulsory notification of certain
behaviours and HIV test results, mandatory (routine) testing
and criminalization of transmission
Concerns:
Fear; implications on positive diagnosis; associations with bad behavior; stigma and its
consequences; attitudes of health workers; acceptability and accessibility of services;
age of consent issues unresolved in many countries; possible repercussions in settings
where key populations face criminal prosecution
Proportion of young people (15-24) who
received an HIV test in the last 12 months
and knew the results, 2005 - 2011
12
Source : Prepared by www.aidsdatahub.org based on 1. National Statistics Bureau, UNICEF, & UNFPA. (2011). Bhutan Multiple Indicator Survey 2010; 2. National Institute of
Statistics Ministry of Planning, Directorate General for Health Ministry of Health, & MEASURE DHS ICF Macro. (2011). Cambodia Demographic and Health Survey 2010 -
Preliminary Report; 3. National AIDS Programme Myanmar, & WHO. (2008). Behavioral Surveillance Survey 2008: Out of School Youth; 4.National Statistics Office
Philippines, & ICF Macro. (2009). Philippines National Demographic and Health Survey 2008; 5. Population Division Ministry of Health and Population, New ERA, MEASURE
DHS IFC Macro, & U.S. Agency for International Development. (2011). Nepal Demographic and Health Survey 2011 - Preliminary Report; and 6. National Institute of Hygiene
and Epidemiology Vietnam, ORC Macro, USAID, & CDC. (2006). Vietnam Population and AIDS Indicator Survey 2005.
22
13
5 5
3
1
18
7
13
4
0
20
40
60
80
100
%
Female
Male
HTC (adolescents): 3 strategies
Integration of services facilitates comprehensive care and allows adolescents to
take care of many of their health needs at the same time, in the same place,
simplifying their experience of the health care system.
Decentralization of services brings ART and other treatment and support
services and interventions closer to home. Decentralization may also support
health equity by alleviating logistical and financial burdens for adolescents.
Decentralization, if carefully planned and implemented, may provide safer,
more discreet health care options particularly for adolescents who are
members of key populations.
Community-based approaches can support the health system, allowing for
critical linkages and referrals between formal health services and community-
based programmes and ensure that a multi-disciplinary approach is available,
giving adolescents access to a range of medical, mental health, social and peer
support services. Community-based approaches may be able to support
adolescents to better adhere to treatment and be linked to and remain in care.
HTC (adolescents): community-
based approaches
Test negative:
Help minimize risk behaviours; facilitate timely and low-cost referrals for
prevention support
Test positive:
Support for treatment adherence; support for care and support; strengthening
the continuum of care (cross sectoral)
Key Considerations:
1. Rapid Tests and dissemination of results
2. The role of peers (especially in concentrated epidemics)
3. Disclosure and confidentiality
4. Laws and legal environment (e.g. N&S; OST)
NGO-GOVT Youth Friendly Clinic: Indonesia
NGO Testing and Peer Education: Cambodia
NGO Youth Friendly Services: Vietnam
Government; Church; Community
partnerships: North East India
apps.who.int/adolescent/hiv-testing-treatment
THANK YOU
Emma Brathwaite