What role has UNAIDS played in the running and organizing of ICAAP?

UNAIDS is one of two major co-sponsors of ICAAP along with the AIDS Society for Asia and the Pacific. We have been involved in the organization of the last three ICAAPs and will be involved in Kobe, Japan in 2003.

Our contribution has been in all aspects. We took part in the discussions on the scientific program, community program and positive forum program as well as the composition of the plenary session. We also contributed to the theme of the conference and how to translate the theme into different messages. In addition UNAIDS also sponsors a number of sessions which address critical issues and key areas. An example is a session on the success story of Cambodia. We organized that and brought in different ministers, NGOs and other partners. We sponsored the session of First Ladies--who made a strong commitment to a response, especially in relation to the vulnerability of rural women. We also sponsored a session with parliamentarians who pledged to mobilize their peers and constituents as well as to look into the changing of domestic laws and policies.

What is the significance of addressing issues such as Gender and Sexuality which are generally considered taboo and not talked about in the region?

I believe that it is critical to address these so called "sensitive issues" in the region. For UNAIDS these are not sensitive issues, they are important and critical issues that we need to address in order to advance a response to the epidemic. We always encourage and promote organizations which address these issues in their countries. We also encourage politicians and national leaders to make tough political decisions in admitting that those issues exist in their country. These need to be brought into the discussion even if they have to confront traditional views. These include sexuality, gender inequality, condom promotion, harm reduction among injecting drug users, indigenous and minority issues, mobile populations and prices of drugs.

What is UNAIDS' position on access to drug therapy and the cost of these drugs?

UNAIDS negotiates with pharmaceutical companies to get the drugs as cheaply as possible for developing countries. We strengthen the role of the community and people living with HIV/AIDS with the government to be able to put their needs and demands in negotiation in terms of getting a good price. We also help to build capacity in terms of implementing the treatment.

Does the Ministerial Meeting really show political commitment? Is there going to be a change on the ground?

This meeting organized by the Australian government is by itself evidence of very high level and strong commitment from the countries. Over 30 ministers, not just health ministers, set aside the work in their own countries and came here. They have discussed openly how to advance the response, not only in their own country but also in the region. I attended the meetings and I heard every single minister pledge their commitment in a very strong way which I never heard before at this level. Quite a number also put a target for those commitments publicly in front of their peers. They said they would go back and address sensitive issues. They all agree on the declaration of commitment and the discussion on the statement didn't take very long. Of course when a commitment comes one wonders if resources to support it will follow. But, for instance, the Vice-Minister for Health in China said that China will increase the national budget on HIV/AIDS. Donor governments there also pledged their support. Looking at the success stories of Thailand and Cambodia they felt much more confident that whatever the situation is in their country they can really make a difference.

How much progress has been made since the 5th ICAAP in Kuala Lumpur?

I can cite a few achievements since the 5th ICAAP. Of course one of them is the success story of Cambodia as a country. We are very proud that this region has two success stories--Thailand and Cambodia. And I truly believe that at Kobe we'll be able to announce another success story and that's a goal we have to work toward.

There is consensus that the epidemic is spreading in this region even though it is at a lower level in some countries. There is definitely a sense of urgency. We see more recognition of vulnerable populations like indigenous people, minorities, sex workers, injecting drug users and men having sex with men.

And what are the goals for the next two years till Kobe?

There are still a few barriers that we need to address. That includes access to prevention for many people in many countries, access to treatment and care and support. We have to strengthen health care, but also community and home care support. Because in this region family and community care is the really important thing. So I think it's good that in December there will be the International Home and Community Care conference in Chaing Mai Thailand. It's the first time it is organized in a developing country. That will also help linking this ICAAP and the next in terms of home and community care which is the basic structure of care in this region. In western countries you go to hospitals, in this region it's the community and home.

We still have a lot of work to do in terms of access to treatment and care, however we felt that in this conference the recognition of the role of people in the community as well as people living with HIV/AIDS was very strong. It's the first time that we have a forum specifically for people living with the virus. There was also greater collaboration such as the attendance of ministers from different ministries. The organization of the coalition of regional NGO networks, called the 7 sisters was also an achievement.

I think another achievement is in getting resources. The Australian government has pledged commitment and support, as well as other donors. I believe that with the Global Health and AIDS fund more resources will be available.

In terms of political commitment--at the UN special session in June there was some commitment. At this conference you hear that people saying that no Asia-Pacific head of government went to the UN GA and that message will be brought home. With the ministerial meeting I think in the near future we will see more awareness, attendance and commitment from the heads of government. We're looking forward to the ASEAN head of government summit in November in Brunei at which they have a special session in AIDS for the first time in history.

I hope that in Kobe there will be a high level of participation possibly from First Ladies again, heads of government and definitely from ministries. I think it's good news that Australia is planning to host the next ministerial meeting in two years.

What countries in the region are most at risk of a large scale epidemic? Potentially if they don't do any expanded response in an intensive way--we talk about Vietnam, Indonesia, India and of course we talk about Myanmar as well. These are the countries we are concerned about. China as well, even though prevalence is in pockets around urban areas, because of the size of the population the numbers are high.

Minister Downer pledged money to harm reduction for injecting drug users and there have been many sessions on this topic. How will this increase support for prevention and treatment for injecting drug users?

I think in the past the issue of injecting drug use and HIV/AIDS was not well addressed in this region. It is very important in terms of the spread of HIV through sharing needles. The vulnerability and stigmatization around drug use is high and they could not come out to receive services or express their needs and demands. I think in this ICAAP we have achieved a major step in awareness and recognizing that HIV spread among injecting drug users is a priority to push forward.

Unless we address this issue from both the prevention of HIV side and also the stigma and discrimination side we cannot make a difference in terms of controlling the epidemic in this region. So again, congratulations for the success that came out of both the Ministerial Meeting and the ICAAP. Pushing awareness and commitment to this issue has to continue. There's still a lot of work to be done to push harm reductions policy to many governments who don't have favorable positions and also implementing programs that involves planning, decision making and participation of drug users.

What are the key factors in advancing HIV/AIDS prevention and treatment in the region?

First is to get political commitment at the highest level. At the next ICAAP it would be wonderful to announce that so-and-so country now has the Prime Minister or President chairing the National AIDS Committee. Secondly, for many countries to announce that their national AIDS program involves many ministries other than health. Of course health plays a key role, but ministries of labor, education, interior and agriculture have to be involved. They have to come up with a major role, have their AIDS plan and budget to reach the population. The aim is to implement intensive prevention programs within a short period of time to cover all the population. Another key to success is large scale implementation of programs. You can have a thousand success stories, but not much change in the course of the epidemic unless you cover at least half the country or the whole country. Reducing stigma and discrimination is a major obstacle. Even if you have care and support facilities no one will come out if there is stigma. That is why some of the community groups say our motto should be "My son with AIDS is still my son." Cooperation between countries in terms of exchange of experience is important as well as peer support among politicians and leaders and an increase in government budgets. These are some of the things that everyone knows about and are common sense, but we have to get out and do them.