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Новый Отчет по СПИДу призывает сконцентрироваться на группах риска

A new independent report on AIDS in Asia just handed over to United Nations Secretary General Ban Ki-Moon exhorts governments to cut to the chase. The report, prepared by a nine-member commission chaired by Chakravarthi Rangarajan, who also chairs the Economic Advisory Council to the Prime Minister of India, urges jettisoning general, poorly defined AIDS awareness programs and, instead, focusing on groups that are most prone to transmit the HIV virus.

“You see, this report actually is not a UN report, it is an independent group of economists, sociologists (and others) who looked at the Asian AIDS situation from a totally different perspective, not just in terms of how many infections are there, but where are the risk factors, and what is the impact on society at various levels,” J.V.R. Prasada Rao, member secretary of the commission, told India-West when reached in Bangkok. “To that extent the agenda itself is new.”

High-impact interventions, such as HIV prevention programs focused on key populations and antiretroviral treatment, should constitute the core of the HIV response across Asia, according to the report.

Nearly five million people are living with HIV in Asia with 440,000 people dying each year. If the current rate of transmission continues, the study contends, an additional eight million people will become newly infected by 2020.

The commission’s new report, entitled “Redefining AIDS in Asia – Crafting an Effective Response,” was presented to United Nations Secretary-General Ban Ki-Moon March 26 at an event in New York.

Rao, who is the director of the UNAIDS regional support team for Asia and the Pacific, says the independent panel’s offers a fresh look.

“The commission now says it is not just an epidemic restricted to sex workers, drug users or homosexual men, it is an epidemic among adult males, especially young males who have disposable money and who go for paid sex and also the women who cater to them,” Rao said. “That number the commission tried to estimate, and it’s quite huge, it’s about 75 million young men who pay for their sex, and there are about 10 million people who cater to these people. That is a large population.”

Rao said the current system of classification tends to breed complacency. “The present classification from low, concentrated and generalized epidemic, that doesn’t really help the situation,” he told India-West. “In another classification, most of the countries in Asia are low-level epidemics. But if you call them low-level epidemics, the political leaders will never take action on the problem…The commission said that you must use your resources more for focused intervention on at-risk populations (rather) than just spreading it too thin over soft programs like media campaigns.”

Rao said that focused intervention was the key. “You see, normally, money is given for AIDS programs. Most of it is spent on general programs like, say, awareness generation. These do not normally have a good effect. Focused interventions are those where you work with those populations who are at high risk of contracting infections like sex workers and clients who come to them, and intravenous drug users, and also men who have sex with men. These are the three groups of people who have a very high infection rate, and unless you address infection among them, the infection moving into the general population can never be controlled,” he explained.

India, he said, had taken some strides, but needed to focus its programs like Thailand and Cambodia.

“These are the countries which have exactly gone for this sort of focused programs when they saw that infection was spreading through sex workers and their clients. They put their entire resources on (focused) programs…and that has yielded results. Infection levels have come down. So one has to take lessons from them,” he said.

“And India knows. They are aware of the successes of Thailand and Cambodia and partly tried to reflect it in their national program, but that is not getting implemented uniformly across the country. There are some states like Tamil Nadu, Maharashtra, which are doing it and where the results are evident. You can see a trend of infections coming down. But in a large part of the country, in northern India, and in the Northeast, that is still not happening.”

At-risk groups also need to be destigmatized, Rao told India-West. “You (need to) address the issue of destigmatizing…at two levels; one is at the legal policy level where you need to amend the laws, and secondly, at the implementation level where local police and local officials, they often act as stumbling blocks,” he said. “So you need to sort of sensitize them, make them also aware of the need to reach out to this section of population.”

The independent Commission on AIDS in Asia was created in June 2006 to give an opportunity to look at the unfolding realities of the HIV epidemic in Asia from a wide socioeconomic perspective reaching beyond the public health context.

In order to deliver on this mandate, nine leading economists, scientists, civil society representatives and policy-makers from across the region were appointed to the commission led by Rangarajan.

Over an 18-month period, the commission held five sub-regional and regional consultations, meeting more than 30 experts and 600 individuals and governmental and civil society groups, as well as reviewing more than 5,000 published and unpublished studies. Through its review and consultations with a broad range of stakeholders, the commission produced its findings and recommendations.

Source: San Leandro India West, USA