Australia and Cambodia working to end the inequalities underpinning HIV

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A clinic counsellor consults with patients at Chhouk Sar Clinic in Phnom Penh. SUPPLIED

On June 5, 1981, the US Centers for Disease Control and Prevention (CDC) published a study on five cases of a rare pneumonia – it was not known at the time, but these were the first documented cases of AIDS-related illnesses. By the end of 1986, 85 countries had reported cases of AIDS to the World Health Organisation.

The CDC estimated 493,000 people were living with HIV, including about 84,000 new cases that year. As with other pandemics, the world faced a new and unknown virus, which led to illness, death and fear. Four decades on, while HIV treatment has saved millions of lives, there is no cure and no vaccine for HIV.

The AIDS pandemic is driven by inequalities. In many parts of the world, those living with HIV experience high levels of stigma, discrimination and violence. Almost two-thirds of new HIV infections globally occur among what we call “key populations” (gay men and other men who have sex with men, people who use and inject drugs, sex workers, and transgender people) and their sexual partners.

Australia has a long history of support and action on HIV in the Indo-Pacific region. We are committed to working with global partners to end AIDS as well as to address the inequality faced by those living with and affected by HIV. In June, Australia was proud to co-facilitate the Political Declaration on HIV and AIDS, which puts human rights, gender equality, science, and communities at the centre of the HIV response.

We acknowledge progress towards the global 2030 target to end AIDS as a public health threat has been slow and uneven. All the 2020 global HIV/AIDS targets, launched in 2014, were missed. Dr Khin Cho Win Htin, UNAIDS acting country director in Cambodia, said: “Worldwide the missed targets have resulted in 3.5 million more HIV infections and 820,000 more AIDS-related deaths since 2015 than if the 2020 targets were met.”

On top of this, over the last almost two years, we have witnessed the devastating impact of Covid-19. Women, alongside the poor, elderly, disabled and migrant populations, have borne the brunt of the pandemic. There has been a devastating impact on poverty levels and increasing wealth, gender, and ethnic inequalities.

Covid-19 has exposed the fragility of the gains made in the HIV response and exacerbated the inequalities that drive the AIDS pandemic. At the end of 2020, the first year of Covid-19, UNAIDS reported an estimated 1.5 million people had contracted HIV worldwide that year, 37.7 million people were living with HIV, and 680,000 people had died of AIDS-related illnesses..

Here in Cambodia, Australia is working in collaboration with UNAIDS, the government, civil society and communities of people living with HIV and key populations, as well as relevant development partners, to end AIDS in Cambodia, and to build a stronger, healthier, safer and more inclusive Indo-Pacific region. We are working to support community-led organisations to improve prevention and testing services and address inequality, stigma and discrimination faced by people living with HIV and key populations, ultimately increasing their access to quality and stigma free services.

At the same time, a consortium of Australia’s leading infectious disease research centres – the Kirby, Doherty, and Burnet Institutes – together with international collaborators, the Clinton Health Access Initiative (CHAI) and FIND, the global alliance for diagnostics – is also strengthening laboratory capacity for testing and diagnosis of Covid-19, HIV, malaria and tuberculosis in Cambodia.

Cambodia’s HIV response has been commendable. Its success is grounded in national leadership and inclusiveness, with a focus on people-centred services and progress towards an enabling legal environment.

This success was seen in Cambodia’s early achievement of international diagnostic and treatment targets, as well as the delivery of innovative HIV prevention and testing services, including the important work, launched by the National Centre for HIV/AIDS, Dermatology and STD (NCHADS) in 2019, on PrEP (medicine taken by people at risk for HIV to prevent it), and HIV self-testing for key populations in 2020.

Sadly, Dr Ly Penh Sun, the director of NCHADS, recently passed away. Dr Ly’s leadership was focused on how to improve the lives of people living with HIV and key populations. He will be sorely missed by all those who knew him, worked with him and benefitted from his dedication.

For Dr Ly’s legacy, and if we are to meet our collective commitment to achieving the Sustainable Development Goals by 2030 – including the goal of ending AIDS by 2025 in Cambodia – there is more to be done. Fighting the HIV epidemic is a priority for UNAIDS and the Australian government.

Despite the pressures of the Covid-19 pandemic, we should not lose sight of the need to support essential health services such as HIV prevention. We know community-led testing, treatment, and prevention are the pillars of an effective HIV response.

Today, on World AIDS Day, Australia is committed to keeping up the momentum and working together to end the inequalities that underpin the HIV epidemic. Tackling these inequalities will make societies better prepared to beat Covid-19 and other pandemics, while supporting economic recovery and stability.

Together, we can end AIDS.

Pablo Kang is Australian ambassador to Cambodia