Challenges

An estimated 4.9 million people were living with HIV in the Asia and the Pacific region in 2012. Regionally, the numbers of new HIV infections have fallen by 26 per cent since 2001, with a number of countries reducing infections by over 50 per cent in that time. However, the overall number of new HIV infections across the region has remained largely unchanged in the past five years. The number of people accessing antiviral treatment in the region had risen to 1.25 million by the end of 2012 but the rate of increase in access to treatment has slowed in recent years.

(www.unaids.org/sites/default/files/media_asset/2013_HIV-Asia-Pacific_en_0.pdf)

Toward a Solution

The South-to-South (S2S) Learning Exchange on HIV is a partnership between Cambodia, Indonesia and Thailand on HIV prevention outreach and community- based HIV testing approaches for key affected populations that focuses on adaptation in Indonesia. The objective of the learning exchange is to strengthen the capacity of HIV prevention organizations in Indonesia by establishing an ongoing capacity development partnership with key organizations in Cambodia and Thailand that have a track record of scaling new and innovative programmes. Both the HIV Foundation Asia and KHANA are non-governmental organizations that support innovative community- level support services and capacity development across the HIV prevention-treatment cascade. Their proven approaches and systems have the potential to fast-track the response to HIV and enable countries to achieve the sustainable development target of ending the AIDS epidemic.

The methodological approach includes a series of learning and exposure visits by key policymakers and practitioners from Indonesia to study key innovative HIV interventions in Cambodia and Thailand. KHANA is the largest national non- governmental organization providing integrated HIV prevention, care and support services at the community level in Cambodia. For this learning exchange, the focus was on their pioneering community-led HIV testing approach, which has led to substantial increases in the rate and coverage of low-threshold testing with key populations. The HIV Foundation Asia (based in Thailand) is an independent, non-profit organization focused on the development of innovations at the cutting edge of HIV prevention for key populations. The learning-exchange focus has been on their HIV case-finding and case-management approaches, which are increasing the numbers of men who have sex with men who are identified as HIV positive, initiated and retained in treatment. The adaption and application of these interventions are expected to contribute to fast- tracking the HIV response in Indonesia.

The initial visit to Cambodia and Thailand has already produced tangible results. Indonesia returned having built ongoing technical-support relationships with organizations in Cambodia and Thailand. Since the learning exposure experience in Thailand, the Indonesian delegation has fully adopted the innovative and more proactive HIV-prevention approach of community-led case finding and case management. Through a follow-up consultation on its return from Cambodia, the Indonesian delegation adopted a test-for-triage approach to community-led HIV testing.

The Joint United Nations Programme on HIV/ AIDS (UNAIDS) and the Global Fund to Fight AIDS, Tuberculosis and Malaria will fund the programme through 2017. A transition and sustainability plan is currently being developed to ensure that S2S learning is an ongoing feature of efforts to strengthen the response to HIV in Indonesia. Since the country is large, diverse and spread across a long archipelago, learning exchange within the country is critical for local-level application and adaption. The model can be easily replicated in the HIV response across the region depending on the willingness of governments to recognize the crucial value of civil society and fund their efforts.

Stakeholders include: (a) the Spiritia Foundation in Indonesia and the 75 subrecipient partner organizations that it supports at the district level to implement HIV prevention, care and support; (b) local non-governmental organizations working with the men-who-have-sex-with-men and transgender communities; (c) the Ministry of Health; (d) the National AIDS Commission; and (e) UNAIDS.