South Asia: Addressing HIV and AIDS in the region

UNODC recently interviewed Mr. Prasada Rao who has just been appointed as the Senior Advisor to the Executive Director of UNAIDS. He has a longstanding commitment to the work and policy reform on prevention of HIV and AIDS in the Asian region. He previously served as the Regional Director of UNAIDS based in Bangkok, and before that as the Health Secretary and Director of National AIDS Control Organisation, Government of India.

UNODC: You have been working for many years as the Regional Director for UNAIDS and just recently retired from that official function. Can you tell us, what were and are the main challenges for Asia, especially South Asia with regard to HIV?

Mr. Rao: In comparison to other regions in the world, South Asia has distinct challenges relating to drug use and high proportion of injecting drug use. This problem is gaining prominence mainly in India, Nepal, Pakistan and especially in Afghanistan. It is essential for the international development community to view injecting drug use as an important component of national programmes to prevent the spread of HIV from injecting drug use.

UNODC: In your capacity as a Regional Director, you also had to deal a lot with one of the co-sponsors of UNAIDS, which is UNODC. What are the main issues that UNODC has to deal with and what is the specific situation in South Asia in this regard?

Mr. Rao: UNODC is not just a co-sponsor but also the lead agency for prevention of injecting drug use. It is a critical constituent to the global response on prevention of AIDS. UNODC is today increasingly focusing on drug demand reduction, not only on needle exchange and oral substitution programmes, but on the issues of drug use in general and how to educate the youth. Another aspect that UNODC can focus on is supporting Member States to ensure that national legislations in countries are not oppressive and distinguish between a drug user and a drug trafficker. It must help in creating an enabling environment for the drug users so that they can be reintegrated to society and not criminalised.

Prison interventions are important as well. HIV infected prisoners who are not provided with health services in prisons, make prisons ideal breeding grounds for the spread of HIV. UNODC must work closely with Governments to reform prison policies that emphasize on using the communities to ensure inmates attend treatment programmes in open settings.

UNODC: Despite important progresses, we are still - far -way from a HIV free society or a HIV free next generation in South Asia. What can Governments/societies in South Asia do to achieve that the next generations are HIV free and that people currently living with HIV can enjoy their full rights to health?

Mr. Rao: It is very difficult to have an AIDS free society, mainly because people who are HIV positive are treated so that they can live another 20 - 30 years. There are more people living with HIV as opposed to dying of HIV. What we can do is work towards an AIDS free next generation by reducing the mother to child transmission to zero. Firstly, AIDS needs to be normalised, made treatable and the stigma attached to it addressed comprehensively. I will also emphasise that criminal laws relating to injecting drug use, sex work, male to male sex, and people living with HIV are reformed. If we can realize this - it will be one of the biggest achievements for humanity. Mainstream societies had been oppressing these vulnerable populations for centuries and HIV provides an opportunity to initiate social reforms awaited for several decades. This is one of the most exciting things in the field of prevention of HIV and AIDS.

UNODC: One issue that sometime causes frictions is the different thinking and/or acting of health and law enforcement authorities regarding people who require drug treatment and /or who live with HIV. What do you think societies/Governments can do to address this? What can UNAIDS and UNODC do?

Mr. Rao: Usually programmes on prevention of HIV are predominantly considered as part of the health agenda by the United Nations (UN) and the Government. Also it is mainly the Health Ministries that implement these programmes. What is often forgotten is the inter-sectoral nature of the problem. Law and order, drug control and social development ministries need to take initiatives and ownership of programmes on prevention of HIV and AIDS. In the last Commission on Narcotic Drugs (CND) meeting, several Governments who are implementing good, national programmes on prevention of HIV, were reluctant to support harm reduction. There needs to be greater alignment and coordination between ministries at the national level which is a challenge for both UNAIDS and UNODC. By working with Ministries of Interior, we need to ensure that their responses, in important global meetings like the CND, reinforce their overall national programmes.

UNODC: Any other issue you would like to share with us?

Mr. Rao: Having worked for several years in the United Nations and in the Government in the field of prevention of HIV, I understand well the health challenges that HIV and AIDS presents. We need to balance well what is immediately needed in the next 3-4 years and what is required in the long run to address the HIV epidemic. In addition, injecting drug users and their spouses as well as men who have sex with men should not be criminalised and stigmatized - instead their rights should be ensured by appropriate national legislations. In my present capacity as the Senior Advisor to the Executive Director, UNAIDS, I shall strive to work together with the Governments and UN in the region to address these issues.