Never is a promise

Never is a Promise - Fiona Apple

Today is World AIDS Day. 2008 is also the 20th anniversary of World AIDS Day. Not the anniversary of the AIDS epidemic, but the observance of a day when people living with HIV/AIDS, those working in the field of AIDS, and other stakeholders around the world come together to commemorate and to remind themselves that there is much more to be done in addressing this epidemic.

World AIDS Day, or WAD, in Cambodia is a particularly huge event. Many things happen in Phnom Penh and in the provinces. It is, in fact, a non-working holiday here–one of the UN holidays that are considered as non-working holidays here (the others are International Women’s Day and Human Rights Day, among others). This year, I am not involved in any of the WAD celebrations in Phnom Penh. Aside from this blog, I have no other contribution to the ‘celebration’.

This year’s theme is ‘Lead, Empower, Deliver’, which is closely related to last year’s theme, leadership. According to the UNAIDS website, designating leadership as the theme provides an opportunity to both highlight political leadership and celebrate leadership that has been witnessed at all levels of society. In his official message, out-going UNAIDS Executive Director Peter Piot states that, “Presidents and prime ministers, doctors and lawyers, scientists and schoolteachers, chiefexecutives and trade union leaders, religious groups and communities, and critically people living with HIV, are coming together in a brilliant coalition that has proved that, with clear targets and strong commitment, we can move mountains”.

He is also quick to point out that ‘many more mountains remain to be moved’. HIV/AIDS programmes around the world is affected by the on-going gloabl economic and financial crisis. Expansion of HIV prevention and treatment is critical, especially in the so-called ‘low and slow epidemic’ countries like the Philippines. The effects of gender inequality and weak health and social systems in delivering health information and services to those who need it continues to resonate in many places.

These are just one of the things that are in the minds of those who are infected and affected by the AIDS epidemic. Cambodia’s efforts have been commendable for reversing a very high prevalence rate but these gains will be overshadowed if it fails to respond to the rapidly changing trends of HIV infection among emergingpopulation groups. While new interventions are promising, Cambodia’s HIV/AIDS programming deserves a re-boot, so to speak.

The HIV/AIDS epidemic in the Philippines has long baffled epidemiologists and public health practitioners. In the last 20 years, incidence has remained low and the increase in the infected has been slow. All the signs point in the direction of a full-blown epidemic, the likes of which was seen in Thailand: multiple sex partners, a thriving sex industry, almost non-existent condom use, high incidence of sexually transmitted infections like syphilis, and so on. But no significant change occurred, until recently.

Apparently, the Philippine Department of Health is ‘grappling with the problem of declaring an HIV epidemic among MSM (males-who have-sex-with-males)’. This article is the first ‘official’ declaration/recognition of the rise of HIV related to male same-sex behaviour. I am also glad that the DoH was enlightened enough not to go the way of Singapore, whose health minister blamed all MSM for his country’s HIV epidemic. This is, however, just the tip of the iceberg. The Philippine HIV epidemic will prove to be as complex as the epidemics in other countries like Cambodia, requiring an equally complex response.

NGOs in the Philippines implementing HIV prevention and treatment have been constrained by a lack of available funds because of this ‘low-and-slow’ status. Who knows, if the spotlight is focused on the Philippine HIV epidemic, maybe more funds for programmes will become more available.

But if Cambodia was able to deal with its HIV epidemic, I am confident that the Philippines can as well. Cambodia, in fact, has benefited from programs developed in the Philippines. Its AIDS law is modeled after the AIDS law in the Philippines. Not to mention the human resources of Filipino consultants who are currently working in Cambodia in the AIDS field (myself included).

However, critical in the response to HIV is the leadership. Cambodia is fortunate to have a leadership that do not pander to the whims of a church that vociferously resists the promotion of sexual health. Of course, this doesn’t mean that they (Cambodia’s leaders) do not pander to other influencers. This is totally a different story. But when it comes to HIV programming, I think Cambodia is more open compared to the Philippines.

I am, however, confident that this will also change in the near future.