Inspiringly, we heard how key-population led health service delivery is the way forward if we want to reach the WHO 90-90-90 target. However, the main message that I left with was that many people living with HIV (PLHIV) in who live in many Asia Pacific countries like Indonesia, China, Singapore and others are still faced with high rates of stigma and discrimination - to the point where families are asking doctors not to write ‘HIV’ on their family member’s death certificate as they are too ashamed, scared that other family members will find out and isolate them. One presentation described it as frequent practice in China for doctors NOT to test and treat patients with whom they disagree with their practices or behaviour, including MSM - however access is seemingly better if a PLHIV has already started ART because the doctor just needs to write the script - no follow up required! As a clinician, it is very hard to hear that people aren’t able to access testing let alone treatment for HIV because they are greeted by attitudes like this from trusted heath professionals. Sepi Maulana Ardiansyahby gave a memorable, moving and very brave tribute to Prof Cooper, presenting a key population oriented perspective and highlighting the broader social stigma experienced by young MSM living with HIV. Sepi powerfully told us that HIV cannot be solved by statistics and medicine alone - we as communities need to start loving and accepting. If having a focus on key led population service delivery is truly the way forward in this region for HIV care, then I would like to directly from more people from key populations at next year’s APACC- their work, their experiences and ideas for the future of the HIV and co-infections field.
I know not every state government, doctor, health service or hospital is perfect in Australia but you cannot attend a conference like this highlighting issues from across Asia Pacific and not think just how lucky we are - free accessible, affordable, health care, mostly without discrimination, stigma or judgment from health professionals. Given the education and resources we have, I would hope that ALL clinicians in Australia are professional, non judgmental and able to treat patients/clients with respect, but I know that is not the case. Having working in the area and having heard of GP practices where people don’t feel comfortable asking for sexual health care or STI testing and don’t have access to specialist sexual heath clinics, and may therefore choose not to be tested...
Stigma and discrimination toward LGBTQ communities and PLHIV is still clearly a global issue that we need to continue to address in our clinical practice, and in all settings.
Finally, I have also taken away an awareness of the huge variations in resources available across this region, particularly in terms of the cost of ARTs.
The impact of the cost of medications in some of the poorly resourced countries is astounding - so many drug pricing variations -one country paying $30 and the other paying $600 to the same supplier for the same drug - such a need for political and economic change. When I look at the available treatments, the community and political support and the research being conducted, I feel very lucky to be living and working in Australia and hope that we will have even more representation at APACC 2019, to learn from, share in and build continued collaborations around the exciting work being done across the Asia Pacific in HIV and co-infections.
