The Asia-Pacific region is home to 56 per cent of world's population and its 44 countries represent an enormous sociocultural diversity. In the present era, they also represent a very broad development spectrum with varying degrees of socio-economic development. In the twenty-first century, this region is also turning out to be the economic powerhouse of the world with some of the economies growing at 8 per cent of GDP and above annually. In contrast, there are also many countries with a fragile financial base and weak economies resulting in weak delivery systems in social sectors. Poverty, unemployment, and traditional dependence on the primary sector for growth are some of the inhibiting factors towards rapid economic development of the region.
However, in recent years, no other problem has impacted on the economies of these countries as the epidemic of HIV and AIDS. HIV entered this region around 1986 about 5 to 6 years after its first appearance in US and later in Africa. In the last two decades, it has spread rapidly across the region with varying degrees of prevalence. Even though the percentage of population infected with the virus is still low, Asia today is home to over 5 million infected persons and the numbers are growing rapidly. At the current level of inadequate response, it is expected this number will rise to about 20 million in the next 5 years. The number of deaths is averaging around 300 thousand and the estimated financial loss to the countries is put at $ 5 billion every year.
The reasons for the sub-optimal response to the epidemic in this region are manifold. They range from low level of awareness and understanding of its long term impact among policy makers and administrators to weak health care delivery systems, inadequate budgets, and poor community involvement. Part of the reason for the low level support and commitment among policy makers and opinion leaders is on account of the methodological and empirical difficulties in predicting the dynamics of disease progression and the lack of awareness about the deep impact an uncontrolled epidemic can cause on the socio-economic development of countries. It is predicted that the economic costs could rise to as high as $ 15 billion per year by the year 2015 if the epidemic is not controlled. In spite of these projections, investments on HIV control in the region remained extremely low at 10 per cent of the required $ 5 billion per year.
The HIV and AIDS pandemic have also raised some basic questions on societal norms that form the basic fabric of societies. Sex and sexuality remained high taboo, with very little encouragement for sex and family life education for young people and adolescents. As the epidemic is mainly driven by multi-partner sex and injecting drug use which are criminal acts in the eyes of the law and are socially unacceptable, the Governments are often at a loss on defining priorities for implementation of control programmes including access to care and treatment to infected population. As a result, the infected populations remain highly stigmatized and deprived of even the limited health care services available in the countries.
With the possibility of a cure or a preventive vaccine emerging on the international scene appearing very remote in the near future, the problem of HIV will continue to challenge Governments and civil societies for the next decade and beyond. It would be necessary for countries in the region to be sensitive to the short- and medium-term implications of the presence of a large HIV infected population and members of their families who are affected. The problem needs to be understood not just at the macro economic level but at the individual, family, and community level also where the impact will be maximum in Asian countries. Governments need to adopt policies which will minimize the impact of HIV at all levels while attempting to halt and reverse the spread of the epidemic.
UNAIDS, the Joint UN Programme for HIV/AIDS, is vitally interested in getting an objective and independent analysis conducted to address these issues and provide various policy options to member countries in the region for an active engagement in their fight against the pandemic. UNAIDS therefore proposes to constitute an Independent Commission on AIDS in Asia with the following Tbrms of Reference:
• To objectively assess the state of the AIDS epidemic in Asia and the Pacific region in terms of incidence, awareness, prevention, and treatment and its progression at existing and scaled up levels of national and international efforts;
• To analyse the socio-economic composition of the infected and affected populations and the impact of the epidemic on them at household, community, workplace, and societal levels;
• To analyse the medium- and long-term implications of the presence of a large HIV infected population in Asian societies and its impact on the socio-economic environment in the affected countries. Special focus needs to be given on human resources, labour productivity, poverty reduction, social stability, and household savings;
• To assess the impact of the epidemic on Governments, with regard to allocation of limited resources to health budgets, strain on existing health systems, diversion of resources from priority areas of social and economic development, issues of national security, and the ability to stay competitive in the emerging global economic scenario; and
• To provide specific recommendations on the nature of institutional reforms and policies that need to be adopted to minimize the adverse impact of HIV and AIDS on households, community, society, and the economy.
The findings of the Commission will be summarized in a Report to be completed by the end of 2007. The findings will also be widely disseminated to the UNAIDS Cosponsors and the Secretariat, National Governments of the Region, bilateral and multilateral donors, and prominent leaders of civil society.
The duration of the Commission will be of 18 months and financial support for the functioning of the Commission will be provided by the UNAIDS Secretariat. Given the short time frame, maximum use will be made of available data and information, and operational research will be undertaken only for filling critical gaps. For commissioning such studies, putting together the evidence in the form of a Report and providing secretarial assistance to the Commission in its day-to-day work, a leading Research/Academic Institution will be engaged from the region.
The Commission, during its first sitting, will determine the plan of work and develop operational guidelines for conduct of business and preparation of the Report.