Building networks with cities around the world to combat HIV.

In July 9th 2021, the "First Fast-Track Cities Workshop Japan" was held virtually. Fast-Track Cities (FTC) is an international partnership aimed at ending AIDS by 2030, with HIV prevention as an urgent issue. The United Nations Joint AIDS Programme (UNAIDS) and cities around the world are working together to combat HIV and AIDS.
The workshop was attended by not only domestic and international experts, but also groups of participants and supporters working in various parts of the country, and introduction on their efforts against HIV has also been shared during the Workshop.

What is AIDS? What is HIV? Current situation in Japan

In 2019, 903 people was infected with HIV (Human immunodeficiency virus) in Japan and 333 people with AIDS (acquired immunodeficiency syndrome), a total of 1,236 people. Compared to the peak of infection in 2013, which had 1,600 people, we can say that it is on a slightly downward trend. From 1985 to the end of 2019, the total number of people living with HIV and AIDS was 31,385.
The number of people living with HIV and AIDS is high in urban areas, with Tokyo accounting for more than 3% of the total, followed by Osaka and Aichi prefectures.

AIDS develops when infected with HIV (see HIV/AIDS page for details). Even if you get HIV, and if treatment (anti-HIV drugs) is started early before you develop AIDS, you can prevent the onset and majority of the people can avoid the development of AIDS.
HIV is not easily transmitted and a less infectious virus, so it is unlikely to infect others in a regular life. In addition, long-term suppression of the virus' levels below the detection limit (Undetectable) with anti-HIV drugs also eliminates transmission from sexual intercourse (Untransmutable). This is known as U=U.

Advances in anti-HIV drugs have made HIV infection a controllable 'chronic disease'. However, many people are still unaware of this fact and people infected with HIV are still subject to prejudice and discrimination. Another problem is that people infected with HIV do not get tested at the right time due to the lack of correct knowledge about HIV. In view of the current situation in Japan, the 1st Fast-Track Cities Workshop Japan will focus on the dissemination of HIV testing, infection prevention measures and the issue of stigma (including discrimination and prejudice) against HIV-infected people and people living with AIDS.

The role of Fast-Track Cities InstituteとInternational Association of Providers of AIDS Care

The first session, chaired by Dr Shinichi Oka of the National Centre for Global Health and Medicine featured reports from abroad on AIDS care.

Dr José Zúniga, President of the International Association of AIDS Care Providers (IAPAC), recommended that, in order to achieve zero new HIV infections, zero AIDS-related deaths and zero prejudice against AIDS by 2025, prejudice and discrimination must be eliminated as "Introduction to FTC - Basic Understanding of Commitment".
95% of people at risk of HIV infection take comprehensive infection prevention measures and 95% of HIV-infected people receive retroviral therapy - these preventative measures will bring us closer to ending AIDS. He stated that it is important that others share this information as well. Eliminating prejudice and discrimination in relation to HIV and AIDS would also help to establish gender equality and eliminate violence.
It was also mentioned that with the ageing of AIDS patients, it is expected that there will be more opportunities to visit medical institutions for illnesses other than AIDS in the future, and that the challenge is how to accept these patients and build a medical system to deal with them.
Dr Jane Anderson from the UK then reported on the Fast Track City Initiative (FTCI) in London.
In London, where 40% of all HIV-infected people in the UK live, HIV treatment is managed across the city through the HIV Forum, a network of clinicians. There are 1,500 primary care clinics and anyone who is a member of the UK's National Insurance Service can receive guideline-based treatment free of charge. Including support provided by the volunteers.
The UK Public Health Agency, in collaboration with the Clinical Practice and Prevention Unit, uses an HIV surveillance and monitoring system to collect information. Thi is made widely available and used to assess the HIV situation and take action at regional and national level.
In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the '90-90-90' strategy to control the HIV epidemic, which includes, by 2020, at least 90% of infected people being diagnosed, at least 90% of diagnosed infected people receiving treatment, and at least 90% of infected people receiving treatment to control the level of virus in their blood. 1). London has achieved this target and is also the first city in the world to achieve '95-95-95'. It has also set a target of zero HIV cases, related deaths and HIV related stigma by 2030.
This will require a change in the attitudes of not only those affected but also the general public. A large-scale survey of the general public will be conducted to eradicate the stigma of HIV, the results of which will be made public as well. The aim is to train personnel to support the elimination of the internalised stigma of people with HIV and to develop a workforce. She also stated that there is a need to promote FTC by working in partnership with London's healthcare and voluntary organisations, removing barriers such as traditions and limitations.
He stated that the future of HIV care will require changes in the services provided as the characteristics of infected people change and their needs change, and that the urgent task is to develop a community-based approach, integrating medical and social care. Although the virus pandemic has forced some changes in plans, London is working towards high goals.
1）https://www.unaids.org/en/resources/documents/2017/90-90-90

Finally, Dr Nitthaya Phanufak from Bangkok, Thailand, gave an introduction on 'Best Practices at FTC-Bangkok'.
In Thailand, Key Population Led Health Services (KPLHS) has been established to provide medical care for HIV and general sexual health, with a focus on the person receiving care. The aim here is to close the support gap for key populations, with client-centred services, a neutral approach and placing equal importance on HIV treatment and prevention.
The KPLHS reduces the number of steps to access care and ensures that people receive the support they need quickly. If a person is found to be HIV-positive on testing, the first step is to explain about anti-HIV therapy (ART). 90-95% of positive people accept ART on the same day and 80% actually do.
While HIV infection among male-to-male sex workers (MSM) is declining in Thailand, it is increasing among transgender women. This change in infection status has necessitated the establishment of transgender-friendly healthcare services. In running this service, opinions and requests were sought from several transgender groups in order to meet the needs of users.
The newly established Tangerine Clinic in the heart of Bangkok provides sexual health services to all genders. Over the past five years, more than 4,000 transgender women have used the clinic, and it was through transgender influencers on Facebook. This encouraged people to go for consultations. 70% of those came in says they found out about the clinic through these Facebook pages, 40% of whom led to their first HIV test, and pre-exposure prophylaxis medication (PrEP) uptake has grown by around 300%.
In 2020, Bangkok ran a campaign called "PrEP in The City", which began advertising on public transports. Through these works, we are working towards ending AIDS by integrating PrEP into daily life and reducing stigma.