Will We-the-Quails Unite To Lift The Net Or Wither Away The Gains Made In AIDS Response?

Let us refresh the old gold Buddhist tale of The Quail and the Net: “Long ago a flock of quails lived in a forest. Everyday a hunter would cast a net and trap many of them. But eventually, a wise quail told the rest that if they worked together, they could lift the net collectively at the same moment and escape as one. Next time the hunter tried to capture them, quails moved in unison, raising the net and flying off together. Unity is strength,” said Eamonn Murphy, Director of UNAIDS for Asia Pacific and Central Asia and Eastern Europe regions around the world’s largest conference on HIV science (13th International AIDS Society Conference on HIV Science).

He continued narrating this tale of deep wisdom: “For several days thereafter, quails were able to drop the net far from the catcher’s reach. But soon some of them became annoyed – small quarrels started – one quail felt ‘I am doing most of the work’ the other felt ‘I want to go in the opposite direction’ - eventually they stopped working together. Next time the net fell, instead of flying, they argued. Then the hunter caught them all. This tale teaches us that the discord and breaking focus can lead to ruin.”

AIDS response faces the ruin but would we – the quails – fight or unite?

“I would be blunt. Today, it is the AIDS response that faces ruin. We are all the quails – from advocates to academics, countries to communities, doctors to development partners - we worked together to lift the net of the disease that once threatened to devastate us. We even came up with a plan to cast it off for good. Some of us have grown tired, others are doing part of the work but not all they should – many are not pulling their weight – and now we risk being tracked by a disease we should be condemning to history,” said Eamonn Murphy of UNAIDS.

“Recent global funding cuts could send the world back to levels of HIV infections and AIDS-related deaths not seen since the early 2000s,” said Murphy while showing a 5-years projection of how new HIV infections and AIDS-related deaths globally can dangerously rise if the lost funding both this year and in recent years does not return. “Many countries have reduced their investments and domestic funding is often inadequate to fully fund the AIDS response – which has been relying on external support.”

Agrees Dr Jakkrapatara Boonruang, research physician at the Institute of HIV Research and Innovation (IHRI) and a Mark Wainberg Fellowship Awardee: “There is more work which needs to be done for ending AIDS by 2030. The latest UNAIDS global AIDS update 2025 launched before IAS 2025 shows that along with US funding cuts, other international financing for HIV is also waning. The impact is more severe where HIV programmes were majorly funded by international donors.”

“Even though in Thailand where most of the HIV-related services have been included in universal health coverage of the government, there are some aspects like reimbursements that have not been covered. Salaries of service providers and utility courses are yet to be covered by the universal health coverage for instance,” added Dr Boonruang. “While services are fully covered by tax payers money, service providers are losing jobs or facing salary reductions. For example, we at IHRI have lost 20% of our colleagues following the suspension of US funding.”

Rising new infections, low treatment coverage and funding cuts in Asia Pacific

“Nine countries in Asia and the Pacific region have rising new HIV infection rates. 9 countries in the region have too low coverage of lifesaving antiretroviral treatments. Moreover, the region has been hit with funding crisis – and – overall HIV prevention crisis too,” said Cedriann Martin, UNAIDS Communications Advisor.

Between 2010 to 2024, there were 9 countries in Asia Pacific which reported an increase in newly diagnosed people with HIV. Fiji has the world’s fastest growing epidemic, new HIV infections increased by over 3091% in Fiji.

Along with Fiji, other countries in Asia Pacific where there was an upswing in the number of people newly diagnosed with HIV between 2010-2024 are:

* 942% rise in Philippines

* 187% rise in Afghanistan

* 84% rise in Papua New Guinea

* 67% rise in Bhutan

* 48% rise in Sri Lanka

* 42% rise in Timor-Leste

* 33% rise in Bangladesh

* 16% rise in Lao PDR

Between 2010-2024, there were 9 countries in Asia Pacific which are also treating less than half of the people living with HIV, such as Afghanistan (11%), Pakistan (16%), Fiji (24%), Philippines (40%), Bangladesh (41%), Indonesia (41%), Mongolia (41%), PNG (46%), and Maldives (48%).

Cambodia treats most people with HIV (92%) in the region.

Prevention crisis in Asia Pacific

Compared to the decline in the number of people newly diagnosed with HIV between 2010-2024 worldwide (40%), the decline in Asia Pacific is far behind (17%).

“Asia Pacific has a prevention crisis. The reduction of new infections has flatlined. Every 2 minutes a new person contracts HIV in our region today. Every hour we have 35 new HIV infections including 9 among young people. Every single day, we have over 300 men who have sex with men, over 80 persons who inject drugs, over 50 sex workers, and over 15 transgender persons, newly infected with HIV in the region,” said Eamonn. “It is like we are trying to empty the bowl but have not turned off the tap.”

What is worrying for CNS (Citizen News Service) is that as per the Global AIDS Update 2024 (last year), these numbers were also almost the same. So, there is hardly any significant change when it comes to prevention, testing and treatment targets in the region. Rather on the contrary, challenges have gone up manifold this year.

79% of new HIV infections were among key populations and their partners: 43% among men who have sex with men, 7% among sex workers, 12% among persons who inject drugs, 2% among transgender peoples, among others. “Criminalisation and marginalisation deepen their vulnerability making it harder for HIV key populations to access services – and less likely to engage with the services available,” remarked Eamonn Murphy of UNAIDS.

Weak HIV response in Asia Pacific region in recent years: Why?

Not just HIV prevention is flatlined in the region but also HIV testing and treatment have only increased marginally since 2023. “This region is not speeding towards the finish line. At best, it is (too) slowly inching forwards,” said Eamonn Murphy of UNAIDS.

“1 in every 5 people living with HIV still do not know their HIV status; 1 in 4 people are not on lifesaving antiretroviral treatment, 1 in 3 have not achieved a suppressed viral load,” said Murphy.

Scientific research and WHO guidelines show that if a person living with HIV is on lifesaving antiretroviral therapy and viral load remains undetectable, then not only the person lives normal healthy lifespans but also there is zero risk of any further HIV transmission. So, treatment works as prevention too. Undetectable equals Untransmittbale or #UequalsU.

That is why 2025 HIV targets call upon countries to ensure that at least 95% of people know their status, 95% are on treatment and 95% are virally suppressed.

“In Asia Pacific by end of 2024, 79% know their status, 69% of them are on treatment, and 66% of them have suppressed viral load,” said Eamonn. “By the time we reach the end of 2025, we may have to diagnose an additional 1.1 million people with HIV and treat 1.5 million people with HIV in this region. So, realistically we are going to miss 2025 targets in Asia Pacific.”

The latest Global AIDS Update 2025 of UNAIDS shows that when it comes to HIV targets for 2025, progress among children with HIV in the region is the worst. 70% of children (or their caregivers) know their status, 67% are on treatment, and 57% are virally suppressed.

Among women with HIV in Asia Pacific, 83% know their status, 72% are on treatment and 71% are virally suppressed. Among men with HIV in the region, 77% know their status, 67% are on treatment and 65% are virally suppressed.

“By the time we should be realising the dream of AIDS-free generations we are dropping the ball for our future generations. Care for children begins with support for their families. Prevention of mother to child transmission of HIV services, are a critical starting point of early infant diagnosis and ongoing care. For many in our region they do not have access to early HIV screening and treatment and psychosocial support they need,” said Eamonn Murphy.

He added: “We should respond to gender dynamics for both men and women in this region. We have to work with partners to increase health seeking behaviour among men and to lower intimate partner violence for relevant countries and communities. Better HIV service results require a collective intersectional action.

Let us learn the lessons from the Quail and the Net

“The world still has not learnt the lessons of the quails- we need to work together. We have a small window of opportunity to get it right. We know what central components of AIDS response are, we have the science, knowledge, evidence, and partnerships, yet we are continuing to rely too heavily on treatment approach. In Asia Pacific region, we need a HIV prevention revolution that is anchored in human rights,” said Eamonn Murphy of UNAIDS. “If we are together focussed and unified, we can fly towards the end of this epidemic as a public health threat – we can end AIDS now. If not, we will all fail.”

Shobha Shukla, Bobby Ramakant – CNS (Citizen News Service)

(Shobha Shukla and Bobby Ramakant co-lead the editorial at CNS (Citizen News Service) and Shobha was the Lead Discussant on SDG-3 at UN High Level Political Forum 2025. Follow them on Twitter/X: @Shobha1Shukla, @BobbyRamakant)

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