Leading the Way on AIDS in Asia
Drs. Annette Sohn and Nittaya Phanuphak have been leading collaborative initiatives at the forefront of the HIV response in Asia for the past two decades
Dr. Sohn is an amfAR vice president and director of TREAT Asia, a collaborative amfAR program based in Bangkok, Thailand, with more than 20 network sites across the Asia-Pacific. TREAT Asia integrates HIV, coinfection, and comorbidity research among children, adolescents, and adults, with related activities around community advocacy and training.
Dr. Nittaya is executive director of the Institute of HIV Research and Innovation (IHRI), also in Bangkok. She works actively with community and government partners to enhance access to HIV testing, prevention, and treatment in the country and the region. Dr Nittaya has published over 260 peer-reviewed articles and is a Governing Council member of the International AIDS Society. She provides ongoing leadership to multiple studies and programs addressing HIV prevention and treatment, mental health, substance use, and community-led health services.
Dr. Sohn asked Dr. Nittaya about her priorities, the importance of implementation research, her thoughts on U=U, and the main barriers to ending AIDS.
Dr. Annette Sohn: The team at IHRI has been at the forefront of conducting HIV prevention and treatment research in Thailand. Where do you think we need to focus our research priorities in the years to come?
Dr. Nittaya Phanuphak: We need to be more serious about developing, testing, and refining an integrated service delivery model—one that puts people at the center of the design—and move away from a disease/health condition-focused way of thinking. I would like to see a service delivery model that covers multiple health conditions and non-health services designed “around the people” being served.
As a researcher, you need to accept that you don’t know everything. You cannot just pretend, not knowing that there are things you don’t understand, skills you don’t have, living context you never experienced. Once you accept this, learning opportunities will come to you, together with new research networks and diverse community partners.
Many of us who started our research careers in the HIV field have extended our interests and skills into other health conditions commonly faced by the communities we have been working with. This includes hepatitis C, hepatitis B, sexually transmitted infections, HPV-related cervical/anal/ oropharyngeal cancers, mental health issues, and other non-communicable diseases. However, too few of us have stepped out of our comfort zones to explore the human rights and legal aspects of these conditions, knowing that they are the root cause of many of them, to see how we can address them as researchers.
AS: What do you see as key lessons learned in terms of how we can more effectively implement HIV-related research?
NP: We need more implementation researchers! As HIV researchers, we must also apply implementation research beyond health/clinical services. Protecting and promoting human rights and health rights, legal and policy reforms, and financing mechanisms for sustainability could all benefit from implementation research.
AS: You have been a fierce advocate for U=U [undetectable=untransmittable] through your research and policy work. Why do you think this is such a powerful message?
NP: I believe that U=U can immediately bring back the human dignity of a person living with HIV at the moment they become undetectable—knowing that they can live a full life, love and be loved. It is the sense of dignity inside of that person that I feel is most important. The science of U=U can certainly be used to foster an environment that helps reduce or eliminate stigma and discrimination in other settings, but that is a gradual process.
AS: What do you think are the main barriers and facilitators to achieving the “end of AIDS” (e.g., reducing incidence and AIDS-related deaths)?
NP: I think the main barriers include stigma and discrimination, criminalization [of HIV, sex work, substance use, same-sex relationships], lack of professionalism, and a paternalistic health system. I see the main facilitators as an open and growth-oriented mindset, perseverance, and respect.
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