Does Taiwan Have Sexual Health Under Control?

TaiwanPlus News

Taiwan’s Centers for Disease Control reports a decline in new cases of HIV/AIDS since 2017.    On this episode of Zoom In Zoom Out, TaiwanPlus reporter Reece Ayers sits down with Dr. Stephane Ku, an attending physician of the Division of Infectious Diseases at the Taipei City Hospital Renai branch. We first zoom in on the policies that brought HIV/AIDS under control, then zoom out to understand how this decline fits together with a rise in other STIs in Taiwan.

Transcript

00:00Welcome to Zoom In Zoom Out, your global look at news from Taiwan. I'm Rhys Ayres.

00:18HIV and AIDS cases have been falling in Taiwan. A recent Centers for Disease Control report

00:24shows a year-on-year decrease in the number of new cases. There were 941 new HIV cases

00:30last year, continuing a downward trend since 2017, and the lowest number in two decades.

00:37Health officials say better access to testing, treatment and preventative medication have

00:41brought the disease under control.

00:43Today, to dive deeper into the issue of sexual health in Taiwan, we're joined by one of

00:49the biggest names in HIV research and education, Dr. Stephan Khoo, who is an attending physician

00:55of the Division of Infectious Diseases at the Taipei City Hospital Rennai branch. Thanks

01:01for joining us, Stephan.

01:02Thank you for having me.

01:04First, let's zoom in on Taiwan and its efforts to bring HIV rates under control. As we just

01:10saw, recent reports indicate that rates continue to decline, with Taiwan's CDC saying that

01:16HIV infection rates are essentially under control. Is this a cause for celebration,

01:21and how do we get to this point?

01:22Well, I think we can celebrate a little bit because this is really the first time since

01:282017 that we see more than 60% decrease. It's not a single policy that caused this decrease.

01:37For example, we started Treat for All, that people are being tested and get treatment

01:42if they have been receiving diagnosis of HIV. If they want, they can get the treatment

01:47right away. And also, we're promoting self-testing kits, so people can test HIV by themselves

01:55at home. And also, we do start a government-subsidized PrEP program, so making PrEP more available

02:05to everybody.

02:07Part of the battle against HIV and AIDS is also tackling the stigma attached to it. Has

02:13there been progress in changing public perceptions towards the disease?

02:17I think the answer would be yes and no. If you are looking at the survey recently, you

02:23will see that younger generations are more accepting, or they have proper knowledge on

02:29HIV itself. But also, from some other polls and also surveys, we did see that the situation

02:38wasn't that perfect. For example, there was a poll aiming public generations back in 2020.

02:45More than half of the respondents said that they have negative opinions on people living

02:51with HIV still.

02:53And also, there's another survey on people living with HIV from 2021. A quarter of these

03:01respondents reported they had the experience of being rejected by health care providers

03:11because of their status. So I think that while our society is improving, we still have some

03:20way to go.

03:22So is this decline in Taiwan unique to Taiwan, or are we seeing this trend in other places

03:29in the world as well?

03:30I think for the whole world, if you look at the data from the United Nations, it's actually

03:36decreasing. For example, Sub-Saharan Africa used to be a very troubling pandemic area.

03:46Now we see the greatest decrease. Also, other countries in our region, for example, Thailand,

03:53Vietnam, Hong Kong, all see such a decrease. I think for most of these countries, we have

03:59put efforts on this, so you do see the fruit. However, there are some areas in the world

04:08where we do see an increase of HIV infections, new infections. For example, Eastern Europe

04:15and Central Asia, and also North Africa and the Middle East. So these are the countries

04:22that usually have higher levels of stigmatisation, and also the government is not really putting

04:31efforts on this, so you will see the increase.

04:35In terms of contributions towards HIV research, has Taiwan made any specific contributions there?

04:43In terms of all this innovation and clinical research, we did contribute a little bit.

04:48For example, there were monoclonal antibodies. It's kind of antibodies, artificially made

04:56antibodies for HIV treatment. So I think two monoclonal antibodies were invented in Taiwan.

05:04And also, Taiwan has always been a country with a higher prevalence of viral hepatitis.

05:12For example, hepatitis B, there used to be national health issues. So in the previous

05:19clinical research and studies, Taiwan has contributed a lot to the study for people

05:26who had a co-infection of viral hepatitis and HIV. And also, we adopted on-demand PrEP

05:33very early. So if the audience are from the US, they are always being recommended giving

05:41PrEP daily, but Taiwan has started recommendation on-demand PrEP very early.

05:46On the subject of PrEP, I'm from the UK. In the UK, it's free and very easy to get, but

05:52in Taiwan it still costs a decent price. Is that a barrier for some people who are looking

05:59to protect themselves against HIV?

06:01So PrEP, or pre-exposure prophylaxis, is using an antiretroviral agent to prevent HIV.

06:10It's very effective. It's good for all genders and all ages and people with a different category

06:19of risk for getting HIV. And it's widely available and also recommended by WHO as part of the

06:27prevention tool. So it's widely available. So we all know PrEP works great if it's available

06:34to people who need it. I think Taiwan, we started this journey pretty early, like in

06:422016, 17, we started the very first pilot project. But in Taiwan, it's not covered by

06:48the National Health Insurance. So it's like 40% of people will get the PrEP from a CDC-funded

06:56programme. But a lot of the rest of them will actually need to order it online or get that

07:02from abroad.

07:03And finally, for the Zoom in, what's the future looking like for HIV treatment and prevention?

07:09There's been talk of vaccines that are being developed and also preventative injections

07:15that you can take every six months or two years. Is there cause for optimism about the

07:21near future?

07:22Of course, there's no vaccination available so far. So the current situation for HIV treatment

07:29and prevention would be like, for people living with HIV, they just need to take one pill

07:36per day. So it's very easy. I always joke that treating HIV is even easier than treating

07:43COVID or other chronic medical diseases. In the future, we're actually seeing people will

07:51get long-acting formulation for treatment and prevention. For example, for treatment,

07:58there are bi-monthly injectables that you had an intramuscular injection every two months

08:05so that your HIV will be controlled perfectly. And for the prevention, as you mentioned,

08:12there will be a six-monthly injection for prevention.

08:22Well, let's zoom out now and talk more generally about sexual health in Taiwan and also the

08:28work that you've been doing with the LGBTQ community. So we've mentioned that HIV rates

08:34are on the decline, but there seems to be a rise in other sexually transmitted diseases

08:40and infections. What's the reason for that?

08:45Well, if we look at the data provided by CDC, the sharp rise actually started from COVID

08:52period of time. It's not really unique to Taiwan. It's like universal everywhere in

09:00the world. So there are a lot of explanations. Well, of course, very obviously, people are

09:07not using condoms that frequently anymore. And then we do have some new screening tools

09:17for STIs. Nowadays, we have PCR for STIs so we can screen some symptomatic infections.

09:23So in that case, we kind of found more new infections. But I think it's kind of important

09:31we do see something about STIs that we have very good preventive tools for HIV. However,

09:40we don't have that many good tools for STI preventions.

09:45Do you think that, you know, medications, preventative treatments like PrEP, is that

09:50a double-edged sword? You know, is it giving people more confidence to explore their world

09:57sexually, perhaps less safely?

10:00Well, I would say for human behaviours, it's something that's the most difficult thing

10:07to change. But from the experience of like in San Francisco or in London, they actually

10:14saw that even before PrEP was introduced, there were increase of STI infection already.

10:22It's not because people started to use PrEP and they become less aware of HIV. It's usually

10:29the opposite, that they are aware of STI and HIV, so that's why they wanted to stop PrEP.

10:37So that serves a perfect tool for them, like a personal protection against HIV.

10:44You do a lot of work promoting sexual health education, particularly amongst the LGBTQ

10:49community. Are sexual health issues more prominent amongst the queer community? Why have you

10:58chosen to focus your education to that group?

11:03Well, of course there's a personal reason out of that. I'm a gay man, so I was born

11:12in 1980. That was the time when HIV was first documented in human history. So I think we

11:19have been kind of traumatised by the pandemic that happened in the last century. Of course

11:27nowadays we see HIV as a treatable, preventable disease, so it changed a lot. However, I think

11:35sexual health itself is not just important for the LGBTQ community. I think it's important

11:43for everyone. It's a taboo to talk about. And of course, for most of the LGBT community

11:50members, we first know ourselves, we kind of define our identity by knowing our gender

12:01and sexual orientation. And then of course, because you're different, you need to encounter

12:07unfortunately, all the stigma and discrimination coming outside and inside the community.

12:15And finally, what do you think is the biggest, or some of the challenges that Taiwan is facing

12:21in terms of sexual health and education?

12:26It's a lot of challenges, to be honest. As you say, in Asia it's a big taboo to talk

12:32about. I find it particularly difficult to talk about it in schools. I think sex education

12:42for young adults and adolescents would be very, very important. But in Taiwan, you didn't

12:51really talk about this until you become groomed up. Of course, there are other issues. I feel

13:00that making prevention like PrEP or STI screening more affordable to everyone is also very important.

13:12And of course, decriminalising HIV transmission is also very important. So we still have so

13:18many issues to deal with so far.

13:21Well, Stephan, thank you for joining us and thank you for the fantastic work you've been

13:25doing in the sexual health field.

13:27Thank you for having me today.

13:29This has been Zoom In Zoom Out. You can find more stories from Taiwan Plus News by following

13:34us on social media. Thanks for joining us and we'll see you next time.

13:59Enjoy the rich diversity of Taiwan's independent music.

14:29For more stories from Taiwan and around the world, follow Taiwan Plus on social media.

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