Statistical Yearbook for Asia and the Pacific 2011
 
People - Health
HIV and AIDS
Data sources: UNAIDS 2010 Report on the Global AIDS epidemic. WHO Global Health Observatory Database (WHO/GHO). UN MDG Indicators database.

The Asia-Pacific HIV epidemic is stabilizing overall: new infections are declining and AIDS deaths are levelling off. However, prevention among populations at risk remains insufficient.

HIV prevalence

In Asia and the Pacific, an estimated 6.1 million people were living with the human immunodeficiency virus (HIV) in 2009, of whom 5.9 million were adults. The number of people newly infected with HIV in the region was estimated to be 360,000 in 2009, 20% lower than the 450,000 new infections estimated in 2001, indicating that in Asia and the Pacific, as in the rest of the world, the epidemic is decreasing overall. An estimated 22,000 children (under 15 years) became infected with HIV in 2009 – a 15% decrease from the 1999 estimate of 26,000.1

Figure I.16 – Population living with HIV, Asia and the Pacific, 2005 and 2009

Figure I.16 – Population living with HIV, Asia and the Pacific, 2005 and 2009

In 2009, eight countries in the region reported an estimated 100,000 or more people living with HIV: China, India, Indonesia, Malaysia, Myanmar, the Russian Federation, Thailand and Viet Nam. India alone had 2.4 million people living with HIV in 2009 and accounted for about half (49%) of the HIV burden. Together, these eight countries also accounted for 92% of all estimated new HIV infections in the region in 2009.

AIDS deaths

An estimated 300,000 people in the region died from acquired immune deficiency syndrome (AIDS) or related causes in 2009. Although AIDS still claims many lives in Asia and the Pacific, mortality related to AIDS has stabilized over the past several years in many countries. In 21 of the 32 countries with available data, the number of AIDS deaths in 2009 was equal to or less than the number of deaths in 2005. AIDSrelated deaths among children declined from 18,0001 in 2004 to 15,0001 in 2009 – a decrease of 17%.

At risk populations

In most of Asia and the Pacific, HIV epidemics are concentrated in a few key populations: people who inject drugs, sex workers and their clients, men who have sex with men, and transgender persons. Depending on local contexts, their risk behaviours involve marginalized groups such as vulnerable young people, prisoners, migrants and refugees. While epidemics are driven by risk behaviours, the largest groups of people living with HIV are in these “at risk” populations and the intimate partners of those at risk.

The prevalence of HIV among female sex workers is low in most countries (under 10% in all countries except Myanmar). Successful programmes for HIV prevention among female sex workers have minimized HIV infection in several countries (especially, Cambodia, India and Thailand). Male clients of female sex workers may constitute a large HIV-affected population within several countries but remain an underserved population group. The proportion of men who visit sex workers, the number of clients per sex worker, and the levels of condom use during commercial sex are key factors in determining the spread of HIV.

Figure I.17 – HIV prevalence rate in most-atrisk populations, Asia and the Pacific, 2009*

Figure I.17 – HIV prevalence rate in most-atrisk populations, Asia and the Pacific, 2009


* Since there are no available data for year 2009, the following countries used other latest year where data is available: for female sex worker group – Bangladesh and Indonesia (2007), Australia, Azerbaijan, Myanmar, Nepal, and Tajikistan (2008); for injecting drug user group – New Zealand (2004), Bangladesh, Cambodia and Indonesia (2007), Australia, Azerbaijan, Georgia, Myanmar, Pakistan, and Tajikistan (2008); for men who have sex with men group – Cambodia (2005), Indonesia and Georgia (2007), Azerbaijan and Myanmar (2008), and Viet Nam (2010).

Prevalence among people who inject drugs is higher than other at risk populations for all countries in the region with available data, with the exception of Georgia and the Philippines (where men who have sex with men show higher prevalence rates). Despite the fact that epidemic among people who inject drugs have been evident since the beginning of the HIV spread in the region, Asian and Pacific countries have not sufficiently controlled epidemics involving intravenous drug users. HIV prevalence remains high in areas with contracting epidemics and is increasing in areas with expanding epidemics.

Epidemics among men who have sex with men are on the increase around the region – especially in cities. High-prevalence epidemics (13% to 32%) have been observed among those surveyed in cities in China (13%), India (17%), Myanmar (32%), and Viet Nam (17%).2

Figure I.18 – Condom use in most-at-risk populations, Asia and the Pacific, 2009*

Figure I.18 – Condom use in most-at-risk populations, Asia and the Pacific, 2009


* Since there are no available data for year 2009, the following countries used other latest year where data is available: for female sex worker group – Mongolia (2005), Armenia, India, Indonesia, Kazakhstan, Nepal, Pakistan, Russian Federation, Singapore and Viet Nam (2007); for injecting drug user group – Armenia, Azerbaijan, Bangladesh, Japan, Tajikistan, Turkey and Uzbekistan (2007); for men who have sex with men group – Bangladesh and Fiji (2005), Armenia, Australia, Lao PDR, Mongolia, Pakistan, Papua New Guinea, Russian Federation, Thailand, Turkey and Tuvalu (2007).

In 2009, the reported rates of condom use in at risk populations varied substantially between countries and subregions of Asia-Pacific. For female sex workers, the rates ranged from 42% (Turkey) to 99% (Cambodia, Georgia and Singapore); for people who inject drugs, from 10% (Turkey) to 78% (Myanmar and Georgia); and for men who have sex with men, the reported rates of condom use ranged from 17% (Singapore) to 88% (Papua New Guinea and Thailand) based on countries with available data in 2009.

However, the proportion of those at risk who have received an HIV test during the last 12 months and know their results, another important aspect of HIV contagion remains low in most countries; with median reported coverage of 34% for female sex workers, 22% for people who inject drugs, and 29% for men who have sex with men.2

Barriers to effective HIV response3

Legal barriers, gender-based violence, stigma and discrimination continue to hamper access to HIV-related services in the Asia-Pacific region. Laws obstructing the rights of people living with HIV and at risk populations are in effect in 90% of the countries in the region. Same-sex sexual relations are criminalized in 19 countries; 29 countries criminalize some aspect of sex work; and 16 countries pose travel restrictions on people living with HIV. Many countries enforce compulsory detention for people who use drugs and 11 countries apply the death penalty for drug offences. Stigma and discrimination for at risk populations and people living with HIV remain among the most important barriers to effective HIV responses in Asia and the Pacific.

Some national programmes have stepped up efforts to address stigma and discrimination, and some legal barriers are being removed. Despite the recent progress, further efforts are needed – for example, in advancing HIV laws and policies that are coordinated with other relevant laws and policies (such as those on drug control and prostitution) and repealing laws that criminalize key affected populations. Monitoring systems need to be put in place, HIVrelated human rights abuses documented, and HIV laws, policies and guidelines enforced at all levels, including provision of affordable legal redress services.

Treatment coverage – a mixed picture Approximately 820,000 people received ART in low- and middle-income countries in Asia and the Pacific in 2009, up from 629 thousand in 2008, representing the highest annual increase since 2003. Six countries account for over 90% of the ART treatment burden: China, India, Indonesia, Myanmar, the Russian Federation, Thailand, and Viet Nam. Still there are 14 million people estimated to be in need of antiretroviral therapy (ART) in low- and middle-income countries worldwide.4

Figure I.19 – Population receiving antiretroviral therapy (ART), selected Asia and the Pacific countries, 2005 and 2009

Figure I.19 – Population receiving antiretroviral therapy (ART), selected Asia and the Pacific countries, 2005 and 2009

HIV funding gaps

In 2009, global funding for AIDS did not increase for the first time in 10 years.5 Total reported expenditure in 2009 in the Asia-Pacific region was about US$1.07 billion. Overall, domestic public funding accounted for 53% of total reported expenditure, mainly because China and Thailand together spent over US$500 million. International funding represented more than 50% of total AIDS spending in three quarters (19 of 25) of reporting countries. All low-income countries, as well as some middle-income countries (including India and Viet Nam), depend greatly on international funding for their AIDS response.

Total needs for an effective response in Asia and the Pacific are estimated to be about three times the current expenditure levels. In response to stagnating international funding, alternative national plans for AIDS response are imperative for continuing to combat the HIV/AIDS epidemic. According to UNAIDS,6 middle-income Asia-Pacific countries will need to spend as little as 0.5% of their gross national income to fund appropriate responses.

The Asia-Pacific region currently scores lower than the global average in governmental funding for health. To be effective, increases in domestic AIDS funding must be combined with well-funded public health, which includes social protection mechanisms covering essential HIV and AIDS services.

Domestic HIV/AIDS funding as percentage of total HIV/AIDS funding, selected middle-income countries, Asia and the Pacific, 2009

Domestic HIV/AIDS funding as percentage of total HIV/AIDS funding, selected middle-income countries, Asia and the Pacific, 2009


1 UNAIDS, Global Report: UNAIDS Report on the Global AIDS Epidemic 2010 (Geneva, 2010). Available from www.unaids.org/documents/ 20101123_GlobalReport_em.pdf.

2 UNGASS Country Progress Reports, 2010. Data taken from reports on progress in responding to HIV submitted by countries to UNAIDS on behalf of the United Nations General Assembly; reports for 2010 are available from www.unaids.org/en/dataanalysis/monitoringcountryprogress/ 2010progressreportssubmittedbycountries/.

3 This text box is based on: UNAIDS and others, Making the Law Work for the HIV Response: A Snapshot of Selected Laws That Support or Block Universal Access to HIV Prevention, Treatment, Care and Support , July 2010. Available from www.unaids.org/en/media/unaids/contentassets/documents/priorities/20100728_HR_Poster_en-1.pdf.

4 WHO, UNAIDS and UNICEF, Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, Progress Report 2010. Available from www.who.int/hiv/pub/2010progressreport/report/en/index.html.

5 5 A/65/797. Uniting for universal access: towards zero new HIV infections, zero discrimination and zero AIDS-related deaths. Data also sourced from reports on progress in responding to HIV submitted by countries to UNAIDS on behalf of the United Nations General Assembly; reports for 2010 are available from www.unaids.org/en/dataanalysis/monitoringcountryprogress/
2010progressreportssubmittedbycountries/
.

6 United Nations, Redefining AIDS in Asia: Crafting an Effective Response (New Delhi, Oxford, 2008). Available from http://data.unaids.org/pub/Report/2008/20080326_report_commission_aids_en.pdf.

 
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