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
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*
* 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*
* 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
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
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HIV and AIDS
