4. OUTLINES OF THE
PRESENTATION
Key facts
Description of the epidemic
What is the burden of the HIV epidemic in Asia?
Prevalence, Incidence, Women, Children
In different MARPs
What is the transmission dynamics of HIV in Asia?
What are the Vulnerabilities?
MARPs (type, size, behaviour)
Health sector response to the epidemic
Prevention
Care, support and treatment
5. KEY FACTS (QUICK VIEW)
Having claimed more than 39 million
Sub-Saharan Africa-the most affected region, with
24.7 [23.4–26.2] million PLWH in 2013.
Incidence -Sub-Saharan Africa accounts 70% of the
global new HIV cases.
HIV diagnosis- detecting HIV antibodies in blood.
There is no cure for HIV infection.
6. Effective treatment with ART can control the virus
In 2013, 12.9 million (37%) PLWH were receiving (ART)
93% (32.6 million) PLWH come from low- and middle-
income countries.
36% (11.7 million) PLWH are receiving ART in low- and
middle-income countries.
11.7 million (90%) were receiving ART in low- and middle-
income countries.
Access of ART is low in pediatric age group as compared to
adults.(1:4 vs 1:3)
7.
8. The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.
Regional HIV and AIDS statistics and features2013
9. About 6000 new HIV infections a day in 2013
About 4080 (68%) are in Sub Saharan Africa
About 700(12%) are in children under 15 years
of age
About 5 200(88%) are in adults aged 15 years
and older, of whom:
─ almost 47% are among women
─ about 33% are among young people (15-24)
10. 2013 global HIV and AIDS estimates
Children (<15 years)
Children living with HIV 3.2 million [2.9 million – 3.5 million]
New HIV infections in 2013 240 000 [210 000 – 280 000]
Deaths due to AIDS in 2013 190 000 [170 000 – 220 000]
11. Middle East & North Africa
16 000
[11 000 – 22 000]
Sub-Saharan Africa
2.9 million
[2.6 million – 3.2 million]
Eastern Europe & Central Asia
14 000
[13 000 – 14 000]
Latin America
35 000
[27 000 – 54 000]
Caribbean
17 000
[14 000 – 20 000]
Children (<15 years) estimated to be living with HIV2013
Total: 3.2 million [2.9 million – 3.5 million]
Asia and the Pacific
210 000 (7%)
[190 000– 270 000]
North America and Western and Central Europe
2800
[2300 – 3600]
12. Middle East & North Africa
1300
[<1000 – 2000]
Sub-Saharan Africa
180 000
[150 000 – 200 000]
Eastern Europe & Central
Asia
<500
[<200 – <1000]
Latin America
1500
[<1000 – 4200]
Caribbean
<1000
[<1000 – 1100]
Estimated deaths in children (<15 years) from AIDS2013
Total: 190 000 [170 000 – 220 000]
Asia and the Pacific
14 000(7%)
[12 000 – 19 000]
North America and Western and Central Europe
<200
[<100 – <200]
13. Middle East & North Africa
2300
[1500 – 3400]
Sub-Saharan Africa
210 000
[180 000 – 250 000]
Eastern Europe & Central
Asia
<1000
[<1000 – 1200]
Latin America
1800
[<1000 – 7400]
Caribbean
<1000
[<500 – <1000]
Estimated number of children (<15 years)
newly infected with HIV2013
Total: 240 000 [210 000 – 280 000]
Asia and the Pacific
22 000(9%)
[18 000– 32 000]
North America and Western and Central Europe
<500
[<200 – <500]
14.
15.
16.
17.
18. 18
BETTER TO REMEMBER, WHAT YOU
ARE DEALING WITH
HIV Epidemic in Asia started around 1990s
National adult HIV prevalence in most of the Asian
countries are actually low (<1%)
(Ban, Mal, SL, <0.1%; Bh, TL, 0.1%; Ino, 0.2%; In, 0.3%, Np,
0.4%; Myr, 0.6%; Th 1.4%)
However, large population sizes (60% of world popln)
means even with low prevalence, large number of people
are infected
Accounting for 15% of people living with HIV globally
Source: WHO 2009, WHO 2010; UNAIDS Global Report 2010
19. 19
HIV IN ASIA- A COMPARISON OF 2001 VS
2009
Source: WHO, UNAIDS, Global Report 2010
20. 20
HIV BURDEN IN ASIA
Of the total HIV
burden in Asia:
India 60%
India and Thailand
70%
S. No. Country
Estimated Number
of People living with
HIV/AIDS
1 India 2,400,000
2 Thailand 530,000
3 Indonesia 310,000
4 Vietnam 280,000
5 Myanmar 240,000
6 Malaysia 100,000
7 Pakistan 98,000
8 Nepal 64,000
9 Cambodia 63,000
10 Philipines 8,700
11 Lao PDR 8,500
12 Japan 6,400
13 Bangladesh 6,300
14 Republic of Korea 5,200
15 Singapore 3,400
16 Sri Lanka 2,800
17 Bhutan 999
18 Mongolia 100
19 Maldives 99
Source: WHO, UNAIDS, Global Report 2010, (Note: China, between 0.24 to 0.47 million)
21. 21
“OVERALL”, THE HIV EPIDEMIC IN ASIA
IS, STABLE
An estimated 4.9 million people were living with HIV
in 2009
Overall, it is stable around this figure
Source: WHO, UNAIDS, Global Report 2010, (Note: China, between 0.24 to 0.47 million)
22. 22
HIV PREVALENCE, ASIAN COUNTRIES
Source: HIV prevalence curves generated by Spectrum using surveillance data reported by Ministries of Health,
SEAR countries WHO,
24. 24
HIV INCIDENCE IN ASIA (“OVERALL
TREND”)
Overall incidence shows a declining trend
Source: WHO, UNAIDS, Global Report 2010, (Note: China, between 0.24 to 0.47 million)
25. 25
INCIDENCE RATES VARY BY
COUNTRIES
Source: WHO, 2010: Number of new infections estimated by Spectrum model using surveillance data reported by national
AIDS programmes, Member countries, South-East Asia Region.
26. 26
HIV INCIDENCE IN ASIA (2001 AND
2009 )
DECREASE by more than 25% in:
India (60%), Nepal and Thailand
However, the epidemic remained STATIC during
this time in:
Malaysia and Sri Lanka
INCREASED by 25% in:
Bangladesh and Philippines (otherwise low % level)
27. 27
HIV BURDEN
IN WOMEN (SEA)
Except Bhutan and Timor-Leste, F:M ratio < 1
Reasons for higher vulnerability of women: barrier
(access) to health care; stigma, gender inequality,
28. 28
HIV BURDEN IN CHILDREN (S&SEA)
Prevalence:
Estimated no of children (<15 yrs) living with HIV
increased from 140,000 (yr 2005) to 160,000 ( yr 2009)
Incidence:
Estimated number of children (<15 yrs) getting newly infected
with HIV 22,000 (yr 2009) from 26,000 (yr 1999)
15% decline
Reason: increasing access to PMTCT of HIV drop in
number of children getting infected
AIDS related deaths among children declined from
18,000 (yr 2004) to 15,000 (yr 2009)
29. 29
AIDS RELATED MORTALITY
Number of deaths have largely stabilized
Almost 50% of these deaths occurred in India (estimated
172,000)
Source: WHO, UNAIDS, Global Report 2010, (Note: China, between 0.24 to 0.47 million)
30. 30
TILL NOW…
1. HIV prevalence in Asia: overall declining
2. HIV incidence in Asia: overall declining
3. Magnitude differs greatly between countries
4. Some showing decline (India, Thailand, Nepal)
5. Some showing increase (Bangladesh, Philippines,
Indonesia, Pakistan)
MESSAGE
32. MODE OF TRANSMISSION, SEA
COUNTRIES
Unsafe sex and injecting drug use are the main risk
behaviors driving the HIV epidemic in South-East Asia
Source: National AIDS programme, Ministry of Health, SEAR countries, 2007
33. 33
MOST AT RISK POPULATION
(MARP/HRGS)
Although the overall HIV prevalence is around 0.3%,
certain population groups are highly infected
These include:
Female Sex Workers (FSW)
Injecting Drug Users (IDU)
Men who have Sex with Men (MSM), & TG (Trans gender)
34. 34
HIV PREVALENCE BY POPULATION
GROUP, MYANMAR AND THAILAND,
2009
Source: National AIDS Program, 2009 HIV sentinel surveillance report
36. 36
PERCENTAGE OF FEMALE SEX WORKERS
INFECTED WITH HIV, SOUTH-EAST ASIA
REGION, 2007–2010
Source: WHO SEAR Office
Of 281 sentinel sites for FSW, in
33% sites, HIV prev was <1%,
39% sites it was 1-5%, 25% sites it
was 5-20%; highest is noted in
Southern India
37. 37
HIV PREVALENCE IN FSW, 2010
Indonesia: Tanah Papua (16%), Bali (14%), and
Batam (12%)
Myanmar: all five sites >5%
Thailand: all of 51 sites had <5%, except four sites
<5% in Bangladesh, Maldives, Nepal and Timor
No HIV detected in FSW in Sri Lanka
39. 39
HIV PREVALENCE, SEAR 2003–2009
Source: Sentinel surveillance reports, national AIDS programmes, South-East Asia Region.
40. 40
HIV IN IDU
Estimated 4.5 million people in Asia inject drugs
More than half of them are in China
Other large no are in India, Vietnam and Pakistan
On an average, HIV prev = 16% (with variations)
Myanmar= 19- 38%, Thailand = 30-50%, Vietnam =
32-58%, China= 7-13%, India = 0-56%
42. 42
MARPs HIV are , FSW, MSM+TG, IDU
Level of HIV prevalence is very high among MARP
Changing trend of HIV at MARPS seen in countries
Large variations exists within countries
MESSAGE
43. 43
DYNAMICS OF HIV TRANSMISSION
IN ASIA
females
Male Clientsmales
MSM IDUs
FSW
Children
Spouses
(Adopted from Tim
Brown’s)
44. 44
CASUAL SEX IN GENERAL
POPULATION, BUT, BY COMMERCIAL
SEX
Source: Commission of AIDS: Redefining AIDS in Asia,
45. 45
MESSAGE OF THIS SECTION…
Main drivers of the epidemic, globally
1. Heterosexual intercourse
2. Commercial Sex work
3. Injecting drug use
4. Unprotected anal sex between
5. Men who have sex with men
Main drivers African
Main drivers of the
Asian epidemic
Main drivers African
Main drivers of the
Asian epidemic
47. 47
WHY SHOULD WE UNDERSTAND
RESPONSE?
Strategically Planned and Effectively Implemented
Response can halt and reverse the HIV epidemic
Timing of Response has major impact on the course
and magnitude of HIV epidemic
Consolidation of Lessons Learnt will help improve the
Future Response
Understanding of past and current response sets a
baseline for future action
48. 48
WHAT CONSTITUTES PROGRAM
RESPONSE?
Prevention among General Population
Prevention Programmes for MARPs
Care and Support Programmes for PLHA
Improving the Social Environment
49. 49
WHAT IS THE CRUCIAL
(STRATEGIC) INFORMATION WE
NEED TO KNOW?
What are the drivers of the epidemic?
Which GROUP are the (particular) MARPs
What is their size?
What is their profile? (dual risk?)
What are the vulnerabilities?
STIs (levels, trends, geo distribution, by popl grps)
Risk behavior (levels, changes by intervn, by pop grps)
Other vulnerabilities (e.g. migration)
Specific geographic vulnerabilities
Notas do Editor
What do I mean, when I say, Asia?
Better check your denominators before you apply those percentages!!
The burden of HIV in Asia, is again concentrated largely within select countries
Overall declining trend in Myanmar, Nepal, India and Thailand also, but increase in Indonesia
Thailand was the first country to record a drop in HIV incidence in the early 1990s, followed by India, Myanmar and Nepal in the late 1990s to early 2000. HIV incidence is still on the rise in Indonesia.
Of 281 sentinel sites for FSW, in 33% sites, HIV prev was &lt;1%, 39% sites it was 1-5%, 25% sites it was 5-20%; highest is noted in Southern India
This is an idea of what is the level of HIV prevalence among MSM in SEA; for a given geographical area, it also shows the trend over last eight years; difficult to comment on the trend with less than three data points; many issues affect the results of the surveillance; this is one of the issue that you need to focus in this training
This graph is the Commission’s projection of an epidemic in a typical Asian country with about 100m population. This is based on an analysis of epidemic progression in a number of countries. The composition of new infections tells us where they are occurring. You will find that the majority are occurring among adult men visiting sex workers, second largest among the sexual partners and only a small percentage among low risk young men who indulge in casual sex. So, contrary to popular belief, casual sex in general population is not the main cause of the epidemic in Asia. Instead, it is paid sex which is the biggest risk factor in Asian epidemics.
