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HIV/AIDS IN ASIA AND THE
PACIFIC - A FAST RISING PROBLEM |
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| Overview |
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| Despite well-documented and successful HIV
prevention programmes in a few countries, the HIV/AIDS epidemic
continues to spread in Asia and the Pacific. In the past two
years, the situation has changed rapidly in several parts of
the region. |
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| The epidemic in the Asia Pacific is expanding
rapidly. This is most evident with sharp increases in HIV infections
in China, Indonesia and Viet Nam. An estimated 7.4 million people
in Asia are living with HIV. Around half a million are believed
to have died of AIDS in 2003, and about twice as many - 1.1million
are thought to have become newly infected with HIV. Among young
people 15–24 years of age, 0.3% of women and 0.4% of men
were living with HIV by the end of 2003. Epidemics in this region
remain largely concentrated among injecting drug users, men
who have sex with men, sex workers, clients of sex workers and
their sexual partners. |
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| China and India: large epidemics |
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| The region includes the world’s most populous
countries—China and India—with 2.25 billion people
between them. National HIV prevalence in both countries is very
low: 0.1% in China and between 0.4% and 1.3% in India. But a
closer focus reveals that both have extremely serious epidemics
in a number of provinces, territories and states. |
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| In China, 10 million people may be infected
with HIV by 2010 unless effective action is taken. The virus
has spread to all 31 provinces, autonomous regions and municipalities,
yet each area has its own distinctive epidemic pattern. In some,
injecting drug use is fuelling HIV spread. Among injecting drug
users, HIV prevalence is 35–80% in Xinjiang, and 20% in
Guangdong. In other areas, such as Anhui, Henan, and Shandong,
HIV gained a foothold in the early 1990s among rural people
who were selling blood plasma to supplement their meagre farm
incomes. Infection levels of 10–20% have been found, rising
to 60% in certain communities. |
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| India has the largest number of people living
with HIV outside South Africa. In a country of over one billion
5.1 people living with HIV/AIDS (NACO, 2004). Most infections
are acquired sexually, but a small proportion is acquired through
injecting drug use. Injecting drug use dominates in Manipur
and Nagaland in the north-east of the country, bordering Myanmar
and close to the Golden Triangle. In this area, HIV infection
levels of 60–75% have been found among injecting drug users
using non-sterile injecting equipment. |
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| In the southern states of Andhra Pradesh, Karnataka,
Maharashtra, and Tamil Nadu, HIV is transmitted mainly through
heterosexual sex, and is largely linked to sex work. Indeed,
according to selected surveys, more than half of sex workers
have become infected with HIV. In all four states, infection
levels among pregnant women in sentinel antenatal clinics have
remained roughly stable at over 1%. |
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| In India, knowledge about HIV is still scant
and incomplete. In a 2001 national behavioural study of nearly
85000 people, only 75% of respondents had heard of AIDS and
awareness was particularly low among rural women in Bihar, Gujarat
and West Bengal. Less than 33% of all respondents had heard
of sexually transmitted infections and only 21% were aware of
the links between sexually transmitted infections and HIV. |
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HIV transmission through sex between men is also a major
cause for concern in many areas of India. Recent research
shows that many men who have sex with men also have sex with
women. In 2002, behavioural surveillance in five cities among
men who have sex with men found that 27% reported being married,
or living with a female sexual partner. In a study conducted
in a poor area of Chennai in 2001, 7% of men who have sex
with men were HIV-positive. Attention currently focuses on
areas with high recorded prevalence, but there is concern
about what might be happening in the vast areas of India for
which there are little data.
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| In Pakistan, 2001 country-level studies of populations
more likely to be exposed to HIV revealed very low prevalence.
Pakistan has an estimated adult HIV prevalence of 0.1%. It also
has about three million heroin users, many of whom started injecting
drugs in the 1990s. The first outbreak of HIV infection among
injecting drug users happened in 2003. In Larkana, a small rice-growing
town in Sindh province, 10% of 175 injecting drug users tested
HIV-positive. A behavioural survey in Quetta found that a high
proportion of respondents used non-sterile injecting equipment;
and over half of them said they visited sex workers. Few had
heard of AIDS, and even fewer had ever used a condom. |
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| In South-East Asia, three countries in particular-
Cambodia, Myanmar and Thailand- are experiencing particularly
serious epidemics. Cambodia’s national HIV prevalence is
around 3%—the highest recorded in Asia. Data suggest that
there have been some dramatic changes in the shape of Cambodia’s
epidemic. For instance, infection among brothel-based sex workers
fell from 43% in 1998 to 29% in 2002. |
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| In Thailand, the number of new infections has
fallen from a peak of around 140,000 a year in 1991, to around
21,000 in 2003. This remarkable achievement came about mainly
because men used condoms more, and also reduced their use of
brothels. However, Thailand’s epidemic has been changing
over the years. There is mounting evidence that HIV is now spreading
largely among the spouses and partners of clients of sex workers
and among marginalised sections of the population, such as injecting
drug users and migrants. |
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Despite Thailand’s indisputable success, coverage of
prevention activities is inadequate. This is especially the
case among men who have sex with men, and injecting drug users;
their infection levels remain high. In Bangkok, over 15% of
men who have sex with men who were tested in a 2003 study
were HIV-positive, and 21% had not used a condom with their
last casual partner.
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| Indonesia’s epidemic is currently unevenly
distributed across this nation of 210 million people; six of
the 31 provinces are particularly badly affected. The country’s
epidemic is also driven largely by the use of contaminated needles
and syringes for drug injection. HIV prevalence among its 125,000–196,000
injecting drug users has increased threefold—from 16% to
48% between 1999 and 2003. In 2002 and 2003, HIV prevalence
ranged from 66% to 93% among injecting drug users attending
testing sites in the capital city, Jakarta. Indonesia’s
drug users are regularly arrested and sent to jail. In early
2003, 25% of inmates in Jakarta’s Cipinang prison were
HIV-positive.
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Papua New Guinea, which shares an island with one of Indonesia’s
worst-affected provinces, Irian Jaya, has the highest prevalence
of HIV infection in the Pacific . Prevalence is over 1% among
pregnant women in the capital, Port Moresby, and in Goroka
and Lae. Papua New Guinea’s epidemic appears largely
heterosexually driven. High levels of other sexually transmitted
infections indicate behavioural patterns that would also facilitate
HIV transmission beyond sex workers and their clients.
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| HIV/ AIDS ESTIMATES IN ASIA PACIFIC |
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Estimated
number of people living with HIV |
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Adults
and children, 2005 |
Adults
and children, 2003 |
| Country
|
Estimate |
Low
Estmate |
High
Estimate |
Estimate |
Low
Estmate |
High
Estimate |
| Afghanistan |
<1000 |
- |
<2000 |
<500 |
- |
<1000 |
| Bangladesh |
11,000 |
6400 |
18,000 |
7500 |
4500 |
12,000 |
| Bhutan |
<500 |
- |
<2000 |
<100 |
- |
<1000 |
| Cambodia |
130,000 |
74,000 |
210,000 |
150,000 |
83,000 |
230,000 |
| China |
650,000 |
390,000 |
1,100,000 |
530,000 |
320,000 |
880,000 |
| DPR Korea |
- |
- |
- |
- |
- |
- |
| Fiji |
<1000 |
320 |
2100 |
<500 |
- |
<2000 |
| India |
5700,000 |
3,400,000 |
9,400,000 |
5,300,000 |
3,200,000 |
8,800,000 |
| Indonesia |
1,70,000 |
1,00,000 |
2,90,000 |
1,10,000 |
68000 |
1,90,000 |
| Iran |
66,000 |
36,000 |
160,000 |
37,000 |
20,000 |
88,000 |
| Lao PDR |
3700 |
1800 |
12,000 |
1700 |
8200 |
5500 |
| Malaysia |
69,000 |
33,000 |
2,20,000 |
57,000 |
27,000 |
1,80,000 |
| Maldives |
- |
- |
- |
- |
- |
- |
| Mongolia |
<500 |
- |
<2,000 |
<500 |
- |
<1000 |
| Myanmar |
3,60,000 |
2,00,000 |
5,70,000 |
3,90,000 |
2,10,000 |
6,00,000 |
| Nepal |
75,000 |
41,000 |
1,80,000 |
65,000 |
35,000 |
1,60,000 |
| Pakistan |
85,000 |
46,000 |
2,10,000 |
56,000 |
30,000 |
130,000 |
| Papua New Guinea |
60,000 |
32,000 |
1,40,000 |
51,000 |
27,000 |
1,20,000 |
| Philippines |
12,000 |
7300 |
20,000 |
9500 |
5700 |
16,000 |
| Republic of Korea |
13,000 |
7900 |
25,000 |
9400 |
6100 |
14,000 |
| Sri Lanka |
5000 |
3000 |
8300 |
3100 |
1900 |
4400 |
| Thailand |
5,80,000 |
3,30,000 |
9,20,000 |
5,90,000 |
3,20,000 |
9,00,000 |
| Vietnam |
2,60,000 |
1,50,000 |
4,30,000 |
2,10,000 |
1,30,000 |
3,50,000 |
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Estimated
number of people living with HIV (continued) |
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Adults
(15+), 2005 |
Adults
(15+), 2003 |
| Country |
Estimate |
Low Estmate |
High Estimate |
Estimate |
Low Estmate |
High Estimate |
| Afghanistan |
<1000 |
- |
<2000 |
<500 |
- |
<1000 |
| Bangladesh |
11,000 |
6400 |
18,000 |
7500 |
4500 |
12,000 |
| Bhutan |
<500 |
- |
<2000 |
<100 |
- |
<1000 |
| Cambodia |
1,30,000 |
70,000 |
2,00,000 |
1,40,000 |
79,000 |
2,20,000 |
| China |
6,50,000 |
3,90,000 |
11,00,000 |
5,30,000 |
320,000 |
8,80,000 |
| DPR Korea |
- |
- |
- |
- |
- |
- |
| Fiji |
<1000 |
320 |
2100 |
<500 |
|
<2000 |
| India |
5,600,000 |
3,400,000 |
9,300,000 |
5,200,000 |
3,100,000 |
8,700,000 |
| Indonesia |
1,70,000 |
1,00,000 |
2,90,000 |
1,10,000 |
68,000 |
1,90,000 |
| Iran |
66,000 |
35,000 |
1,60,000 |
37,000 |
20,000 |
89,000 |
| Lao PDR |
3600 |
1700 |
12,000 |
1700 |
810 |
5500 |
| Malaysia |
67,000 |
32,000 |
2,20,000 |
56,000 |
27,000 |
1,80,000 |
| Maldives |
- |
- |
- |
- |
- |
- |
| Mongolia |
<500 |
- |
<2000 |
<500 |
- |
<1000 |
| Myanmar |
350,000 |
200,000 |
550,000 |
380,000 |
210,000 |
590,000 |
| Nepal |
74,000 |
40,000 |
1,80,000 |
64,000 |
34,000 |
1,50,000 |
| Pakistan |
84,000 |
45,000 |
2,10,000 |
55,000 |
30,000 |
1,30,000 |
| Papua New Guinea |
57,000 |
31,000 |
1,40,000 |
49,000 |
26,000 |
1,20,000 |
| Philippines |
12,000 |
7200 |
20,000 |
9400 |
5700 |
16,000 |
| Republic of Korea |
13,000 |
7800 |
25,000 |
9300 |
6000 |
14,000 |
| Sri Lanka |
5000 |
3000 |
8300 |
3100 |
1900 |
4400 |
| Thailand |
5,60,000 |
3,20,000 |
9,00,000 |
5,70,000 |
3,10,000 |
8,80,000 |
| Vietnam |
2,50,000 |
1,50,000 |
4,20,000 |
2,10,000 |
1,30,000 |
3,50,000 |
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Estimated
number of people living with HIV (continued) |
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Adults
(15-49) rate (%), 2005 |
Adults
(15-49) rate (%), 2003 |
| Country
|
Estimate |
Low
Estmate |
High
Estimate |
Estimate |
Low
Estmate |
High
Estimate |
| Afghanistan |
<0.1 |
- |
<0.2 |
<0.1 |
- |
<0.2 |
| Bangladesh |
<0.1 |
- |
<0.2 |
<0.1 |
- |
<0.2 |
| Bhutan |
<0.1 |
- |
<0.2 |
<0.1 |
- |
<0.2 |
| Cambodia |
1.6 |
0.9 |
2.6 |
2.0 |
1.1 |
3.1 |
| China |
<0.1 |
- |
<0.2 |
<0.1 |
- |
<0.2 |
| DPR Korea |
- |
- |
<0.2 |
- |
- |
- |
| Fiji |
0.1 |
0.1 |
0.4 |
0.1 |
<0.1 |
0.3 |
| India |
0.9 |
0.5 |
1.5 |
0.9 |
0.5 |
1.5 |
| Indonesia |
0.1 |
0.1 |
0.2 |
0.1 |
0.1 |
0.2 |
| Iran |
0.2 |
0.1 |
0.4 |
0.1 |
<0.1 |
0.2 |
| Lao PDR |
0.1 |
0.1 |
0.4 |
0.1 |
<0.1 |
0.2 |
| Malaysia |
0.5 |
0.2 |
1.5 |
0.4 |
0.2 |
1.3 |
| Maldives |
- |
- |
<0.2 |
- |
- |
- |
| Mongolia |
<0.1 |
- |
<0.2 |
<0.1 |
- |
<0.2 |
| Myanmar |
1.3 |
0.7 |
2.0 |
1.4 |
0.7 |
2.2 |
| Nepal |
0.5 |
0.3 |
1.3 |
0.5 |
0.3 |
1.2 |
| Pakistan |
0.1 |
0.1 |
0.2 |
0.1 |
<0.1 |
0.2 |
| Papua New Guinea |
1.8 |
0.9 |
4.4 |
1.6 |
0.9 |
3.9 |
| Philippines |
<0.1 |
- |
<0.2 |
<0.1 |
- |
<0.2 |
| Republic of Korea |
<0.1 |
- |
<0.2 |
<0.1 |
- |
<0.2 |
| Sri Lanka |
<0.1 |
- |
<0.2 |
<0.1 |
- |
<0.2 |
| Thailand |
1.4 |
0.7 |
2.1 |
1.4 |
0.7 |
2.1 |
| Vietnam |
0.5 |
0.3 |
0.9 |
0.4 |
0.3 |
0.7 |
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AIDS
Deaths |
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Deaths
in adults and children, 2005 |
Deaths
in adults and children, 2003 |
| Country
|
Estimate |
Low
Estmate |
High
Estimate |
Estimate |
Low
Estmate |
High
Estimate |
| Afghanistan |
<100 |
- |
<200 |
<100 |
- |
<200 |
| Bangladesh |
<500 |
- |
<1000 |
<500 |
- |
<1000 |
| Bhutan |
<100 |
- |
<200 |
<100 |
- |
<200 |
| Cambodia |
16000 |
8500 |
26,000 |
17,000 |
9100 |
28,000 |
| China |
31,000 |
18,000 |
46,000 |
26,000 |
16,000 |
40,000 |
| DPR Korea |
- |
- |
- |
- |
- |
- |
| Fiji |
<100 |
|
<200 |
<100 |
|
<200 |
| India |
- |
2,70,000 |
6,80,000 |
- |
2,20,000 |
5,40,000 |
| Indoensia |
5500 |
3300 |
8300 |
2300 |
1400 |
3500 |
| Iran |
1600 |
920 |
2700 |
<1000 |
- |
<1000 |
| Lao PDR |
<100 |
- |
<200 |
<100 |
- |
<200 |
| Malaysia |
4000 |
2100 |
7200 |
1900 |
990 |
3400 |
| Maldives |
- |
- |
- |
- |
- |
- |
| Mongolia |
<100 |
- |
<200 |
- |
- |
- |
| Myanmar |
37,000 |
20,000 |
62,000 |
36,000 |
19,000 |
59,000 |
| Nepal |
5100 |
2800 |
8400 |
4000 |
2200 |
6600 |
| Pakistan |
3000 |
1700 |
4900 |
1500 |
830 |
2500 |
| Papua New Guinea |
3300 |
1800 |
5400 |
2100 |
1200 |
3500 |
| Philippines |
<1000 |
- |
<1000 |
<500 |
- |
<1000 |
| Republic of Korea |
<500 |
- |
<1000 |
<500 |
- |
<1000 |
| Sri Lanka |
<500 |
- |
<1000 |
<100 |
- |
<200 |
| Thailand |
21,000 |
14,000 |
42,000 |
40,000 |
22,000 |
67,000 |
| Vietnam |
13,000 |
7800 |
20,000 |
8900 |
5300 |
13,000 |
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| Source: UNAIDS, 2006 Report
on the Global AIDS Epidemic |
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