The menace of HIV in Asia

New UN report indicates progress but says there is also cause for alarm

Although new HIV infections in the 30 countries that make up the Asia-Pacific region have fallen by 20 percent since 2001, prevalence among intravenous drug users is climbing alarmingly in Pakistan, Bangladesh and the Philippines, according to a new joint United Nations report.

In Pakistan, according to the report, released over the weekend, HIV prevalence almost doubled among people who inject drugs, from 11 percent in 2005 to 21 percent in 2008. In Bangladesh, prevalence rose from1.4 percent in 2000 to 7 percent in 2007, the latest figures available.

The Philippines, which had been presumed to be less at risk because there were fewer intravenous users and because it was off the main heroin trafficking routes, “is experiencing a rapidly growing epidemic,” the report noted. In Cebu, according to the report, HIV prevalence in people who inject drugs increased from 0.6 percent to 53 percent between 2009 and 2011. The report, however, does not say how big the drug-injecting population is.

In the Philippines especially, where the Catholic Church frowns on the use of condoms, the overlap between injecting drug use and sex means that HIV epidemics invariably spread to other population groups unless effective prevention efforts can be put in place. So far, there has been little sign of effective programs from the government.

Because of the sheer size of its population, India now accounts for nearly half of Asia’s HIV epidemic, with 2.4 million people living with the disease. New infections were estimated at 140,000 in 2009, with 170,000 Indians dying of the disease. Women account for 39 percent of all reported HIV cases, most of whom were infected by their sexual partners. Men who have sex with men, (7.3 percent) and injecting drug users (9.2 percent) were the top single categories. Some 320,074 were receiving antiretroviral therapy at the end of the year.

The report, delivered at the five-day 10th International Congress on AIDS in Asia and the Pacific, which ends on Aug. 30 in Busan, South Korea, stressed that with support from civil society, communities and development partners, governments have made steady progress in slowing the spread of the epidemic. But while there has been a three-fold increase in access to anti-retroviral therapy, the epidemic still is outpacing the response.

There are still almost two new HIV infections for every person who starts treatment, according to the report, titled “HIV in Asia and the Pacific: Getting to Zero.” Governments are not focusing adequately on so-called on most-at-risk-populations and neither domestic nor international sources are putting u p enough funding to combat the disease.

An estimated 4.9 million people were living with HIV in this region in 2009, the last year4 for which figures were available, almost the same as in 2005. The majority live in one of the 11 countries in the region – Cambodia, China, India, Indonesia, Malaysia, Myanmar, Nepal, Pakistan, Papua New Guinea, Thailand and Vietnam.

Significant progress has been made in getting sex workers to insist that their customers use condoms, according to the report, particularly in Cambodia, 99 percent of sex workers said their most recent customers had used a condom. Burma reported 96 percent, Laos 94 percent. The laggard countries are Pakistan, where only 43 percent reported their customers used a condom, Papua New Guinea, 53 percent and Malaysia, 61 percent.

Cambodia, India, Burma and Thailand reported reducing their infection rates significantly. Cambodia is one of just eight countries of the world providing antiretroviral therapy to more than 80 percent of the people eligible for it. More than 60 percent of the people in the Asian region who need treatment do not have access to it, however. Only US$1.1 billion was being spent on AIDS across 30 countries in the region in 2009, according to the report. And, although new HIV infections have decreased among children by an estimated 15 percent, regional services to prevent new infections in children are falling behind, especially in South Asia.

An estimated 260,000 to 340,000 people still died of AIDS-related causes in 2009, the report said. As could be expected, new infections remain concentrated among people who buy and sell sex or inject drugs, men who have sex with men, and transgender people. Epidemics “start with the virus spreading rapidly among people who inject drugs and use non-sterile injecting equipment. Many may also buy and sell sex, allowing HIV to spread to larger networks of sex workers and their clients,” the report said.

An estimated 75 million men across Asia and the Pacific are male clients of sex workers. They are the key determinants of both the spread and magnitude of HIV epidemics across the region, the report continues, transmitting the disease to their sexual partners. Women make up about 35 percent of the people living with the disease in Asia and the Pacific, a figure that has remained stable for the past decade. The majority of them were infected by their male partners.

Society in general still discriminates and stigmatizes those with HIV, according to the report. Punitive laws against sex workers and their clients; injecting drug users, men who have sex with men; and transgender people, ironically block access to life-saving services for these affected populations.

Data also suggest that a significant proportion of new HIV infections within key populations are among young people under the age of 25 years. In most settings, HIV prevention programmes are failing to sufficiently reach most at risk young people.

Though China, Malaysia, Pakistan, Samoa and Thailand are funding the bulk of their HIV response from domestic resources, many countries in Asia and the Pacific depend heavily on foreign funding, particularly for the provision of antiretroviral therapy. Funding cut backs from international donors is further aggravating the problem. So, increased investment of domestic resources, especially in middle-income countries, is critical for the ongoing regional response to HIV.