The HIV/AIDS Epidemic in Asia
Jintanat Ananworanich, MD, PhD
US Armed Forces Research Institute of Medical Sciences
The Thai Red Cross AIDS Research Centre
Bangkok, Thailand
Jintanat.A@SearchThailand.org
Outline
• Transmission of HIV: Routes and risk factors
• HIV situation in Asia
– Prevalence
– Injecting drug users and Men who have Sex with Men
• HIV situation in Thailand
– Prevalence
– Future trend
Transmission of HIV
Sexual
transmission
• Unprotected
sex
• Heterosexual
• Men who
have sex with
men (MSM)
Injecting
drug use
• Sharing needles
• (Contaminated
blood product)
Mother to child
transmission
• During
pregnancy,
during delivery,
breastfeeding
Occupational exposure: Needle stick in health care personnel
Factors Associated with
Higher Risk for HIV Transmission
Sexual
transmission
• Anal intercourse
> vaginal
intercourse
• Multiple sexual
partners
• Presence of
other sexually
transmitted
infections
Injecting
drug use
• Sharing needles
with multiple
people
Mother to child
transmission
• Highest risk
during delivery
The person who is the source for infection has high amount of HIV virus in the body
HIV Infection
HIV enters
the body
HIV infects
immune cells
(CD4) of the
body
HIV is spread
through out
the body in
a few days
HIV uses the
human
immune cells
to make
more HIV
and kills the
cell in the
process
After many years
of infection
– Weakened
immune system
- Body is
susceptible to
infection
- AIDS develops
Asia is Large and Diverse
• The continent with the largest population
• Diverse geography, culture, religion, law
and wealth
• Diverse HIV prevalence, HIV risk groups,
and policy on treatment and prevention
HIV Epidemics in Asia
• Statistics (2009)
– 5 million living with HIV (160,000 children)
– New infections 360,000 (22,000 children)
– AIDS deaths 300,000 (15,000 children)
• HIV epidemics in Asia are concentrated
among certain groups
– Injecting drug users
– Sex workers and their clients
– Men who have sex with men
2010 UNAIDS report
HIV Prevalence in Asia
Country
HIV prevalence
Thailand
Cambodia
Myanmar
Vietnam
India
China
1.3%
0.70%
0.61%
0.44%
0.29%
0.06%
Number with
HIV infection
530,000
57,900
238,000
254,000
2,270,000
740,000
UNGASS 2008-2009 Report (From the slide collection of Prof. Praphan Phanuphak)
HIV Prevalence in
Injecting Drug Users (IDUs)
Country
China
Indonesia
Malaysia
Thailand
Vietnam
Pakistan
Myanmar
Estimated number
of IDUs
2,350,000
219,130
205,000
160,528
135,305
130,460
75,000
HIV prevalence
in IDUs
12.3%
42.5%
10.3%
42.5%
33.9%
10.8%
42.6%
Bergenstrom and Abdul-Quader, AIDS 2010
HIV Prevalence in
Men who have Sex with Men (MSM)
Country
Myanmar
Thailand
India
China
Vietnam
Cambodia
Indonesia
HIV prevalence in MSM (%)
23.5 – 35
5.5 – 30.8
4.8 – 24.7
0.05 – 12.5
5.3 – 9.4
0.8 – 8.7
2.1 – 8.1
van Griensven and van Wijngaarden, AIDS 2010
Thailand: From a Concentrated to
a Generalized HIV Epidemic
19841987
Homo/
bisexual
men
1988
1989
IDUs
FSWs
IDUs: Injecting drug users; FSWs: Female sex workers
1990
1991
Male
clients
of
FSWs
Pregnant
women,
children,
general
population
Thailand: HIV Statistics
Statistics in 2009
Thailand population
Number of adults living with HIV
Adult HIV prevalence
Children living with HIV
Deaths since beginning of
epidemics
Antiretroviral treatment coverage
Prevention of mother to child HIV
transmission coverage
Values
67 million
530,000
1%
22,000
500,000
> 80%
95%
2010 UNAIDS report; Thai MOPH
Thailand: HIV in
Different At-Risk Groups
Bertozzi SM, et al. Lancet 2008
% with HIV infection
One in Three MSM in Bangkok
has HIV Infection
van Griensven, JAIDS 2009
Warning Signs of a
Rising HIV Epidemic in Thailand
• Increased unsafe sex among the general
•
•
•
•
population
Sharp increase in sexually transmitted infections
Higher illicit drug use among youth
High HIV prevalence among hard-to-reach
populations (street-based FSWs, MSWs, MSM,
IDUs, migrant workers and fishermen)
A second wave of HIV epidemic in Thailand is
anticipated
Modified from the slide collection of Prof. Praphan Phanuphak (Thai Red Cross AIDS Res Center)