7th IAS Conference on HIV Pathogenesis,
Treatment and Prevention
Tracking the HIV/AIDS epidemic in
Asia and the Pacific
Mr. J.V.R. Prasada Rao
UN Secretary General Special Envoy
on HIV/AIDS in Asia Pacific
3 July 2013
Kuala Lumpur, Malaysia
1. Epidemic and response
2. Financing AIDS response
3. Legal environment
4. HIV/AIDS and post 2015
development agenda
Epidemic and response
State of the epidemic: Global and Asia-Pacific
Global
People living with HIV
Women living with HIV
New HIV infections
Adult HIV prevalence
AIDS-related deaths
Asia-Pacific
34,000,000
4,900,000
[31,400,000 – 35,900,000]
[3,900,000 – 6,100,000]
15,000,000
1,600,000
[13,900,000 – 15,700,000]
[1,200,000 – 2,100,000]
2,500,000
370,000
[2,200,000 – 2,800,000]
[250,000 – 550,000]
0.8 %
0.2 %
[0.7% – 0.8%]
[0.2% – 0.2%]
1,700,000
310,000
[1,500,000 – 1,900,000]
[240,000 – 400,000]
Source: Prepared by www.aidsdatahub.org based on HIV estimates and projections data for UNAIDS (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012
Epidemic and response: Asia-Pacific and
Sub Saharan Africa
Asia-Pacific
Sub-Saharan Africa
Type of
epidemic
Concentrated among key
populations
Generalized
Populations
affected by
AIDS
Sex workers and their clients,
Men who have sex with men,
Transgender, People who
inject drugs, and all of their
intimate partners
General population: men,
women, and young people
Burden of
epidemic
4.9 million People living
with HIV
370,000 New infections
23.5 million People living
with HIV
1.8 million New infections
Relatively smaller
populations but more
difficult to reach due to
stigma and legal barriers
Larger population sizes
but relatively easier to
reach
Prevention
interventions
Death (%)
Disease burden: Asia and Sub-Saharan
Africa
16%
3.2%
South-East Asia,
East Asia, and
Oceania
Source: http://www.healthmetricsandevaluation.org
5.6%
South Asia
Sub-Saharan Africa
New HIV infections (Number)
New HIV infections in Asia-Pacific region
500,000
400,000
18 % decline
300,000
200,000
Stagnated decline
between 2008 and
2011
100,000
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Significant decline in new HIV infections in the last
decade, but slow-down between 2008 and 2011
Source: Prepared by www.aidsdatahub.org based on HIV estimates and projections data for UNAIDS (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012
Example of countries with declining new HIV
infections
Myanmar
Cambodia
69%
decline
2001
42%
57%
decline
decline
2008
27%
decline
2011
2001
2011
2008
PNG
Nepal
2001
73%
48%
decline
decline
2008
2011
28%
19%
decline
decline
2001
2008
2011
Same is true for countries where the epidemic is slowing down
Source: Prepared by www.aidsdatahub.org based on HIV estimates and projections data for UNAIDS (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012
Estimated annual new HIV infections by
population group, Asian Epidemic Model
MSM
Half of all new infections among MSM by 2020 if ‘business
as usual’- Commission on AIDS in Asia
Source: Commission on AIDS in Asia. (2008). Redefining Aids in Asia: Crafting an Effective Response.
HIV prevalence among MSM vs. adults
Rising HIV epidemic among MSM in many regions across the world
Source: Beyrer, C., Baral, S. D., Griensven, F. v., Goodreau, S. M., Chariyalertsak, S., Wirtz, A. L., & Brookmeyer, R. (2012). Global epidemiology of HIV infection
in men who have sex with men. Lancet, 380(9839), 367-377.
100
500
80
400
60
57
51
300
37
40
200
118
20
100
0
0
Female sex
workers
Male sex
workers
Men who have
sex with men
People who
inject drugs
Number of needles and syringes
distributed per PWID per year
Prevention programme coverage
(%)
Key populations reached by prevention
services, regional median, 2011
Key populations are central to the epidemic but not enough are
reached by prevention services
Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012
Mumbai, India (2004-2009)
80
80
20
60
15
40
9.2
5
0
0
25
80
20
43
40
0
15
10
6.3
5
0
2005 2006 2007 2008 2009 2010 2011
Consistent condom use
HIV prevalence
HIV prevalence
Thailand (Bangkok, Chiangmai, Phuket),
2005-2010
100
25
consistent condom use%
100
HIV prevalence %
consistent condom use %
China (National), 2005-2011
20
10
20
Consistent condom use
60
25
20
80
60
20
15
40
70
20
10
5
0
2005
2007
Consistent condom use
HIV prevalence %
100
HIV prevalence %
consistent condom use %
Proportion of consistent condom use and
HIV prevalence among MSM
0
2009 2010
HIV prevalence
Stagnating consistent condom use among MSM - impact on HIV
prevalence
Source: Prepared by www.aidsdatahub.org based on 1) Mishra, R. M., Dube, M., et al. (2012). Changing epidemiology of HIV in Mumbai: an application of the Asian
epidemic model. Glob J Health Sci, 4(5), 100-112.; 2) Lan, W., Lu, W., et al. (2012). HIV Prevalence and Influencing Factors Analysis of Sentinel Surveillance among Men
who have Sex with Men in China, 2003-2011. Chinese Medical Journal, 125(11), 1857-1861.; 3) Data from UNAIDS Country Office Thailand.
Consistent condom use among female
sex workers with their clients
%
100
50
Cambodia, 1997-2010
89 100%
82
94
83
80
94
80
60
FSW with 2 or less client/day
FSW with more than 2 clients/day
Direct FSW
Beer Promoters
40
20
0
%
100
Thailand, 2004-2008
0
Andhra Pradesh, India, 2006-2010
%
100
75
Mumbai, India, 2004-2009
95
80
60
60
40
40
20
20
0
0
Source: Prepared by www.aidsdatahub.org based on 1) Chhorvann, C. (2011). Behavioral Sentinel Surveillance 2010. Power Point Presentation. National Center for
HIV/AIDS Dermatology and STD; 2) Thailand UNGASS Report 2010; 3) Erausquin, J. T., Biradavolu, M., et al. (2012). Trends in condom use among female sex workers in
Andhra Pradesh, India: the impact of a community mobilisation intervention. J Epidemiol Community Health, 66(2), 2011-200511; 4) Mishra, R. M., Dube, M., et al. (2012).
Changing epidemiology of HIV in Mumbai: an application of the Asian epidemic model. Glob J Health Sci, 4(5), 100-112.
80
68
80
78
60
40
88
93
97
60
40
54
20
6.3
0
20
0
Pakistan, Lahore (2005-2011)
100
80
60
40
20
0
45
43
28
3.8
Consistent use of sterile injecting equipment *
100 %
80
60
40
20
0
35
30
25
20
15
10
5
0
30.8
HIV prevalence
97
36
31
28
38
Pakistan (Lahore, Indonesia (2011)
2011)
45
5
47
14
58
16
Bangladesh
India (Maharastra,
Myanmar
(Dhaka, 2011)**
2009-10)
(Yangon, 2012)***
* Duration of consistent use of sterile injecting equipment varies from last week to last 6 months;
** Behavioral data for 2006-07, Never used used-needles and syringes;
*** Behavioral data for 2008
6
Nepal
(Kathmandu,
2011)
Source: Prepared by www.aidsdatahub.org based on National HIV Sentinel Surveillance reports, Integrated Biological and Behavioral Surveillance reports and other reports
HIV prevalence (%)
100
Safe injection in the past
month(%)
Nepal, Kathmandu (2002-2011)
HIV prevalence (%)
Safe injection in the past
week(%)
Correlation between safe injecting and HIV
prevalence among PWID
Prevention of mother-to-child transmission
coverage, by region, 2010 and 2011
%
100
2010
2011
80
60
40
20
0
Middle East South and
and North South-East
Africa
Asia
East Asia
and
Oceania
Caribbean Sub-Saharan
Africa
Latin
Low- and
America middle-income
countries
Only one in five pregnant women living with HIV received effective
ART regimens for PMTCT in South and South-East Asia
Source: 2012 country progress reports (www.unaids.org/cpr) and UNAIDS estimates.
% reduction
Percentage reduction in new HIV
infections among children, 2009 to 2011
50
45
40
35
30
25
20
36
15
32
24
10
24
24
13
5
12
0
Oceania
Caribbean
Latin
America
Sub-Saharan Eastern
Africa
Europe and
Central Asia
Asia
Global
Progress NOT apparent in eliminating new HIV infections among
children
Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012
HIV testing coverage (%)
HIV testing coverage among key populations,
regional median, 2011
100
80
60
44
44
40
33
29
20
0
Female sex workers
Male sex workers
Men who have sex
with men
People who inject
drugs
Though HIV is concentrated among key populations, less than
half of them know their HIV status
Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012
Thousands
Number and proportion of eligible people
receiving ART at the end of 2011
Number of people receiving ART
1,200
1,000
800
600
400
200
0
100%
1.1 million
Recent trends in global and Asia-Pacific ART coverage
80%
60%
40%
36%
46%
54%
37%
18%
20%
46%
2009
2010
2011
0%
Global
Asia-Pacific
1.1 million people are receiving antiretroviral therapy – lagging behind
global trend
Source: Prepared by www.aidsdatahub.org based on 1)UNAIDS. (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012.; 2) www.aidsinfoonline.org
200
Botswana
150
100
50
44% of people currently on ART
have been on treatment since 2006
Number (in thousands) of
people on ART
Number (in thousands) of
people on ART
Correlation between high level of treatment
coverage and decline in new infections
600
Kenya
500
400
300
200
23% of people currently on ART
100
have been on treatment since 2006
0
0
2004 2005 2006 2007 2008 2009 2010 2011
People receiving ART
People receiving ART
New HIV infections
New HIV infections
20,000
15,000
36%
decline in
new HIV infections
10,000
5,000
0
Number of new HIV infections
Number of new HIV infections
2004 2005 2006 2007 2008 2009 2010 2011
140,000
17%
decline in
new HIV infections
105,000
70,000
35,000
0
2004 2005 2006 2007 2008 2009 2010 2011
Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org
2004 2005 2006 2007 2008 2009 2010 2011
HIV-1 drug resistance in ARV-naïve
populations
SDRM = Surveillance Drug Resistance Mutations
As ART coverage continues to grow, there is evidence of drug
resistance emerging
Source: Stanford University HIV Drug Resistance Database at http://hivdb.stanford.edu/surveillance/map/
Financing AIDS response
Trends in domestic public and international
AIDS spending, global and the Asia-Pacific
Asia-Pacific
Global
2011 51%
2011 66%
2010 50%
2010 57%
2009 44%
2009 51%
2008 43%
2008 50%
49% 50% 56% 57%
34% 43% 49% 50%
Domestic public (%)
International (%)
Decreasing dependence on external aid
Source: Prepared by www.aidsdatahub.org based on 1) UNAIDS. (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012.; 2) www.aidsinfoonline.org
HIV expenditure from domestic sources,
Asia-Pacific
0
Malaysia (2011)
China (2011)
Thailand (2011)
Sri Lanka (2010)
Philippines (2011)
Indonesia (2010)
Pakistan (2011)
Mongolia (2011)
PNG (2010)
Fiji (2011)
Viet Nam (2010)
India (2011-12)
Myanmar (2011)
Lao PDR (2011)
Bangladesh (2011)
Cambodia (2009)
Nepal (2009)
Afghanistan (2011)
25
50
75
100 %
94
90
85
53
52
40
37
31
24
21
17
10
9
7
4
3
1
0
Upper-middle income
Lower-middle income
Low income
90% Committed for NACP IV
Investing in AIDS: Shared responsibility in Asia-Pacific
23
Source: Prepared by www.aidsdatahub.org based on 1) UNAIDS. (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012.; 2) www.aidsinfoonline.org
US$ in millions
Total AIDS spending and amount spent on
key populations prevention programmes
1,400
1,332
1,200
1,000
800
600
346
400
200
67
12
22
33
MSM
prevention
spending
Sex workers
and clients
prevention
spending
PWID
prevention
spending
0
Total AIDS
spending
Prevention
spending
Key
populations
prevention
spending
AIDS spending in Asia Pacific – low on High Impact Prevention
Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org
Legal environment
Adverse legal environment - Why the
law matters?
28
29
HIV/AIDS in post 2015 development
agenda
Millennium Development Goal 6: Global
progress by region, 2012
Goal 6: Combat HIV/AIDS, malaria and other diseases
Africa
Goals and
Targets
Northern
SubSaharan
Halt and
begin to
reverse
the spread
of
HIV/AIDS
Low
incidence
High
incidence
Halt and
reverse
the spread
of TB
Low
mortality
High
mortality
Asia
Oceania
Latin
America &
Eastern
SouthEastern
Southern
Western
Low
incidence
Low
incidence
Low
incidence
Low
incidence
Low
incidence
Low
incidence
Moderate
mortality
Low
mortality
High
mortality
Low
mortality
Low
mortality
Moderate
mortality
Caribbean
Caucasus &
Central Asia
Low
incidence
Moderate
mortality
The progress chart operates on two levels. The word in each box indicate the present degree of compliance with the target. The colours show progress towards the
target according to the legend below:
Target already met or expected to be met by 2015.
Progress insufficient to reach the target if prevailing trends persist.
No progress or deterioration.
Sources: Statistics Division, Department of Economic and Social Affairs, United Nations. (2012). Millennium Development Goals: 2012 Progress Chart.
Status of progress towards MDG targets in
Asia-Pacific, 2010-11
Country
MDG Goal 6
HIV prevalence
TB incidence
TB prevalence
Asia Pacific
Cambodia
China
India
Indonesia
Lao PDR
Malaysia
Myanmar
Nepal
Pakistan
Philippines
Thailand
Viet Nam
Early achiever
On track
Slow
Regressing/No
progress
Source: Prepared by www.aidsdatahub.org based on UNESCAP, ADB, & UNDP. (2012). Accelerating Equitable Achievement of the MDGs : Closing Gaps in Health and
Nutrition Outcomes , Asia- Pacific Regional MDG Report 2011/12. Bangkok.
Post 2015 development agenda
• UNSG’s High Level Panel of Eminent
Persons
• Rio + 20 Conference on Sustainable
Development
• Task Team for Global Thematic
Consultation on Health
Is HIV/AIDS a priority ?
HLP report - Proposed new health MDGs:
Post 2015
• 4a. End preventable infant and under-5 deaths,
• 4b. Increase by x% the proportion of children,
adolescents, at-risk adults and older people that are
fully vaccinated
• 4c. Decrease the maternal mortality ratio to no more
than x per 100,000
• 4d. Ensure universal sexual and reproductive health
and rights
• 4e. Reduce the burden of disease from HIV/AIDS,
tuberculosis, malaria, neglected tropical diseases
and priority non-communicable diseases
MDG on AIDS 2015 and 2030
Millennium Development
Goal of 2015
Post 2015
4e. Reduce the burden of disease
from HIV/AIDS, tuberculosis,
malaria, neglected tropical
Target 6.A: Have halted by 2015 and diseases and priority nonbegun to reverse the spread of
communicable diseases
HIV/AIDS
Goal 6: Combat HIV/AIDS, malaria
and other diseases
Target 6.B: Achieve, by 2010,
universal access to treatment for
HIV/AIDS for all those who need it
Target 6.C: Have halted by 2015 and
begun to reverse the incidence of
malaria and other major diseases
• Country support in UN General
Assembly for a specific MDG for ending
AIDS by 2030.
• Donors and UN agencies need to support
the call to end AIDS by 2030.
• Civil society pressure crucial
Global response to HIV/AIDS is
delicately balanced.
We need to firmly tilt it towards
the goal of elimination.
Thank you