Regional overview slides

Transcription

1 HIV and AIDS Data Hub for Asia-Pacific Review in slides Regional overview slides Last updated: March 218

2 Key population size estimates

3 Female sex workers size estimates Country Estimated size Definition Females (15-49) HIV and AIDS Afghanistan(215) 12,5 Information not available 7,383,134.2 Data Hub for Asia-Pacific Australia(212) 2,5 Self identify as having a history of sex work 5,541,628.4 As% of females (15-49) Bangladesh(215) 12,26 Cambodia(211) 34, Females 1+ yrs; who sell sex and contracted by clients at hotel/street/residence/brothel during last year Females 18+ yrs; venue-based - who work in entertainment establishment or non-venue based - who are freelance/ street-based or park-based 45,2, ,22,198.8 China(213) 2,52, Females yrs; who have sex intercourse with males for money(excluding transgender) 376,689,55.7 Fiji(212) 538 India(215-16) 657,829 Indonesia(216) 226,791 LAO PDR(216) 13,4 Malaysia(214) 21, Females 18+ yrs; self-identified as engaging in transactional sex work (i.e. the provision of sexual services in exchange for cash, goods or service) Programme data of Targeted Intervention Programme based on the criteria a female sex worker (FSW) is an adult woman (18+years) who engages in consensual sex for money or payment in kind, as her principal means of livelihood. Females aged 15 years or older who receive money or goods in exchange for anal or vaginal penetrative sex in the last 12 months Female who works in small drink shops, beer gardens, karaoke bars, discotheques or other entertainment establishments at which men may seek to access women for the purposes of commercial sex. Females 18+ yrs; having been paid in cash or kind for penetrative sex within the last 3 months, having more than 1 client in the same period 224, ,429,.2 7,53,12.3 1,811, ,483,38.2 Myanmar(215) 66, Females yrs; having been paid for sex in cash or kind in the past 12 months 14,771,977.4 Nepal(216) 49,13 Pakistan(216) 174,11 Philippines(215) 66, Females 16 years and above, reporting having been paid in cash or kind for sex during the last 12 months. (establishment based, home based and street based) Females who exchanges sex with others in return for money or benefits, irrespective of site of operation (e.g. street, bars, home, hotel, etc.). Females 15+ yrs; who has accepted payment (cash or kind) in exchange for sex in the past one month. 8,6, ,734, ,15,52.3 Sri Lanka(213) 14,132 Any female who is selling sex in exchange of money or goods. 5,339,29.3 Thailand(216) 129,133 Females 18+ who exchange money or goods for sexual services, either regularly or occasionally within the last 12 months. 17,93,48.7 Viet Nam(213) 71,936 Information not available 25,831,489.3 Source: Global AIDS Monitoring reporting 216 and 217, China 213 HIV estimation, and United Nations, Department of Economic and Social Affairs, Population Division (217). World Population Prospects: The 217 Revision

4 Men who have sex with men size estimates Country Estimated size Definition Afghanistan(215) 1,7 Males 15+yrs; both active and passive 8,49,121.1 Australia(211) 19, Self identify as men who have sex with men 5,614, Bangladesh(215) MSM:11,695 MSW: 29,777 Cambodia(214) 3,891 MSM: Males 1+ yrs; who had sex with males with consent in the last year regardless of whether they have sex with women or have a personal/social gay or bisexual identity but do not sell sex. MSW: Males who sell sex to other males in exchange of money or gifts in last 3 months Male who have sex with male regardless of whether or not they have sex with women or have a personal or social gay or bisexual identity. Adult males 53,473,975 As% of males (15-49) MSM:.2 MSW:.1 4,83,152.8 China(213) 3,96, Males yrs; who have sex with men in recent year 4,323, India(215-16) 238,175 Programme data of Targeted Intervention Programme based on the criteria Males 15+ yrs; who had anal or oral sex with a male/hijra partner in the last one month 365,281,26.1 Indonesia(216) 754,31 Biological males aged years or older who had sex with a man in the last 12 months 71,618, Japan(213) 519,721 Not available 27,384, Lao PDR (216) 5, year old men who have anal or oral sex with men 1,817, Malaysia(214) 17, Males 18+ yrs, who had engaged in anal sex with men at least once in the previous six months 8,472, Mongolia(214) 3,118 Males yrs; who had anal or oral sex with men in the past 12 months 836,336.4 Myanmar(215) 252, Males 15+ yrs; who has had anal sex with another male in the past 6 months 14,349, Nepal(216) Pakistan(216) Philippines(215) MSM: 6,333 MSW: 18,287 MSM: 832,213 MSW: 55,34 MSM: 531,5 MSW: 86,6 Sri Lanka(213) 7,551 Thailand(216) MSM: 527,9 MSW: 26,341 MSM: Males who have oral and/or anal sex with other biological males, at least once, in the past 12 months. MSW: Males 16+yrs; who had oral and/or anal sex with other males in the past 12 months in exchange for money or other benefits. MSM: Male 13+ yrs who has sex with other men as a matter of preference or practice, regardless of their sexual identity/orientation, and irrespective of whether or not they also have sex with women MSW: Males 13+yrs; who undertakes sexual activity with a man in return for money or benefits MSM: Males 15+ yrs; who had oral or anal sex with a male in the past 12 months. MSW: Males 15+yrs; who had oral or anal sex with a male in the past 12 months and accepted cash or kind in exchange for sex regardless of establishment-based or not All men who have sex with other men as a matter of prevalence or practice, regardless of their sexual identity or sexual orientation. MSM: Male 18+, anal or oral sex with male in the past 6 months. MSW: Male 18+ who exchange money or goods for sexual services either regularly or occasionally in the last 12 months 7,145,55 51,45,195 24,435,734 MSM: 1 MSW:.3 MSM: 1.6 MSW:.1 MSM: 2.2 MSW:.4 5,49, ,559,378 Viet Nam(213) 382,56 Men who have sex with men 26,182, MSM: 3 MSW:.2 Source: Global AIDS Monitoring reporting 216 and 217, China 213 HIV estimation, and United Nations, Department of Economic and Social Affairs, Population Division (217). World Population Prospects: The 217 Revision

5 People who inject drugs size estimates Country Estimated size Definition Males (15-49) As% of males (15-49) Afghanistan(215) 4,9 Information not available 8,49,121.5 Australia(25) 215, Information not available 5,822, Bangladesh(215) 33,67 (Total) 32,21 (Male) 145 (Female) Males who injected drugs within the last 1 year Females who injected drugs within the last 1 year 45,33,462.7 Cambodia(212) 13 (Total) 1124 (Male) 176 (Female) 18+yrs; who injected drugs at least one time in the last 1 year 3,966,282.3 China(213) 1,93, Persons who ever injected drugs 4,323,128.5 India(215-16) 127,532 Indonesia(216) 33,492 (Male) Programme data of Targeted Intervention Programme based on the criteria-males 15+ yrs; who has used any psychotropic (addictive/mind altering) substance or drug for recreational or non-medical reasons through injections, at least once in the last 3 months People aged 15 years or older who injected drugs categorized as narcotics in the last 12 months 365,281, ,618,154.5 Lao PDR (216) 16 Information not available 1,817,676.1 Malaysia(214) 17, Males 18+ yrs; who injected drugs in the last 6 months 8,472,244 2 Myanmar(214) 83, Males 15+ yrs, who injected drugs in the last month 14,191,87.6 Nepal(216) 3,868 Pakistan(216) 113,776 People who inject various drugs into their muscles or veins for the purpose of intoxication in the last 12 months Persons 15+ yrs; who injected drugs regularly, for non-therapeutic purposes in the last 6 months 7,145, ,45,195.2 Philippines(215) Males 15+ yrs; who injected drugs for non-medical purposes in the last six months 24,435, Sri Lanka(213) 423 Persons who are currently injecting drugs 5,49,25.1 Thailand(215) 42,65 People who inject drugs at least once within the last month 17,685,689.2 Viet Nam(213) 271,56 Information not available 26,182, Source: Global AIDS Monitoring reporting 216 and 217, China 213 HIV estimation, and United Nations, Department of Economic and Social Affairs, Population Division (217). World Population Prospects: The 217 Revision

6 Transgender (male-to-female) size estimates Country Estimated size Definition Males (15-49) As% of males (15-49) Afghanistan(215) 28, Information not available 8,49,121.3 Bangladesh(215) 1,199 (Total) 7,925 (TGSW) Transwomen 18+ yrs; who identify themselves as belonging to a traditional hijra sub-culture and who maintain the guru-chela hijra hierarchy. They maybe sub-categorized as: Sex Worker Hijra, Badhai Hijra and Radhuni hijra 45,33,462.2 Cambodia(214) 38 TG women who are biologically male at birth and who self identify as female or third gender. This entail dressing up, expressing charateristic, attitudes and behaviour of a woman 4,36,42.1 Fiji(212) 319 (TG SW) Male-to-female transgender 18+ yrs; self-identified as engaging in transactional sex work (i.e. the provision of sexual services in exchange for cash, goods or service) 237,117.1 India(215-16)* Individuals who voluntarily seek initiation into the Hijra community, whose traditional profession is badhai (blessings or good wishes by clapping their hands and seeking alms). 365,281,26.1 Indonesia(216) Biological males aged 15 years or older who identify their gender identity as females 71,618,154.1 Malaysia(216) 24, Individuals who are biologically male but with female identity 9,19,.3 Nepal(216) 2146 Pakistan(216) (TG SW) Philippines(215) 122,8 Thailand(216) 62,8 TG women are biological males who have identified themselves as Transgender. A transgender is a male who appears as, wishes to be considered as, or has undergone surgery to become a female. Individuals 15+ yrs who identify themselves as transgender and receive money or goods in exchange for sexual services, either regularly or occasionally Born males 15+ yrs; identifies as female, who had oral or anal or vaginal sex with a male in the past 12 months. Men who express women characteristics e.g. long hair, wearing make-up, breast appearance, not necessarily undergo sex reassignment surgery. 6,962,.3 5,46,.1 24,435, ,686,.4 Source: GARPR online reporting 217, Department of Economic and Social Affairs, Population Division (217). World Population Prospects: The 217 Revision

7 Cambodia Population size estimate Key data availability for transgender people (21-216) (National) HIV prevalence (Subnational) Condom use Prevention coverage* HIV testing coverage* Treatment Spending India Indonesia Lao PDR Malaysia Myanmar Nepal Pakistan Philippines PNG Singapore Thailand Timor-Leste Viet Nam *Survey or programme data DATA AVAILABLE DATA NOT AVAILABLE/ NOT REPORTED Source: Prepared by based on HIV Sentinel Surveillance Reports, Integrated Biological and Behavioral Surveillance Reports, Behavioral Survey Reports, Global AIDS Response Progress Reporting and other country reports

8 HIV prevalence and epidemiology

9 Number HIV and AIDS Data Hub for Asia-Pacific Regional overview of trends in HIV infections and AIDS-related deaths 6,, 5,, 4,, HIV and AIDS in Asia and the Pacific zoom-in People living with HIV 5.1 million New HIV infections 27, 3,, 2,, 1,, People living with HIV Women living with HIV Young people living with HIV Children living with HIV New HIV infections AIDS-related deaths Source: Prepared by based on UNAIDS 217 HIV Estimates Women living with HIV 1.8 million Children living with HIV 19, Deaths 17, 9

10 Rate of decline in new HIV infections: Global vs. Asia and the Pacific New HIV infections New HIV infections 4,5, Global 3,, 16% decline between 21 and 216 1,5, - 75, 5, Asia and the Pacific 1 8 new HIV infections in % decline between 21 and 216 Fast-Track Target 22: 5 new HIV infections 25, - 27 new HIV infections in Fast-Track Target 22: 9 new HIV infections Source: Prepared by based on UNAIDS 217 HIV Estimates New HIV infections 22 Fast-Track target* *The 22 target is equivalent to a 75% reduction since 21.

11 Number Number Number in millions HIV and AIDS Data Hub for Asia-Pacific Trends in HIV infections and AIDS-related deaths among women in Asia and the Pacific, Women living with HIV , 1 - New HIV infections among women Women living with HIV New HIV infections AIDS-related deaths , AIDS-related deaths among women 2, 2, 1, 78 1, Source: Prepared by based on UNAIDS 217 HIV Estimates

12 Countries in Asia and the Pacific that account for >9% of PLHIV and new infections, and percent change in new infections New HIV infections (216) % decline of new HIV infections between 21 and 216 % increase of new HIV infections between 21 and 216 People living with HIV (216) India 8, -22% 2,1, Indonesia 48, -21% 62, China* 45, N/A 85, Pakistan 19, 39% 13, Viet Nam 11, -34% 25, Myanmar 11, -26% 23, Philippines 1,5 141% 56, Thailand 6,4-5% 45, Malaysia 5,7-35% 97, Papua New Guinea 2,8 4% 46, Bangladesh 1,5 7% 12, Nepal <1, -57% 32, Cambodia <1, -58% 71, Source: Prepared by based on UNAIDS 217 HIV Estimates *213 HIV estimates

13 % change in new HIV infections between 21 and 216 HIV and AIDS Data Hub for Asia-Pacific A significant variation in new HIV infections trends in Asia and the Pacific countries Percent change in new HIV infections between 21 and % 1% 141% Distribution of new HIV infections by country, new HIV infections in Asia and the Pacific in 216 5% % n/a 39% -5% -1% -22% -21% -26% -5% -34% -15% China India Indonesia Pakistan Thailand Myanmar Philippines Vietnam % increase % decrease Source: Prepared by based on UNAIDS 217 HIV Estimates (1,5, 4%)

14 Diverse epidemic trends in Asia and the Pacific Proportion of new HIV infections by risk groups Indonesia Thailand Philippines Pakistan MSM MSW Transgender Male PWID Female sex workers Clients of sex workers Currently low risk females Currently low risk males

15 A significant variation in new HIV infections trend by age group in Asia and the Pacific Distribution of new HIV infections by age group, 216 Percent change in new HIV infections between 21 and 216 by age group 2% 6% 6% 37% 17% % 27 new HIV infections in % Age group (year) 34% % 12% 13% % % Total % decrease % increase Source: Prepared by based on UNAIDS 217 HIV Estimates

16 Sub-national HIV prevalence among key populations in Asia and the Pacific, PNG, Port Moresby (216) Philippines, Cebu City (215) Viet Nam, Can Tho (216) Myanmar, Yangon (216) China, Shenyang (214) Malaysia, Kuala Lumpur (214) Thailand, Bangkok (214) Indonesia, Denpasar (215) Viet Nam, Thai Nguyen (216) Bangladesh, Dhaka (216) Philippines, Cebu City (215) Indonesia, Jakarta (215) Malaysia, Kelantan (214) Pakistan, Kasur (216-17) Myanmar, Bamaw (216) Pakistan, Sukkur (216-17) Viet Nam, Hanoi (216) Myanmar, Myawaddy (216) Indonesia, Jakarta (215)* Malaysia, Kuala Lumpur (214) Cambodia, Banteay Meanchey (215) Philippines, Cebu City (215) Thailand, Chiang Mai (214) Pakistan, Larkana (216-17) Malaysia, Kuala Lumpur (214) Indonesia, Jakarta (215) 9% 9% 15% 12% 23% 36% 34% 65% HIV prevalence (%), Men who have sex with men People who inject drugs Female sex workers Transgender * Direct female sex workers Source: Prepared by based on HIV Sentinel Surveillance Reports and Integrated Biological and Behavioral Surveillance Reports and GAM Reporting

17 HIV prevalence (%) HIV and AIDS Data Hub for Asia-Pacific HIV prevalence among people who inject drugs, * Kathmandu Source: Prepared by based on Global AIDS Response Progress Reporting and Global AIDS Monitoring 217

18 HIV prevalence (%) HIV and AIDS Data Hub for Asia-Pacific HIV prevalence among who inject drugs by gender, Afghanistan (212) China (215) Nepal (215-16) India (214-15) Viet Nam (216) Malaysia (214) Bangladesh (216) * Pakistan (216) Philippines (215) Thailand (214) Myanmar (216) Indonesia (215) ** Male who inject drugs Female who inject drugs * Male PWID Dhaka and Hili; female PWID Dhaka **Small sample size for female PWID Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; and 3) UNAIDS. Global AIDS Monitoring Reporting 217

19 HIV prevalence (%) HIV and AIDS Data Hub for Asia-Pacific HIV prevalence among PWID in geographical locations that are higher than national prevalence, HIV prevalence among people who inject drugs, Afghanistan Bangladesh Cambodia China India Indonesia Malaysia Myanmar Nepal Pakistan Philippines Thailand Viet Nam * Bihar, Uttar Pradesh & Uttarakhand ** Chhattisgarh & Madhya Pradesh Source: Prepared by based on HIV Sentinel Surveillance Reports and Integrated Biological and Behavioral Surveillance Reports and GAM Reporting

20 HIV prevalence > 5% among MSM in selected geographical locations, % Source: Prepared by based on National AIDS Committee Thailand. (212). Thailand Global AIDS Response Progress Report, 212; HIV Sentinel Surveillance Reports; Integrated Biological and Behavioral Surveillance Reports; Lan, W., et al. (212). HIV Prevalence and Influencing Factors Analysis of Sentinel Surveillance among Men who have Sex with Men in China, and Chengdu Center for Disease Control and Prevention. (214). Intensifying HIV response among MSMs with city-approach in Chengdu city, China.; Global ADIS Response Progress Reporting 216; Global AIDS Monitoring 217 2

21 HIV prevalence (%) HIV and AIDS Data Hub for Asia-Pacific High and/or rising HIV prevalence among men who have sex with men in cities, Cambodia, Siem Reap Indonesia, Jakarta Indonesia, Bandung Malaysia, Kuala Lumpur Philippines, Cebu Thailand, Bangkok Viet Nam, HCMC Source: Prepared by based on HIV Sentinel Surveillance Reports and Integrated Biological and Behavioral Surveillance Reports; GARPR Reporting and Global AIDS Monitoring

22 Bangladesh (215) Afghanistan (212) Sri Lanka (214) Nepal (215) ** Pakistan (216) India (214-15) Fiji (211) PNG (216) *** Rep. of Korea (211) Japan (215) China (215) Mongolia (214) + Timor-Leste (211) Lao PDR (214) ++ Cambodia (215) Singapore (215) Philippines (215) Myanmar (216) Viet Nam (216) Malaysia (214) Thailand (214) Indonesia (215) HIV and AIDS Data Hub for Asia-Pacific HIV prevalence among MSM by region, latest available year, % South Asia Pacific East Asia South-East Asia ** Kathmandu, *** Port Moresby, + 3 cities, ++ 4 provinces 22 Source: Prepared by based on 1. HIV Sentinel Surveillance Reports; 2. Integrated Biological and Behavioral Surveillance Reports; and 3. Bangladesh icddr,b, 213. HIV Midline survey among MSM, MSW & TG; Global AIDS Response Progress Reporting 216; Global AIDS Monitoring 216

23 Syphilis prevalence among men who have sex with men, Thailand (213) # Indonesia, Jakarta (215) Indonesia (215) Singapore (213) # Afghanistan (212) * Guangxi, China (212) China (212) Timor-Leste (211) Mongolia (214) Fiji (211) * Myanmar (214) Philippines, Cebu (215) Bangladesh (213)* Sri Lanka (214) ** Nepal (212) * Viet Nam (213) # STI clinic/monitoring data * Capital city ** Colombo, Galle and Anuradhapura % Source: Prepared by based on 1) HIV Sentinel Surveillance Reports; 2) Integrated Biological and Behavioral Surveillance Reports; 3) Global AIDS Response Progress Reporting 213 to 215 ; 4) Wang et al.(214). HIV and syphilis prevalence trends among men who have sex with men in Guangxi, China: Yearly cross-sectional surveys, BMC Infectious Diseases 214, 14:367 23

24 Available data indicate higher HIV prevalence among transgender people in certain geographical areas in select countries Jakarta 4 % National versus location specific HIV prevalence among transgender, countries where data is available, Source: Prepared by based on HIV Sentinel Surveillance Reports, Integrated Biological and Behavioral Surveillance Reports and other serological survey reports Indonesia (215) India (214-15) Malaysia (214) Pakistan (216-17) Philippines (215) Cambodia (215-16) Thane Kuala Lumpur Larkana Cebu Banteay Meanchey Terai Highway Districts National Nepal (215-16)

25 Source: Prepared by based on HIV Sentinel Surveillance Reports, Integrated Biological and Behavioral Surveillance Reports and other serological survey reports HIV and AIDS Data Hub for Asia-Pacific High HIV prevalence observed in some cities and geographical locations HIV prevalence among transgender people, % Bangladesh (215) * TG sex workers in Suva, Nadi, Lautoka, Labasa Fiji * (212) Lao PDR (212) Malaysia (214) Cambodia (215-16) Nepal (215-16) India (214-15) Philippines (215) Thailand (214) Pakistan (216-17) Indonesia (215)

26 HIV prevalence among MSW, countries where data is available, % Philippines (215) Bangladesh (216)* Pakistan (216) Nepal (215) Thailand (214)** * Capital city, **Average for 5 provinces (Bangkok, Chiang Mai, Phuket, Ratchaburi and Chonburi) Source: Prepared by based on 1.Integrated Biological and Behavioural Surveys; 2.HIV Sentinel Surveillance Surveys; 3. National AIDS Committee. (215). Thailand Ending AIDS. Thailand AIDS Response Progress Report 215. Reporting Period: Fiscal Year of 214; 4. Global AIDS Monitoring 217

27 HIV prevalence data on MSW is scarce but it indicates higher HIV prevalence than FSW in most of the countries, % FSW MSW Bangladesh* (216) Nepal** (215) 3.7 Pakistan (216) PNG *** (216) Philippines**** (215) 11.9 Thailand++ (216) * MSW data is for 215 in Dhaka and Hili ** Kathmandu data is reported as national *** Port Moresby; MSW data is for 211 **** FSW data is for MSW data is for 214 Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) icddr,b. (215). A Survey of HIV, syphilis and risk behaviors among males having sex with males, male sex workers and hijra. Global Fund Rolling Continuation Channel Project of icddr,b; 4) National AIDS Committee. (215). Thailand Ending AIDS. Thailand AIDS Response Progress Report 215. Reporting Period: Fiscal Year of 214 ; Global AIDS Monitoring 217

28 HIV prevalence (%) HIV and AIDS Data Hub for Asia-Pacific HIV prevalence among female sex workers, Source: Prepared by based on Integrated Biological and Behavioural Surveys; HIV Sentinel Surveillance Surveys; and 28

29 Geographic locations where HIV prevalence among FSW is higher than national prevalence, % Philippines (Freelance FSW) Indonesia (Indirect FSW) *Thailand (Indirect FSW) Viet Nam India *Myanmar *Thailand (Direct FSW) Pakistan Indonesia (Direct FSW) PNG Malaysia Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys * Data from HSS 29

30 Risk behaviours

31 Level of condom use among key populations: not high enough to prevent new HIV infections Condom use at last sex and consistent condom use, regional median, condom use at last sex consistent condom use FSW 83 FSW 64 MSM 57 MSM 48 PWID 35 PWID (%) 5 1 (%) Source: Prepared by based on Behavioural Surveys and Integrated Biological and Behavioural Surveys

32 HIV and HCV burden among PWID and population interactions with other populations - implications on onward transmissions 4.1 M PWID Half a million PWID living with HIV 43 K HCV co-infection Note: HCV prevalence among PWID in the region varies with a range of 28% to 88% 51% (33%- 7%) 27% (1%- 42%) 14% (4%-37%) Married or in partnership Had sex with FSW Had sex with males Source: Prepared by based on Integrated Behavior and Biological Surveillance (IBBS) and HIV sentinel surveillance plus (HSS+) reports and Platt, L., Easterbrook, P., Gower, E., et al. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis. The Lancet Infectious Diseases 32

33 Only one in three people who inject drugs used a condom at the last sexual encounter 1 % 8 6 Condom use at last sex among people who inject drugs in Asia and the Pacific, Source: Prepared by based on Global AIDS Monitoring (GAM) reporting

34 Condom use among both male and female who inject drugs are still below 6% in many countries 1% 8 Condom use at last sex among people who inject drugs by sex ( ) Male Female Source: Prepared by based on Global AIDS Response Progress Reporting 215 and 216

35 Safe injecting practices among people who inject drugs in Asia and the Pacific 1 % Percentage of people who inject drugs reporting the use of sterile injecting equipment the last time they injected ( ) Source: Prepared by based on Global AIDS Monitoring (GAM) reporting

36 No remarkable difference in safe injection practice among male and female PWID in countries where data is available Safe injection practice among male and female PWID, % 9% AustraliaBangladesh* China Indonesia* Pakistan Philippines Male PWID Female PWID * Female PWID sample size 7-1 Source: Prepared by based on and Global AIDS Response Progress Reporting and Global AIDS Monitoring 217

37 Proportion of MSM who reported condom use at last anal sex with male partner, % Source: Prepared by based on Global AIDS Response Progress Reporting; Global AIDS Monitoring 217

38 Prevention gap: consistent condom use is less than 6% in many countries where data is available 1% Consistent condom use among men who have sex with men, % 5% Prevention gap % Consistent condom use * with commercial/paid male partners; ** casual male partners Source: Prepared by based on Country Global AIDS Response Progress Reports; Integrated Bio-Behavioural Surveys; HIV Sentinel Surveillance Surveys and Behavioural Surveillance Surveys 38

39 Dhaka, Dhaka, National, 213 National, 213 National, 211 National, 211 National, National, National, 215 National, 215 Ulaanbaatar, 211 Source: Prepared by based on Country Global AIDS Response Progress Reports 212; Integrated Bio-Behavioural Surveys; and Behavioural Surveillance Surveys Ulaanbaatar, 211 Kathmandu, 215 Kathmandu, 215* Colombo (214)** Colombo (214)** National, 21 Bangkok, 21 Chiang Mai, 21 National, 212 National, 212 HIV and AIDS Data Hub for Asia-Pacific Condom use at last anal sex and consistent use among MSM, % Condom use at last sex Consistent condom use Bangladesh* Cambodia* China India* Indonesia Mongolia Nepal Sri Lanka Thailand Viet Nam * with commercial/paid male partners; ** casual male partners

40 Proportion of MSM who had sex with female partners in the last year, % Philippines (213) Cambodia (215) Bangladesh, Dhaka (213-14)** Mongolia, Ulaanbaatar (212) Fiji (21) * Nepal, Kathmandu (215) ** India (215)*** Viet Nam, Hanoi (29) Sri Lanka, Colombo (214) *** * Last 6 months; ** Last month, female non paying sexual partner; *** ever had a female sexual partner Source: Prepared by based on 1. Integrated Biological and Behavioral Surveys; 2. Behavioral Surveillance Surveys; and 3. Bavinton, B., Singh, N., Naiker, D. S., et al. (211). Secret Lives, Other Voices: A Community-Based Study Exploring Male-to-Male Sex, Gender Identity and HIV Transmission Risk in Fiji. Suva, Fiji: AIDS Task Force of Fiji.

41 Proportion of surveyed MSM who sold sex to men, % 1 Ever last 12 months Source: Prepared by based on Integrated Biological and Behavioural Surveys and Behavioural Surveillance Surveys 41

42 Proportion of MSM who inject drugs, % injected drugs last year 6 ever injected drugs * Capital city Source: Prepared by based on 1. Integrated Biological; 2. Behavioural Surveys and Behavioural Surveillance Surveys; and 3. icddr,b. (215). A Survey of HIV, syphilis and risk behaviors among males having sex with males, male sex workers and hijra. Global Fund Rolling Continuation Channel Project of icddr,b. 42

43 Proportion of transgender people who reported condom use at last sex with male clients, % * Dhaka ** Combined use of condom and water-based lubricant *** Bangkok, Chonburi, Chiang Mai, Ratchaburi and Phuket Source: Prepared by based on 1) Behavioural Surveillance Surveys; 2) Integrated Biological and Behavioral Survey (IBBS) reports; 3) Malaysia Global AIDS Response Progress Reporting 215. (Country narrative report); 4) National AIDS Committee. (215). Thailand Ending AIDS. Thailand AIDS Response Progress Report 215. Reporting Period: Fiscal 43 Year of 214; 5) Global AIDS Monitoring 217

44 Proportion of transgender people who reported condom use at last sex with casual male partners, % Bangladesh (213-14) * Malaysia (29) Lao PDR (212) Indonesia (211) India ( ) Cambodia (213) * Dhaka Source: Prepared by based on 1) icddr,b. (215). A Survey of HIV, syphilis and risk behaviors among males having sex with males, male sex workers and hijra. Global Fund Rolling Continuation Channel Project of icddr,b.; 2) Malaysia AIDS Council and Ministry of Health. (21). Integrated Biological and Behavioral Survey 29; 3) India National AIDS Control Organization. ( ). National Integrated Behavioural and Biological Survey Hijras/Transgender People( ); 4) CHAS, USAID, The Global Fund, and PSI. (212). Results of Second Round HIV/STI Prevalence and Behavioral Tracking Survey among Male-to-Female Transgender in Vientiane Capital and Savannakhet, Lao PDR, 212. Consensus Meeting; 5) Ministry of Health Republic of Indonesia. (211). IBBS Integrated Biological and Behavioral Survey; and 6) National Center for HIV/AIDS Dermatology and STD Cambodia. (213). Behavioral 44 Sentinel Surveillance (BSS 213): Presented by Mun Phalkun on 16 December 213.

45 Proportion of transgender people who reported consistent condom use with their sexual partners, % last month last three months undefined period Pakistan (216) Bangladesh* (213-14) Lao PDR (212) India ( ) Nepal** (215) Cambodia (216) Indonesia (215) * Dhaka ; ** Kathmandu Source: Prepared by based on Behavioral Surveillance Surveys and Bio-Behavioral Surveys.

46 Proportion of surveyed transgender people who sold sex or had sex with clients, countries where data is available, % 82 in the last week in last last 12 months undefined period Dhaka, Bangladesh (213-14) * Dhaka, Bangladesh (213-14) ** Cambodia (216) Cebu, Philippines (215) India ( ) Indonesia (211) Malaysia (214) * Sold sex to new clients; ** Sold sex to regular clients Source: Prepared by based on Behavioral Surveillance Surveys and Bio-Behavioral Surveys; A Survey of HIV, syphilis and risk behaviors among males having sex with males, male sex workers and hijra. Global Fund Rolling Continuation Channel Project of icddr,b; and Malaysia Global AIDS Response Progress Reporting (Country narrative report)

47 Proportion of transgender people who reported consistent condom use with male clients, % 1 last week last month last three months Bangladesh (213-14) * Pakistan (216) Malaysia (29) India ( ) Lao PDR (212) Cambodia (216) * Dhaka Source: Prepared by based on Behavioral Surveillance Surveys and Bio-Behavioral Surveys. 47

48 Proportion of transgender reported injecting drug use, countries where data is available, % 5 last 3 months last year undefined period India Bangladesh ( ) (213-14) * Indonesia (211) Malaysia (214) Paksitan (216) Cambodia (213) * Dhaka Source: Prepared by based on Behavioral Surveillance Surveys and Bio-Behavioral Surveys. 48

49 Proportion of MSW who reported condom use at last sex, % Pakistan (216) Bangladesh (215) Philippines (215) Nepal (215) Thailand (214) Source: Prepared by based on Global AIDS Monitoring 217

50 Proportion of MSW who reported consistent condom use with male clients, Dhaka,Bangladesh (213-14) 45 Chittagong,Bangladesh (213-14) 54 last week Pakistan (216) 9 last month Kathmandu,Nepal (215)* % Source: Prepared by based on Behavioral Surveillance Surveys and Bio-Behavioral Surveys. * with one time paying male anal sex partner 5

51 Prevention services are reaching female sex workers but accelerated action required to reverse the HIV epidemic Condom use at last sex and consistent condom use with clients, regional median, HIV testing coverage trend among FSW, regional median, condom use at last sex 9% FSW 5 1 (%) consistent condom use FSW (%) Source: Prepared by based on Behavioural Surveys, Integrated Biological and Behavioural Surveys, Global AIDS Monitoring 217

52 Proportion of FSW who reported condom use at last sex, % Source: Prepared by based on Global AIDS Response Progress Reporting and Global AIDS Monitoring 217

53 Proportion of FSW who reported consistent condom use with their clients, % 8 last month 6 last 3 months last year No defined period Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys 53

54 Proportion of FSW who inject drugs, Philippines * (Cebu city, 215) Nepal (Kathmandu, 215) Cambodia (216) Nepal (Kathmandu, 216) India (214-15) Nepal (Pokahara, 216) Lao PDR (214) Pakistan(216) Pakistan(Street-based,216) Pakistan(Hyderabad,216) India (Manipur, ) India (Mizoram, ) Viet Nam (215) Viet Nam (Hanoi, 215) Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys; % Injected drugs in last 6 month Injected drugs in the last 12 months Ever injected drugs *freelance FSW 54

55 Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) Behavioral Surveillance Survey reports HIV and AIDS Data Hub for Asia-Pacific Need for a greater focus: a considerable proportion of sex workers are under 25 years of age % 1 8 Proportion of sex workers who are under 25 years of age where data is available Lao PDR (214) Philippines (213) PNG (21) Fiji (212) Maldives (28) Viet Nam (216) Nepal (215) Myanmar (215) Pakistan (216) Indonesia* (215) Malaysia (214) * Direct FSW Unmet HIV and health service needs of young sex workers-programs often do not reach young sex workers (no age disaggregated data) Legal policy barriers (i.e. condom policy not favoring unmarried young people, parental consent, existing gender inequality, etc.) Need for clarity on policy and programmatic approach for reaching under-18 young people who sell and buy sex Need to ensure broader opportunities health, education and security

56 Gender-based violence

57 Women who experienced intimate partner violence in Asia and the Pacific, 216 % of women who reported experience of physical or sexual violence, or both, by an intimate partner in their lifetime % of women who reported experience of physical or sexual violence, or both, by an intimate partner in the last 12 months. Source: UNFPA. (216). knowvawdata- Measuring prevalence of violence against women in Asia and the Pacific accessed at pshot_1.pdf

58 Prevailing stigma, discrimination and violence against MSM 5 % Physical violence Sexual violence Stigma and mental health Beaten Beaten Experienced physical violence Hit or beaten Reported being raped Forced to have sex Experienced stigma at health facility Avoided seeking healthcare due to stigma Ever attempted suicide *Bangladesh (Dhaka), *Nepal (Terai highway districts), 216 *India (214-15) *Myanmar (Yangon), 215 Source: Prepared by based on Integrated Behavioral and Surveillance Surveys * Experienced violence or rape in the last year

59 Proportion of MSM who had been raped/forced to have sex in the last 12 months, % Colombo Sri Lanka (214) Kathmandu Nepal (215) 8 Dhaka Bangladesh (213-14) 12 India (214-15) 2 Port Moresby PNG (216) 31 Suva Fiji (21) * 44 Kabul Afghanistan (212) ** * Last 6 months; ** ever raped Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys ; and 2. Behavioral Surveillance Surveys 59

60 Prevailing stigma, discrimination and violence against transgender people % Forced sex by client * 16 Forced sex by police * 21 Physical abuse by police * Physical abuse by family* Any forced sex * PNG (21) Fiji (212) Raped by a client ** 2 Bangladesh (213-14) Blackmailed** 3 Raped ** 26 Beaten ** 31 Source: Prepared by based on Integrated Behavioral and Surveillance Surveys * in the last 6 months; ** in the last 12 months

61 Social justice and human rights are fundamental to address the public health needs of transgender women In India In Bangladesh In Cambodia In Pakistan 1 in 5 Transgender women 1 in 4 Transgender women 1 in 5 Transgender women 1 in 6 Transgender women experienced sexual violence in last 12 months reported being raped in last 12 months have been denied/thrown out of a housing in their life time have been denied healthcare in their life time Prepared by based on Integrated Biological and Behavioural Surveys

62 Proportion of female sex workers who experienced physical violence, % last 12 months 4 ever Kathmandu Chandigarh Madhya Pradesh Odisha Yangon Nepal (215)* Fiji (212) India (214-15) Myanmar (215) Pakistan (216) * Street-based FSW Source: Prepared by based on Behavioural Surveys and Integrated Biological and Behavioural Surveys 62

63 India Madhya Pradesh Mandalay Yangon Kathmandu valley 22 Terai districts Pakistan (all FSW) Kothikhana-based HIV and AIDS Data Hub for Asia-Pacific Proportion of female sex workers who have been forced to have sex in the last year, % India (214-15) Myanmar (215) Nepal (215-16) Pakistan (216)* Source: Prepared by based on Behavioural Surveys and Integrated Biological and Behavioural Surveys *ever beaten or forced to have sex

64 Proportion of women living with HIV who had a desire to have children reported being coerced to undergo sterilization, % 3% 25% 2% 15% 33% 1% 22% 5% % 5% Lao PDR (213) 11% 11% Indonesia ( ) Philippines ( ) Pakistan ( ) Nepal ( ) Source: Prepared by based on 64

65 Proportion of surveyed HIV-positive pregnant women who were asked to undergo sterilization, 211 5% 4% 3% 2% 35% 39% 4% 1% % 15% 15% 18% Nepal Bangladesh Viet Nam Cambodia India Indonesia Source: Prepared by based on Women of the Asia Pacific Network of People Living with HIV. (212). Positive and pregnant, How dare you. A study on access to reproductive and maternal health care for women living with HIV in Asia 65

66 Number of HIV-positive pregnant women HIV and AIDS Data Hub for Asia-Pacific Number of HIV-positive pregnant women who were asked to undergo sterilization and had the option to decline, Asked to undergo sterilisation Had the option to decline Source: Prepared by based on Women of the Asia Pacific Network of People Living with HIV. (212). Positive and pregnant, How dare you. A study on access to reproductive and maternal health care for women living with HIV in Asia 66

67 Proportion of women (15-49) who have experienced physical violence during pregnancy, Maldives (26) Nepal (211) 6 6 Viet Nam (29) 5 Thailand (25) Bangladesh (26) Philippines (213) Cambodia (214) Timor Leste (29-21) % Sources: Prepared by based on Demographic and Health Surveys; Viet Nam General Statistics Office.(21). Keeping Silent Is Dying Results from the National Study on Domestic Violence against Women in Viet Nam; Ministry of Gender and Family. Ministry of Gender and Family. (27). The Maldives Study on Women s Health and Life Experiences: Initial results on prevalence, health outcomes and women s responses to violence. Malé.; Garcia-Moreno, C., Jansen, H., Ellsberg, M., Heise, L. and Watts, C. (25). WHO Multi-country Study on Women's Health and Domestic Violence against Women. World Health Organization. Geneva.

68 Urban Rural Total Urban Rural Total Urban Rural Total Urban Rural Total Urban Rural Total Urban Rural Total HIV and AIDS Data Hub for Asia-Pacific Proportion of women (15-49) who have ever experienced physical or sexual violence, % physical violence sexual violence Cambodia (214) India (25-6) Nepal (211) Pakistan (212-13) Philippines (213) Timor Leste (29) Source: Prepared by based on Demographic and Health Surveys

69 Proportion of women (15-49) who have experienced physical violence in the last 12 months, % Philippines (213) Bangladesh (26) Cambodia (214) Nepal (211) India (25-26) Timor Leste (29-21) Source: Prepared by based on Demographic and Health Surveys

70 Proportion of women who have experienced sexual violence by spouse or intimate partner, % 2 18 Last 12 months Ever Bangladesh (26) Timor Leste (29-21) Philippines (213) Cambodia (214) Maldives (26) Viet Nam (29) India (25-26) Nepal (211) Pakistan (213)* * Physical or sexual violence Source: Prepared by based on Demographic and Health Surveys;Viet Nam General Statistics Office. (21). Keeping Silent Is Dying Results from the National Study on Domestic Violence against Women in Viet Nam. Ministry of Gender and Family; Ministry of Gender and Family. (27). The Maldives Study on Women s Health and Life Experiences: Initial results on prevalence, health outcomes and women s responses to violence. Malé.

71 Proportion of men (15-49) who agree that a husband is justified in hitting or beating his wife if she refuses to have sexual intercourse with him, % Urban Rural Cambodia (214) India (25-6) Indonesia (212) 9 Pakistan (212-13) Samoa (29) Timor-Leste (29-1) Total Source: Prepared by based on Demographic and Health Surveys

72 Vulnerability and HIV knowledge

73 Comprehensive HIV Knowledge (%) HIV and AIDS Data Hub for Asia-Pacific Proportion of PWID with comprehensive HIV knowledge, *Kathmandu Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys; 3) UNAIDS. (21). Global Report: UNAIDS Report on the Global AIDS Epidemic.

74 Proportion of MSM with comprehensive HIV knowledge, by age group, countries where data is available, % Total <25 yr 25+ yr Source: Prepared by based on UNGASS Country Progress Reports 26,28 & 21 * Manipur 74

75 Proportion of transgender with comprehensive HIV knowledge, % Indonesia (211) Malaysia (29) Fiji (212) Bangladesh (26-7) Source: Prepared by based on 1) Ministry of Health Republic of Indonesia. (211). IBBS Integrated Biological and Behavioral Survey; 2) Malaysia AIDS Council and Ministry of Health. (21). Integrated Biological and Behavioral Survey 29; 3) Bavinton, B., Singh, N., Naiker, D. S., et al. (211). Secret Lives, Other Voices: A Community-Based Study Exploring Male-to-Male Sex, Gender Identity and HIV Transmission Risk in Fiji. Suva, Fiji: AIDS Task Force of Fiji; 4) National 75 AIDS/STD Programme Bangladesh. (21). UNGASS Country Progress Report: Bangladesh.

76 Proportion of MSW with comprehensive HIV knowledge, % Pakistan, 28 Thailand, 29 Bangladesh, 27 Indonesia, 27 Nepal, 29 Source: Prepared by based on UNAIDS. (21). Global Report: UNAIDS Report on the Global AIDS Epidemic.

77 Comprehensive HIV knowledge (%) HIV and AIDS Data Hub for Asia-Pacific Proportion of FSW with comprehensive HIV knowledge, Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys 3) UNAIDS. (21). Global Report: UNAIDS Report on the Global AIDS Epidemic.

78 Truckers(26-27) Rickshaw pullers (26-27) Electricity workers (28) Seafarers(28) Uniformed services(28) STI clinic attendees(28) Plantation workers(28) STI clinic attendees(28) Petroleum workers(28) STI clinic attendees(29) Prisoners(211) Men at higher risk *(211) HIV and AIDS Data Hub for Asia-Pacific Proportion of men at higher risk with comprehensive HIV knowledge, % Bangladesh Lao PDR Fiji PNG Mongolia Indonesia * Seafarers, dock workers, truck drivers and moto-taxi drivers Source: Prepared by based on Behavioural Surveillance Surveys,Integrated Biological and Behavioral Surveys, UNGASS Progress Reports 21

79 Nepal. India HIV and AIDS Data Hub for Asia-Pacific Proportion of migrants with comprehensive HIV knowledge, Active migrants, Thane (211) 4 Returned migrants, Thane(211) 5 Active migrants, Ganjam (211) 3 Returned migrants, Ganjam (211) 19 Active migrants, Northern Bihar (211) Returned migrants, Northern Bihar (211) Mobile men, Mongolia (29) Returned migrants, Mid to Far-Western(28) Wives of migrants, (21) % Source: Prepared by based on 1) Success Search Option (P) Ltd Nepal, Intrepid Nepal, & Save the Children Nepal. (21). Integrated Biological and Behavioral Surveillance Survey among Male Labor Migrants: Round 3 - Mid and Far-Western Regions of Nepal.; 2) Saggurti N, Mahapatra B, Swain SN, et al. (211). Migration and HIV in India: Study of Select Districts. New Delhi: UNDP, NACO, and Population Council; 3) Mongolia Second Generation Sentinel Surveillance 29 cited in UNGASS 79 Country Progress Report, 21

80 HIV expenditure

81 Million US$ Million US$ Million US$ Millions US$ Millions US$ Million US$ Million US$ Millions US$ Asia and the Pacific HIV and AIDS Data Hub for Asia-Pacific HIV investments Increased government investments in AIDS to fill the gap of decline in international funding 86 CHINA 7% 25 INDIA 133% 11 INDONESIA MALAYSIA 119% 12% 53 59% 273% % % change % % change % change % change MYANMAR PHILIPPINES THAILAND VIET NAM 85 37% 9% % 25 1% % Domestic expenditure % change International expenditure -5% % change % % change Prepared by based on Global AIDS Response Progress Reporting and Global AIDS Monitoring % % change

82 Asia and the Pacific HIV and AIDS Data Hub for Asia-Pacific Increasing total health expenditure vs. plateauing or declining HIV expenditure in most countries Total health expenditure Health financing and HIV investments HIV expenditure Cambodia 939 million US$ 44 million US$ Total health expenditure China billion US$ million US$ HIV expenditure Domestic funding on HIV Lao PDR 218 million US$ 8 million US$ International funding on HIV Source: Prepared by based on Global Health Expenditure Database - and Global AIDS Response Progress Reporting

83 Asia and the Pacific HIV and AIDS Data Hub for Asia-Pacific Health financing and HIV investments Increasing total health expenditure vs. plateauing or declining HIV expenditure in most countries Total health expenditure HIV expenditure Malaysia 14 billion US$ 53 million US$ Total health expenditure Philippines billion US$ million US$ HIV expenditure Domestic funding on HIV Viet Nam 13 billion US$ 95 million US$ International funding on HIV Source: Prepared by based on Global Health Expenditure Database - and Global AIDS Response Progress Reporting

84 Resource Availability and Fast-Track Resource Needs in Asia and the Pacific US$ million $7, $6, $5, $4, $3, $2, $1, $ Domestic( public and private ) United States (Bilateral) Global Fund Other international Resource needs (Fast-Track) Prepared by based on UNAIDS estimates on HIV resource availability, 217

85 External financing sources as % of health vs. HIV expenditure, Western Pacific countries 1 % External financing sources as % of total health expenditure Source: Prepared by based on Global Health Expenditure Database - External financing sources as % of total HIV expenditure

86 Million US$ HIV and AIDS Data Hub for Asia-Pacific Key populations account for 6-9% of new HIV infections in Asia and the Pacific countries but only a third was spent for key populations HIV prevention programme Proportion of prevention spending among key populations in Asia and the Pacific region Total prevention spending (15 countries) 35% 64 Key populations prevention spending (15 countries) 19% 1% 6% of total prevention spending 34 Spending on people who inject drugs (13 countries) 18 Spending on sex workers and clients (15 countries) 15 countries: Afghanistan, Bangladesh, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Nepal, Palau, Pakistan, Philippines, Solomon Island, Sri Lanka, Thailand and Vietnam Source: Prepared by based on GARPR reporting 12 Spending on men who have sex with men (15 countries) 86

87 Prevention spending on key populations is heavily dependent on international financing sources Distribution of prevention spending by financing source in Asia and the Pacific, latest available year, Prevention spending on 1% Total prevention spending (28 countries) Sex workers and clients (15 countries) MSM (15 countries) PWID (13 countries) 8% International 6% 4% 2% Domestic public % 43% 12% 1% 3% Spending by service category is not available for India and China Source: Prepared by based on Global AIDS Response Progress Reporting 87

88 Domestic public investment (%) HIV and AIDS Data Hub for Asia-Pacific Government investment on HIV and health in Asia and the Pacific % domestic public AIDS expenditure as % of total AIDS spending % domestic public expenditure on health as % of total health expenditure Source: Prepared by based on Global AIDS Response Progress Reporting 215; and India National AIDS Control Organisation. (214). Annual Report ; WHO Global Health Expenditure Database at

89 DPR Korea (211) Malaysia (213) Thailand (213) Timor-Leste (29) Cambodia (212) Indonesia (212) Viet Nam (212) Mongolia (211) Philippines (213) Myanmar (211) Bangladesh (213) Lao PDR (211) Nepal (29) Pakistan (213) India ( ) Afghanistan (213) Sri Lanka (21) REGIONAL HIV and AIDS Data Hub for Asia-Pacific Percent distribution of AIDS spending by category in Asia, % 8% 6% 4% 2% % Prevention Care and treament Programme management and administration Others Source: Prepared by based on and National AIDS Control Organisation. (214). Annual Report

90 Palau (213) Tonga (29) Papua New Guinea (212) Kiribati (212) Tuvalu (213) Nauru (29) Micronesia (Fed. State) (213) Solomon Islands (211) Marshall Islands (212) Samoa (213) Vanuatu (213) REGIONAL HIV and AIDS Data Hub for Asia-Pacific Percent distribution of AIDS spending by category in the Pacific, % 8% 6% 4% 2% % Prevention Care and treament Programme management and administration Others Source: Prepared by based on 9

91 National response

92 Key populations and vulnerable populations

93 Asia and the Pacific Key populations prevention gap Female sex workers Men who have sex with men People who inject drugs Key populations size 4.2 M 11.4 M 4.1 M Condom use at last sex 83% 9% G A P 57% 9% GAP 35% GAP 9% HIV testing coverage 47% 9% GAP 53% 9% GAP 44% GAP 9% Needles and syringes needles and syringes GAP On treatment Limited data Limited data Limited data PrEP countries have PrEP projects for FSW Prepared by based on Global AIDS Monitoring countries have PrEP projects for MSM 2 countries have PrEP projects for PWID Asia and the Pacific

94 PrEP availability through pilot/demonstration sites by key populations Prepared by

95 Availability of community-based and lay provider testing approaches in Asia and the Pacific Both community-based and lay provider HIV testing available Community-based HIV testing available Lay provider HIV testing available Not available No info

96 HIV testing is the entry point for prevention and treatment but about half of key populations do not know their HIV status HIV testing coverage among key populations, Female sex workers 47 Men who have sex with men 53 Transgender people 41 People who inject drugs 44 Regional median Source: Prepared by based on Global AIDS Monitoring (GAM) Reporting 217

97 HIV testing is the entry point for prevention and treatment, but many key populations do not know their HIV status Afghanistan Bangladesh Cambodia China India Indonesia Lao Malaysia Myanmar Nepal Pakistan PNG Philippines Sri Lanka Thailand Viet Nam Female sex workers Male sex workers % 9% 17 9% Men who have sex with men Transgender people % 8 People who inject drugs % Prepared by based on Global AIDS Monitoring 217; Integrated Bio-Behavioural Surveys; and Behavioural Surveillance Surveys

98 Snapshot of harm reduction in Asia and the Pacific, 216 Needle and syringe programmes operational Needle and syringe programmes coverage Possession of needle and syringe used as evidence for arrest Opioid substitution therapy programmes operational Opioid substitution therapy programmes coverage Naloxone available through community distribution Afghanistan Yes NO INFO Yes No Australia Yes NO INFO Yes NO INFO Bangladesh* Yes No Yes No Cambodia Yes No Yes Yes China Yes No Yes Yes India Yes No Yes Yes Indonesia Yes NO INFO Yes NO INFO Lao PDR Yes No No No Malaysia Yes No Yes Yes Myanmar Yes No Yes No Nepal Yes Yes Yes No New Zealand Yes No Yes No Pakistan Yes Yes No No Philippines No Yes No No Sri Lanka No No No No Thailand Yes Yes Yes Yes Viet Nam Yes NO INFO Yes NO INFO Countries with HIV prevalence among PWID 5% NSP programme coverage (syringes per PWID per year) High coverage: >2 Medium coverage: >1 <2 Low coverage: <1 No service No info/ not reported OST programme coverage (% opioid injectors on OST) High coverage: >4% Medium coverage: 2 4% Low coverage: < 2% No service No info/ not reported Source: Prepared by based on Global AIDS Monitoring (GAM) reporting * HIV prevalence from 2 sentinel sites - Dhaka and Hili

99 Number of syringes distributed per PWID per year HIV and AIDS Data Hub for Asia-Pacific Number of needles and syringes distributed per PWID per year in Asia and the Pacific, High coverage: >2 syringes per PWID per year Medium coverage: >1 < syringes per PWID per year Low coverage: <1 syringes per PWID per year Source: Prepared by based on Global AIDS Monitoring Reporting 217

100 % OST coverage HIV and AIDS Data Hub for Asia-Pacific Coverage of opioid substitution therapy among people who inject drugs, Fast-track target Source: Prepared by based on Global AIDS Monitoring Reporting 217

101 HIV testing response gap to reach Fast-Track target: two out of three people who inject drugs do not know their HIV status 1% HIV testing coverage among people who inject drugs, % 5% % Response gap to reach Fast-Track target Source: Prepared by based on and Global AIDS Response Progress Reporting Testing coverage * Programme data 11

102 Female PWID have similar level of HIV testing coverage comparing to their male cohort 1 % 9% HIV testing coverage among male and female PWID, Male PWID Female PWID Australia Bangladesh* China Indonesia* Philippines Source: Prepared by based on and Global AIDS Response Progress Reporting * Female PWID sample size

103 Impact of drug policies on HIV among people who inject drugs HIV prevalence (%) Sweden (213) Finland (215) Australia (215) Select countries that have early and consistently implemented comprehensive harm reduction strategies Belgium (213) USA (214) China (215) France (213) Select countries that have introduced harm reduction strategies partially (or) late in the progress of the HIV epidemic Malaysia (214) Portugal (213) Thailand (214) Philippines (215) Russia* *Information on year of survey conducted not available Select countries that have consistently resisted large scale implementation of harm reduction strategies, despite the presence of the epidemic, drug injection and sharing Source: Prepared by based on and Global AIDS Response Progress Reporting (GARPR) 13

104 HIV testing response gap to reach Fast-Track target: less than half of men who have sex with men know their HIV status HIV testing coverage among men who have sex with men, % 9% 5% % Response gap to reach Fast-Track target Testing coverage Source: Prepared by based on ; Global AIDS Response Progress Reporting; Global AIDS Monitoring 217 * Dhaka and Hili ** Programme 14 data

105 Prevention coverage (%) HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM reached with HIV prevention programmes in the last 12 months, Definition of reach : Know where to go to receive an HIV test and had been given condoms in the last 12 months NOTE: Data for Afghanistan (7%) is excluded in calculation of the regional median because their definition of reach is different from the one used in the standard indicator * Programme data ** Data for Kathmandu Source: Prepared by based on

106 With current level of response, we cannot end AIDS among transgender, and we cannot end AIDS in Asia and the Pacific HIV prevention and testing coverage among transgender women Bangladesh Philippines 9% Fast-Track Target by 22 9% Fast-Track Target by 22 Gap Coverage Prevention coverage HIV testing Prevention coverage HIV testing Source: Prepared by based on Global AIDS Monitoring (GAM) Reporting 217

107 HIV testing coverage among transgender people, % 9% 5% % Response gap to reach Fast-Track target Testing coverage Source: Prepared by based on Global AIDS Monitoring 217 * Dhaka ** Programme data

108 Proportion of MSW who received an HIV test in the last 12 months and knew their results, % Philippines (215) Pakistan (216) Bangladesh (215) Thailand (214) 54 Nepal (215) 85 Indonesia* (211) 89 It is not strictly comparable across countries since methods and sampling varied. In addition, many surveys were conducted in a few urban areas and it might not necessarily reflect prevailing conditions at the national level. Source: Prepared by based on Global AIDS Monitoring 217

109 Source: Prepared by based on Source: Prepared by based on Behavioural Surveys, Integrated Biological and Behavioural Surveys, Global AIDS Monitoring 217 HIV and AIDS Data Hub for Asia-Pacific Proportion of FSW who received an HIV test in the last 12 months and know their results, * Port Moresby data Data is not strictly comparable across countries since methods and sampling varied. In addition, many surveys were conducted in a few urban areas and it might not necessarily reflect prevailing conditions at the national level.

110 Prevention coverage (%) HIV and AIDS Data Hub for Asia-Pacific Proportion of FSW reached with HIV prevention programmes in the last 12 months, Definition of reach : Know where to go to receive an HIV test and had been given condoms in the last 12 months NOTE: Data for Bhutan (18%) and Afghanistan (14%) is excluded in calculation of regional median because their definition of 'reach' is different from the one used in the standard indicator Source: Prepared by based on * Programme data ** Data for Kathmandu

111 Independent access to HIV testing and related services for young people in Asia and the Pacific Age of legal capacity to consent independently to an HIV test, Asia and the Pacific Source: UNICEF, UNESCO, UNFPA, UNODC, Youth LEAD, & Youth Voices Count. (215). Adolescents Under the Radar in the Asia-Pacific AIDS Response.

112 Laws and regulations that allow adolescents (1-19 years) to seek services without parental/spousal consent, countries where data is available, Yes No No information Source: Prepared by based on information from countries that responded to the Global Maternal, Newborn, Child and Adolescent Health Policy Indicator Surveys (29-1, , , 216) undertaken by Department of Maternal, Newborn, Child and Adolescent Health; World Health Organization - ild_adolescent/epidemiology/p olicy-indicators/en/ (accessed Feb 1, 217)

113 Being young + key populations = less access to HIV services HIV testing coverage among key populations by age group, Female sex workers (1 countries) Men who have sex with men (13 countries) People who inject drugs (9 countries) % 9% key populations <25 years key populations >25 years Prepared by based on Global AIDS Monitoring 217; Integrated Bio-Behavioural Surveys; and Behavioural Surveillance Surveys

114 Support countries to put in place guarantees against discrimination in law, policies, and regulations Legal barriers to the HIV response remain in 38 UN Member States in Asia and the Pacific Source: Prepared by based on UNAIDS, Punitive Laws Hindering the HIV Response in Asia and the Pacific (as of June 216) Asia and the Pacific

115 Stigma: the major barrier to HIV and health services 21% avoided going to local clinic 63% felt ashamed 9% denied SRH services Multiple layers of stigma also experienced by sex workers, MSM, TG, people who use drugs, migrants. 32% late diagnosis* 14% denied health services Access to health services Averages from PLHIV Stigma Index in 14 countries in the region (28-214) *Late diagnosis- CD4<2 at the time of diagnosis (based on treatment programme data)

116 Treatment: Antiretroviral therapy

117 HIV testing is the entry point for prevention and treatment but about half of key populations do not know their HIV status HIV testing coverage among key populations, Female sex workers 47 Men who have sex with men 53 Transgender people 41 People who inject drugs 44 Regional median Source: Prepared by based on Global AIDS Monitoring (GAM) Reporting 217

118 HIV testing is the entry point for prevention and treatment, but many key populations do not know their HIV status Afghanistan Bangladesh Cambodia China India Indonesia Lao Malaysia Myanmar Nepal Pakistan PNG Philippines Sri Lanka Thailand Viet Nam Female sex workers Male sex workers % 9% 17 9% Men who have sex with men Transgender people % 8 People who inject drugs % Prepared by based on Global AIDS Monitoring 217; Integrated Bio-Behavioural Surveys; and Behavioural Surveillance Surveys

119 Availability of community-based and lay provider testing approaches in Asia and the Pacific Both community-based and lay provider HIV testing available Community-based HIV testing available Lay provider HIV testing available Not available No info Source: based on Global AIDS Monitoring (GAM) 217

120 Independent access to HIV testing and related services for young people in Asia and the Pacific Age of legal capacity to consent independently to an HIV test, Asia and the Pacific Source: UNICEF, UNESCO, UNFPA, UNODC, Youth LEAD, & Youth Voices Count. (215). Adolescents Under the Radar in the Asia-Pacific AIDS Response.

121 People receiving ART HIV and AIDS Data Hub for Asia-Pacific ENDING AIDS BY 23: Fast-Track Treatment to Reach by 22 5,1, People receiving ART in Asia and the Pacific 216 estimate: 2.4 million Fast-Track Target 22: 4.2 million people on ART At current pace: 4.2 million people on ART by 22 15% annual increase between 213 and *As of June 217, estimated 2.5 million people were receiving ART in Asia and the Pacific region People receiving ART Trend to Fast-Track target People receiving ART by 22 (at current pace) Source: Prepared by based on UNAIDS 217 HIV Estimates; Global AIDS Monitoring (GAM) 217

122 Number of people Asia and the Pacific Towards Fast-Track treatment targets Treatment cascade, M 71% 5.1 M 3.6 M 66% 2.4 M 83%.43 M.4 M Countries with CD4 threshold policy for treatment initiation 24 Estimated PLHIV PLHIV know their status People on ART * Tested for viral load ** treat all regardless of CD4 CD4 5 but treat all key populations regardless of CD4 CD4 5 CD4 35 but treat all key populations regardless of CD4 countries have national policy on routine viral load monitoring for antiretroviral therapy Suppressed viral load *As of June 217, estimated 2.5 million people were receiving ART in Asia and the Pacific region ** China and India do not report viral load testing data in 217 GAM reporting and Indonesia reported only.2% of people on ART tested for viral load in 216. Estimated 52% of PLHIV who are on treatment in 18 reported countries had tested for viral load in the past 12 months. Prepared by based on Global AIDS Monitoring 217 Reporting and UNAIDS 217 HIV Estimates

123 PROGRESS TOWARDS THE TARGETS Global versus Asia and the Pacific, 216 Global 7% [51 84%] 77% [57 >89%] 82% [6 >89%] Asia and the Pacific 71% [47 >89%] 66% [44 >89%] 83% [55 >89%] Source: Prepared by based on UNAIDS special analysis, 217 of people living with HIV know their status of people living with HIV who know their status are on treatment of people on treatment are virally suppressed

124 People living with HIV in million HIV and AIDS Data Hub for Asia-Pacific Regional overview: target and gaps 5.1. ACHIEVED.98 M 3.6 M People living with HIV who know their status Australia; Malaysia; Thailand NOT ON-TRACK Afghanistan; Bangladesh; Indonesia; Mongolia; Sri Lanka 1 st 9 target GAP PLHIV know the status 2.4 M People living with HIV on treatment ACHIEVED 1.7 M Australia; Singapore NOT ON-TRACK Afghanistan; Bangladesh; Fiji; Indonesia; Malaysia; Pakistan; Philippines 2 nd 9 target GAP PLHIV are on treatment * Prepared by based on UNAIDS special analysis 217; UNAIDS 217 estimates and Global AIDS Monitoring M 1.97 M People living with HIV who are virally suppressed ACHIEVED Cambodia; Singapore NOT ON-TRACK Afghanistan; Fiji; Pakistan 3 rd 9 target GAP PLHIV are virally suppressed *As of June 217, estimated 2.5 million people were receiving ART in Asia and the Pacific region

125 Number of adolescents Number of adolescents Number of adolescents HIV and AIDS Data Hub for Asia-Pacific HIV testing and treatment cascade among adolescents, select countries, 216 9,7 9,7 9,6 Estimated adolescents living with HIV Adolescents know their status Thailand >95% 7% n/a On ART 5,2 6,7 Tested for viral load 87% 5,8 Suppressed viral load 17, Philippines 17, Estimated adolescents living with HIV n/a Adolescents know their status Indonesia 9% 1,5 On ART n/a Tested for viral load n/a Suppressed viral load 5,2 Estimated adolescents living with HIV Adolescents know their status 3% On ART Prepared by based on UNAIDS 217 estimates and Global AIDS Monitoring 217 n/a 11% Tested for viral load 84% Suppressed viral load 125

126 ART coverage (%) HIV and AIDS Data Hub for Asia-Pacific Current treatment scale-up has made significant achievement but the region is lagging behind the global trend 1 ART coverage and treatment gap, Asia and the Pacific, 216 >81 > ART coverage (%) < 3% 3-54% 55-74% 75% Treatment gap Prepared by based on Global AIDS Monitoring 217 Reporting and UNAIDS 217 HIV Estimates

127 3 in 5 children living with HIV are not receiving life-saving ART 1% 8% 6% 4% Children ART coverage and treatment gap, Asia and the Pacific, 216 >95% 2 nd 9 target 2% % 1% 4% 43% Treatment coverage Prepared by based on UNAIDS 217 estimates and Global AIDS Monitoring 217 Gap 127

128 ART coverage (%) HIV and AIDS Data Hub for Asia-Pacific Low level of access to treatment among key populations ART coverage: Female sex workers living with HIV vs. Female PLHIV 9% 81% 45 2X 11X 24X Myanmar Pakistan Viet Nam FSW Female PLHIV Prepared by based on Global AIDS Monitoring 217

129 ART coverage (%) HIV and AIDS Data Hub for Asia-Pacific Low level of access to treatment among key populations ART coverage: Male key populations living with HIV vs. Male PLHIV 9% 81% 45 Myanmar Pakistan Viet Nam PWID MSM Male PLHIV Prepared by based on Global AIDS Monitoring 217

130 Late diagnosis: Proportion of PLHIV with initial CD4 count <2 5 1 % Thailand Philippines Papua New Guinea Indonesia Fiji Mongolia Malaysia Myanmar Singapore India Nepal Cambodia China Bangladesh Sri Lanka New Zealand % of PLHIV with initial CD4 count <2 3-5% of PLHIV with initial CD4 count <2 < 3% of PLHIV with initial CD4 count <2 Note: Lao PDR and Viet Nam reported 47% and 59% of PLHIV respectively were reported with initial CD4 count <35 Prepared by based on UNAIDS 217 estimates and Global AIDS Monitoring 217

131 HIV self-testing policy landscape, 216 As of October 216, 4 countries in Asia and the Pacific report having policies supportive of HIV self-testing * * HIV self-testing in Thailand is under consideration Source: WHO.(216). Overview of the New Guidelines on HIV Self-Testing and Partner Notification: What You Need to Know

132 Treatment cost per patient per year (US$) HIV and AIDS Data Hub for Asia-Pacific Generic competition lowers live-saving ART prices Evolution in price of different first-line regimens X 1 times lower Originator: Cat. 1 TDF/FTC/EFV Generic TDF/3TC/EFV* Originator: Cat. 2 TDF/FTC/EFV Generic TDF/FTC/EFV* Prepared by based on Medecins Sans Frontieres (MSF) (216). Untangling the Web of Antiretroviral Price Reductions -18th Edition

133 Generic ARVs and impact on government budget: Thailand example Cost saving comparing with originated product price Antiretroviral drug (GUL- Government use of license) Year Mil THB Cost saving Mil USD , , , , Total saving 1, Source: Presentation by Chutima Akaleephan presented at the Regional Experts Consultation on Access to Affordable Medicines, Diagnostics and Vaccines in Bangkok, March 216 based on NHSO Thailand data

134 US$ per person per year HIV and AIDS Data Hub for Asia-Pacific Newer, more effective, less toxic medicines often unaffordable for the poor and developing countries 2 15 X17.4 X6.5 $ X2.7 $16 $286 First-line regimen Second-line regimen Third-line regimen Lowest generic price Lowest generic price (TDF/3TC/EFV) (AZT/3TC+ATV/r) (RAL+DRV+r+ETV) Prepared by based on Medecins Sans Frontieres (MSF) (216). Untangling the Web of Antiretroviral Price Reductions -18th Edition

135 High out of pocket health payment in countries with highest HIV burden Out-of-pocket payment as % of total health expenditure 1 % Prepared by based on

136 Treatment: PMTCT

137 New HIV infections HIV and AIDS Data Hub for Asia-Pacific Estimated new HIV infections among children (-14 years) in Asia and the Pacific: current trend and trend to Fast-Track target 4, 3, 2, 1, New HIV infections (children -14 yr) Current trend to 22 Trend to Fast-Track 22 target Estimate 216: estimate based on current trend: 1 new HIV infections Falls short of target by 8 Fast-Track Target 22: 19 new HIV infections Source: Prepared by based on UNAIDS 217 HIV Estimates

138 PMTCT coverage (%) HIV and AIDS Data Hub for Asia-Pacific Efforts are needed to eliminate new HIV infections among children (-14 years) in Asia and the Pacific Prevention of mother-to-child transmission (PMTCT) coverage, Global and Asia and the Pacific, % % 19% 46% Global Asia and the Pacific Prepared by based on Global AIDS Monitoring 217 Reporting and UNAIDS 217 HIV Estimates

139 Number HIV and AIDS Data Hub for Asia-Pacific Towards ending AIDS in children starts with mothers: time to improve linkages and prevent leakages 8, Service cascade of prevention of mother-to-child transmission of HIV in Asia and the Pacific, 216 Mothers 6, 46% received ARVs for PMTCT Infants 4, 71, 52% early infant diagnosis 2, n/a 32, n/a 17, - Estimated pregnant women living with HIV Diagnosed HIV positive pregnant women HIV positive pregnant women received ARVs for PMTCT Infants born to HIV positive mother received ARV prophylaxis within first 6 wks Infants born to HIV positive mother received an HIV test within 2 months of birth Note: PMTCT testing and coverage of infant ARV prophylaxis are not captured in GAM 217 reporting Prepared by based on Global AIDS Monitoring 217 Reporting and UNAIDS 217 HIV Estimates

140 PMTCT coverage (%) HIV and AIDS Data Hub for Asia-Pacific Regional overview: Prevention of mother-to-child transmission 1 Pregnant women living with HIV who received ARVs to reduce the risk of mother-to-child transmission of HIV, > PMTCT coverage (%) < 3% 3-54% 55-74% 75% PMTCT Gap Prepared by based on UNAIDS 217 estimates and Global AIDS Monitoring 217

141 Regional PMTCT gap, 216 Regional child new HIV infections gap Received PMTCT (216) GAP 22 target Children new infections (216) GAP 22 target India 95% India Indonesia Indonesia Pakistan China PNG Viet Nam Myanmar Pakistan, 7% Proportion of regional PMTCT gap by country Indonesia, 28% India, 52% Pakistan, 6% Indonesia, 21% Proportion of regional child new infections gap by country India, 6% Pakistan Myanmar PNG China Viet Nam Philippines Philippines Remaining countries Prepared by based on UNAIDS 217 estimates and Global AIDS Monitoring 217 Remaining countries

142 Commitment of member states on emtct in Asia and the Pacific

143 Treatment: TB-HIV Co-treatment

144 TB snapshot 216 Asia and the Pacific is the home for More than 2/3 of estimated new TB cases globally 7.1 M 199 K 1/5 of estimated TB-HIV co-infections globally More than 1/2 of estimated TB mortality globally (both HIV-negative and HIV-positive) Source: Prepared by based on WHO. (217). Global TB Report K 144

145 Over a third of high TB burden countries are in Asia and the Pacific 3 high-burden countries (Tuberculosis) Angola Bangladesh Brazil Cambodia Central African Republic China Congo DPR Korea DR Congo Ethiopia India Indonesia Kenya Lesotho Liberia Mozambique Myanmar Namibia Nigeria Pakistan Papua New Guinea Philippines Russian Federation Sierra Leone South Africa Thailand UR Tanzania Viet Nam Zambia Zimbabwe Source: Prepared by based on WHO. (217). Global TB Report 217 Asia and the Pacific

146 Estimated HIV prevalence in incident TB cases, % High TB burden countries in Asia-Pacific Countries with highest number of PLHIV in Asia-Pacific Asia-Pacific countries Source: Prepared by based on WHO. (217). Global TB Report

147 TB patients with known HIV status (%) HIV and AIDS Data Hub for Asia-Pacific Need to scale-up HIV testing among TB patients in Asia Proportion of TB patients with known HIV status, 216 Mongolia India Sri Lanka Lao PDR Cambodia Thailand Myanmar Singapore Malaysia Viet Nam 5 China Timor-Leste 4 Afghanistan 3 2 Nepal Philippines Indonesia 1 Pakistan Japan Bangladesh Source: Prepared by based on WHO. (217). Global TB Report

148 TB patients with known HIV status (%) HIV and AIDS Data Hub for Asia-Pacific Need to scale-up HIV testing among TB patients in the Pacific Proportion of TB patients with known HIV status, New Zealand Australia Marshall Islands Palau Micronesia Fiji Kiribati PNG Vanuatu Source: Prepared by based on WHO. (217). Global TB Report

149 Thousands HIV and AIDS Data Hub for Asia-Pacific Integrated approaches need to strengthen in diagnosis, treatment, and care of TB-HIV co-infections in Asia and the Pacific Continuum of HIV testing, diagnosis, and access to ART among patients enrolled in TB programmes, ,482 47% of diagnosed TB patients tested for HIV 2,15 4% HIV positivity rate 82% of diagnosed PLHIV on ART 1 Notified TB cases (new and relapse) New and relapse notified TB cases tested for HIV Source: Prepared by based on WHO. (217). Global TB Report New and relapse notified TB cases tested positive for HIV HIV positive new and relapse TB cases on antiretroviral therapy149

150 Number HIV and AIDS Data Hub for Asia-Pacific Tuberculosis diagnosis and treatment continuum among HIV-positive TB patients in Asia and the Pacific, % of estimated new TB cases who are coinfected with HIV did not know their HIV status Programmatic gap 1% 7% 18% of identified HIV-positive TB patients were NOT on ART 37% 3% 82% Estimated incidence of TB cases who are HIV-positive Identified HIV-positive TB patients HIV-positive TB patients on ART Source: Prepared by based on WHO. (217). Global TB Report

151 % ART coverage HIV and AIDS Data Hub for Asia-Pacific About 7% of people with TB-HIV co-infection did not have access to antiretroviral therapy in Asia and the Pacific, 216 Access to antiretroviral therapy among PLHIV vs. people with TB-HIV co-infection, Treatment gap All PLHIV Denominator: Estimated total PLHIV Source: Prepared by based on WHO. (217). Global TB Report 217 HIV-positive TB patients Denominator: Estimated new TB cases who are HIV- positive 151

152 % coverage HIV and AIDS Data Hub for Asia-Pacific Low coverage of TB preventive treatment among PLHIV newly enrolled in HIV care in Asia and the Pacific Proportion of PLHIV newly enrolled in HIV care who were started on TB preventive treatment in 216, countries where data is available Source: Prepared by based on WHO. (217). Global TB Report

153 TB co-infection: preventable death among PLHIV Estimated number of AIDS-related deaths and TB deaths among PLHIV in 216, Asia and the Pacific versus global AIDS-related deaths Proportion of TB deaths among PLHIV Asia and the Pacific 17 K 24% About 1 in 4 AIDS deaths are among people with TB-HIV co-infection Global 1 M Source: Prepared by based on WHO. (217). Global TB Report % About 1 in 3 AIDS deaths are among people with TB-HIV co-infection 153

154 8 countries account for 95% of all TB-related deaths among PLHIV in Asia and the Pacific Source: Prepared by based on WHO. (217). Global TB Report