HIV Situation in South-East Asia. HIV unit Department of Communicable Diseases

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1 HIV Situation in South-East Asia HIV unit Department of Communicable Diseases

2 Outline Magnitude of HIV burden in South-East Asia Progress towards MDGs Regional success stories Issues and concerns Summary Future priorities

3 HIV burden in South-East Asia

4 South-East Asia has a huge burden of HIV An estimated 3.6 million people living with HIV (PLHA); 37% are women South-East Asia Region has the second-highest burden of HIV/AIDS in the world An estimated 26 new infections each year Estimated number of people living with HIV/AIDS, by WHO Region, 27 3 An estimated 3, AIDS deaths each year Number Approximately 1.3 million in need of antiretroviral treatment 5 Africa South-East Asia Americas Europe Western Pacific.58 Eastern Mediterranean Source: Report on Global AIDS Epidemic, UNAIDS, 28

5 HIV prevalence in South-East Asia Region, 27 Country Bangladesh Bhutan DPR Korea India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Timor-Leste Estimated number of people living with HIV (PLHA) 12, <5 NA 2,4, 27, <1 24, 7, 3,8 61, <1 % of adult population infected with HIV <.1 <.1 NA.3.2 < < <.1 There is a wide variation in the number of people living with HIV from less than 1 in Maldives to 2.4 million in India Source: Report on Global AIDS Epidemic, UNAIDS, 28.

6 HIV prevalence in adult population, South-East Asia Region, 27 Myanmar 24, Five countries account for the majority of HIV burden in the Region India 2,4, Thailand 61, Indonesia 27,

7 Distribution of reported AIDS cases by mode of transmission, South-East Asia Region, 27 1% Proportion of reported AIDS cases (%) 8% 6% 4% 2% % India Thailand Myanmar Indonesia Nepal Unsafe sex Injecting drug use Unsafe blood Mother-to-child Others/unknown Unsafe sex and injecting drug use are the main risk behaviors driving the HIV epidemic in South-East Asia Source: AIDS case reports, National AIDS program, Ministry of Health, SEAR countries, 27

8 HIV prevalence in adult population, South-East Asia, HIV epidemics have declined/stabilized in Thailand, India, Myanmar, Nepal and SriLanka; however, Indonesia has one of the fastest growing epidemics % adult population infected with HIV Thailand Myanmar Nepal India Indonesia Sri Lanka Source: HIV prevalence curves generated by Spectrum using surveillance data reported by Ministries of Health, SEAR countries

9 Millennium Development Goals (MDG) Targets 6A. Have halted by 215 and begun to reverse the spread of HIV/AIDS Indicators: HIV prevalence among population aged years Condom use at last high-risk sex Proportion of population aged years with comprehensive correct knowledge of HIV/AIDS Ratio of school attendance of orphans to school attendance of nonorphans aged 1-14 years (not applicable to SEAR countries) 6 B. Achieve, by 21, universal access to treatment for HIV/AIDS for all those who need it Indicator Proportion of population with advanced HIV infection with access to antiretroviral treatment

10 HIV prevalence among young antenatal care (ANC) attendees (aged years) in selected south-east Asian countries, 2-27 ANC attendees, south India ANC attendees, north-east India ANC attendees, Myanmar 3 % ANC attendees HIV-positive Source: Sentinel surveillance data reported by MOH

11 HIV prevalence among vulnerable populations (aged years) in selected south-east Asian countries, Sex workers, Myanmar Sex workers, Andhra Pradesh Injecting drug users, north-east India % population HIV-positive Source: Sentinel surveillance data reported by MOH

12 Percentage of sex workers reporting condom use with their most recent client in south-east Asia, Target Percentage Thailand Sri Lanka India Nepal Indonesia Bangladesh Source: Report on Global AIDS Epidemic, UNAIDS, 28

13 Percentage of young women and men aged with comprehensive correct knowledge of HIV/AIDS, South-East Asia, Target Percentage Males Females Both sexes Bangladesh India Nepal Sri Lanka Thailand Source: Report on Global AIDS Epidemic, UNAIDS, 28

14 Percentage of people with advanced HIV infection receiving antiretroviral treatment, South-East Asia, Target Percentage Thailand India Myanmar Indonesia Sri Lanka Nepal Source: Universal Access Progress Report, WHO, 28

15 Regional success stories

16 Syphilis prevalence among antenatal clinic (ANC) attendees, South-East Asia, % of ANC attendees syphilis-positive (%) Declining syphilis among ante natal attendees in some countries Thailand India Myanmar Sri lanka Source: Surveillance data reported by MOH

17 Scale-up of 1% targeted condom promotion program and decreasing syphilis prevalence among pregnant women in Myanmar 5% Number of condoms distributed 5 % pregnant women infected with syphilis 4% 3% 2% 1% % pregnant women infected Number of condoms distributed (in millions) % Source: NAP Progress Report, Ministry of Health, Myanmar

18 Impact of implementation of 1% condom use programme on the incidence of sexually transmitted infections (STIs) Thailand, Consistent decrease in sexually transmitted infections and AIDS cases with increasing rate of condom use Number of STI cases Source: Bureau of Epidemiology, MOPH, Thailand Number of STIs Condom use Condom use (%)

19 Scale-up of harm reduction and a decreasing HIV prevalence among injecting IDUs in Manipur, India 8 6 % IDUs HiV infected Needle-syringe programme began % IDUs shared equipment at last injection HIV prevalence, Imphal HIV prevalence, Bishnupur HIV prevalence, Churchandpur Percentage IDUs shared equipment at last injection Year Source: National AIDS Control Organization, Ministry of Health, India

20 Proportion of adults and children with HIV surviving 12 months after initiation of ART, South-East Asia, 27 Percentage India Thailand Myanmar Nepal Source: Universal Access Progress Report, WHO, 28

21 Rapid expansion of antiretroviral treatment services and declining AIDS mortality in Thailand Number of AIDS deaths Patients started on treatment AIDS death cases Number of patients on antiretroviral treatment Source: Bureau of Epidemiology, MOPH, Thailand

22 Reported AIDS cases among children (aged -4 years), Thailand, Policy to provide HIV counseling and testing to all pregnant women Operational research on ARV prophylaxis Decrease in paediatric HIV infections after implementation of prevention of mother-tochild transmission programme 12 National Policy and prgramme on PMTCT launched Number of paediatric HIV cases Source: Bureau of Epidemiology, MOPH, Thailand

23 Key concerns

24 HIV prevalence among injecting drug users, south-east Asia, 27 7 HIV epidemics among injecting drug users remain uncontrolled with nearly a third of them being infected in many sites 6 % IDUs HIV infected Year Bangkok, Thailand Chennai, India Myanmar Jakarta, Indonesia Source: Sentinel surveillance data reported by MOH

25 Percentage of injecting drug users sharing injecting equipment at last injection, South-East Asia, Percentage Chapinawabganj Chandpur Dhaka Rajshahi Chennai Mumbai Delhi Manipur Surabaya Jakarta Bandung Medan Bangladesh, 26-7 India, 26 Indonesia, 27 Maldives, 28 Male Addu Source: Behavior surveillance data reported by MOH

26 HIV prevalence among men who have sex with men in selected South-East Asian countries, % HIV infected Karnataka Andhra Pradesh Manipur Maharashtra Delhi Mandalay Yangon Jakarta Surabay India Myanmar Indonesia India Myanmar Indonesia Source: Sentinel surveillance data reported by MOH

27 Most men who have sex with men do not consistently use condoms Unprotected sex in insertive anal sex in the past month, Indonesia, 27 Medan Jakarta Batam Surabaya Malang Bandung % 2% 4% 6% 8% 1% No insertive anal sex Always condom Not always condom Source: Behavior surveillance data reported by MOH

28 Prevalence of sexually transmitted infections is very high among most-at-risk populations 5 Prevalence of sexually transmitted infections among most-at-risk populations in selected SEAR countries, Percentage Syphilis among FSW, Jakarta, 27 Rectal STIs among MSM, Jakarta, 27 Any STIs among FSW, Mumbai, 26 Any STIs among FSW, Pune, 26 Any STIs among MSM, Hyderabad, 26 Rectal Chlamydia among MSW, Kathmandu, 24 Chlamydia among FSW, Terai, 26 Indonesia India Nepal FSW = female sex workers MSW = male sex workers MSM = men who have sex with men Source: National Family Health Survey III, 26

29 HIV prevalence among tuberculosis patients by township, India and Myanmar, 27 Magway Guntur Parbhani Dhule Davanagere Tiruvanamalai Raigarh Villipuram Vizianagaram Thrissur Junagadh Nashik Jodhpur Vadodara Uttar Dinajpur Koch Bihar Monywa Mawlamyaing Bago Pathein Yangon Nyaung-U Hpa-an Pyay A significant proportion of tuberculosis patients are co-infected with HIV India Myanmar Source: Sentinel surveillance data reported by MOHc % HIV infected

30 A large majority of people living with HIV do not know that they are infected Percentage of adult population (15-49 years) tested and who know their HIV Status, by sex, India, 26 2 Females Males 15 Percentage 1 5 Tested in last 12 months Ever tested +ve people who were tested previously Source: National Family Health Survey III, 26

31 Most HIV-infected pregnant women do not have access to antiretroviral prophylaxis 1 Percentage of HIV-infected pregnant women receiving antiretroviral prophylaxis, South-East Asia, 27 8 Percentage Thailand Myanmar India Indonesia Sri Lanka Nepal Source: Universal Access Progress Report, WHO, 28

32 Despite a six-fold increase in the number of people receiving antiretroviral treatment (ART), three out of four who need treatment do not have access to it % of popuation receiving ART 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % receiving ART number receiving ART Target Number of people receiving ART % Source: Universal Access Progress Report, WHO, 28

33 A lack of enabling environment makes it hard to reach the vulnerable populations Unfavorable laws and prevailing stigma and discrimination make it difficult to reach the most vulnerable populations such as men who have sex with men, sex workers, injecting drug users, and migrants

34 Health systems are limited in their capacity to deliver the required services

35 Summary: Epidemic situation HIV prevalence is decreasing/stabilizing in some countries but increasing in others; new epidemics continue to emerge among sub-populations HIV among injecting drug users remains uncontrolled with a third of them being infected in many areas A significant proportion of men who have sex with men (MSM) are infected. Unprotected sex is common among MSM.

36 Summary: National Response Many regional success stories exist for preventing HIV both by sexual and injecting modes of transmission Huge unmet need for HIV prevention, care and treatment services; Nine out of ten HIV positive persons do not know that they are infected Three out of four in need of treatment do not have access to it Nine out of ten pregnant women do not receive PMTCT services MDG targets may not be reached in some countries unless substantial efforts are taken to scale-up the required HIV interventions

37 Future priorities Accelerate efforts to prevent HIV transmission, particularly among the most-at-risk populations Urgently scale-up services for HIV counseling and testing, prevention of mother-to-child transmission of HIV and antiretroviral treatment Strengthen health systems and human resource capacity to deliver the required health services Reduce HIV-associated stigma and create an enabling environment for the vulnerable populations to access health services

38 Thank You