Trends in HIV/AIDS epidemic in Asia, and its challenge. Taro Yamamoto Institute of Tropical Medicine Nagasaki University

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1 Trends in HIV/AIDS epidemic in Asia, and its challenge Taro Yamamoto Institute of Tropical Medicine Nagasaki University

2 Millennium Development Goals Goal 1. Eradicate extreme poverty and hunger Goal 2. Achieve universal primary education Goal 3. Promote gender equality and empower women Goal 4. Reduce child mortality Goal 5. Improve maternal health Goal 6. Combat HIV/AIDS, malaria and other diseases Goal 7. Ensure environmental sustainability Goal 8. Develop a global partnership for development

3 Adults and children estimated to be living with HIV North America 1.2 million [ million] Caribbean [ ] Latin America 1.7 million [ million] Western & Central Europe [ million] Middle East & North Africa [ ] Sub Saharan Africa 22.0 million [ million] Eastern Europe & Central Asia 1.5 million [ million] East Asia [ million] South & South East Asia 4.2 million [ million] Oceania [ ] Total: 33 million (30 36 million)

4 Estimated number of adults and children newly infected with HIV North America [ ] Caribbean [ ] Latin America [ ] Western & Central Europe [ ] Middle East & North Africa [ ] Sub Saharan Africa 1.9 million [ million] Eastern Europe & Central Asia [ ] East Asia [ ] South & South East Asia [ ] Oceania [ ] Total: 2.7 million ( million)

5 Over 7400 new HIV infections a day More than 96% are in low and middle income countries About 1000 are in children under 15 years of age About 6300 are in adults aged 15 years and older of whom: almost 50% are women about 45% are young people (15 24)

6 Estimated number of adult and child deaths due to AIDS globally, Millions Year

7 Number and percentage of HIV positive receiving antiretroviral treatment, Number of HIV positive pregnant women receiving antiretrovirals % of HIV positive pregnant women receiving antiretroviral Year Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries.

8 HIV prevalence (%) among pregnant women attending antenatal clinics in Sub Saharan Africa, Southern Africa Median HIV prevalence (%) Botswana Lesotho Mozambique Namibia South Africa Swaziland Zimbabwe NOTE: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region) Eastern Africa West Africa Median HIV prevalence (%) Ethiopia Kenya Median HIV prevalence (%) Burkina Faso Côte d'ivoire Ghana Senegal

9 5.2% [4.9% 5.4%] 0.2% [<0.2% 0.3%] 0.3% [0.2% 0.3%] 0.1% [<0.1%] 0.6% [0.5% 0.6%] 1.0% [0.9% 1.1%] 0.7% [0.6% 0.8%] 0.3% [0.2% 0.3%] 0.6% [0.5% 0.7%] 0.3% [<0.3% 0.4%] 5.8% [5.5% 6.0%] 0.2% [0.1% 0.2%] 0.3% [<0.3% 0.4%] <0.1% [<0.1%] 0.5% [<0.5% 0.6%] 1.1% [1.0% 1.2%] 0.5% [0.4% 0.5%] 0.2% [<0.2% 0.3%] 0.6% [0.5% 0.7%] 0.2% [<0.2% 0.3%] 1.4 million [ million] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 2000 [ ] 1.4 million [ million] [ ] [ ] [ ] [ ] [ ] [ ] 7900 [ ] [ ] <1000 [< ]

10 The incidence of syphilis in China Incidence (per ) Reported incidence of total syphilis from sentinel sites Reported incidence of total syphilis from the nationwide sexually transmitted disease surveillance system

11 Country Profiles of China Year Population, total (millions) 1, , , Population growth (annual %) Surface area (sq. km) (thousands) 9, , , Life expectancy at birth, total (years) Mortality rate, under 5 (per 1,000 live births) Adult Literacy rate (%) Fertility rate, total (births per women) Immunization, measles (% of children ages months) GNI, Altas method (current US$) (billions) 1, , , GNI per capita, Atlas method (current US$) 930 1, Population male/female urban/rural 51.46/ /62.34 % of age group Over Ethnicity Han Minority (10 thousands)

12 Current situation of HIV/AIDS epidemic in China People living with HIV AIDS cases Cumulative Reported cases 223,501 62,838 Estimated cases 700,000 85,000 (550,000~850,000) (80,000~90,000) New HIV infections AIDS deaths Prevalence of HIV infection (%) 22,205 50,000 (40,000~60,000) 20,000 (15,000~25,000) 0.05 (0.04~0.07) (Derived from: A joint assessment of HIV/AIDS prevention, treatment and care in China 2007, UNAIDS)

13 Modes of transmission among cumulative HIV cases by the end of December 2005 Data from: Ministry of Health of the People's Republic of China

14 HIV/AIDS epidemiologic survey in China

15 The Review of HIV/AIDS Epidemic in Mainland China : The entry phase : The spreading phase 1995 Present: The expansion phase

16 Eastern and Western China Population (10,000) birth rate (%0) Growth rate (%0) GDP (Yuan) US$ (100 million) Household income (Yuan) Eastern 47, , , urban 8, rural 3, Western 36, , , urban 6, rural 1, ,339,344 (6.3%) 31,610,599 (8.7%) No. of beds (10,000) Health workers (10,000)

17 Thailand HIV/AIDS Epidemics From specific to general populations Male with Multiple Partners Prostitutes Pregnant Women Youth and mobile population Injection Drug Users (IDUs) Children Homo/Bisexuals

18 Median percentage of population reached with HIV prevention services within the specified legal environment 100 Median percentage of population reached with HIV prevention services (UNGASS indicator 9) Countries reporting having nondiscrimination laws/regulations with protection for this population Countries reporting NOT having nondiscrimination laws/regulations with protection for this population 0 Sex workers (N=42) Injecting drug users (N=17) Men having sex with men (N=28) Source: UNGASS Country Progress Reports 2008

19 MMT patients in Lingcan county, China ( ) MMT 363 HIV(+) 302 Drop out 113 Care 189 MMT 230 HIV( ) 61 Care 41 Drop out 22 HIV (+) 89 HIV ( ) 41 ART adherence ART HIV/TB/HCV/RPR coinfection CD4 KABP +sex network Follow up

20 HIV and HCV in MMT, in Lingcan HIV tested HIV (+) HCV tested HCV (+)

21 Methadone Maintenance Treatment Methadone Heroin

22 Migration of sex workers in Asia Migration of workers without visa in Asia Source: Global Commission on International Migration. Migration in the Asia Pacific region, available at: