Trends in HIV/AIDS epidemic in Asia, and its challenge Taro Yamamoto Institute of Tropical Medicine Nagasaki University
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
Adults and children estimated to be living with HIV North America 1.2 million [760 000 2.0 million] Caribbean 230 000 [210 000 270 000] Latin America 1.7 million [1.5 2.1 million] Western & Central Europe 730 000 [580 000 1.0 million] Middle East & North Africa 380 000 [280 000 510 000] Sub Saharan Africa 22.0 million [20.5 23.6 million] Eastern Europe & Central Asia 1.5 million [1.1 1.9 million] East Asia 740 000 [480 000 1.1 million] South & South East Asia 4.2 million [3.5 5.3 million] Oceania 74 000 [66 000 93 000] Total: 33 million (30 36 million)
Estimated number of adults and children newly infected with HIV North America 54 000 [9600 130 000] Caribbean 20 000 [16 000 25 000] Latin America 140 000 [88 000 190 000] Western & Central Europe 27 000 [14 000 49 000] Middle East & North Africa 40 000 [20 000 66 000] Sub Saharan Africa 1.9 million [1.6 2.1 million] Eastern Europe & Central Asia 110 000 [67 000 180 000] East Asia 52 000 [29 000 84 000] South & South East Asia 330 000 [150 000 590 000] Oceania 13 000 [12 000 15 000] Total: 2.7 million (2.2 3.2 million)
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)
Estimated number of adult and child deaths due to AIDS globally, 1990 2007 Millions 3.0 2.5 2.0 1.5 1.0 0.5 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year
Number and percentage of HIV positive receiving antiretroviral treatment, 2004 2007 600 000 40 500 000 35 30 Number of HIV positive pregnant women receiving antiretrovirals 400 000 300 000 25 20 % of HIV positive pregnant women receiving antiretroviral 200 000 15 10 100 000 5 0 2004 2005 2006 2007 0 Year Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries.
HIV prevalence (%) among pregnant women attending antenatal clinics in Sub Saharan Africa, 1997 2007 Southern Africa Median HIV prevalence (%) 50 40 30 20 10 0 1997 1998 1999 2001 2002 2003 2004 2005 2006 2007 2000 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 20 20 Median HIV prevalence (%) 15 10 5 0 Ethiopia Kenya 0 1997 1999 2001 2002 2003 2004 2005 2006 2007 1997 1999 2001 2002 2003 2004 2005 2006 2007 1998 2000 1998 2000 Median HIV prevalence (%) 15 10 5 Burkina Faso Côte d'ivoire Ghana Senegal
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 [1.1 1.7 million] 20 000 [15 000 25 000] 270 000 [220 000 310 00] 59 000 [46 000 71 000] 77 000 [66 000 89 000] 12 000 [9300 14 000] 87 000 [72 000 110 000] 13 000 [10 000 15 000] 25 000 [20 000 31 000] 2000 [1100 3100] 1.4 million [1.2 1.7 million] 11 000 [7800 14 000] 260 000 [210 000 320 000] 22 000 [18 000 27 000] 66 000 [56 000 77 000] 20 000 [17 000 23 000] 26 000 [22 000 30 000] 7900 [6500 9700 ] 19 000 [16 000 23000] <1000 [<500 1200]
The incidence of syphilis in China 35 30 Incidence (per 100 000) 25 20 15 10 5 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Reported incidence of total syphilis from sentinel sites Reported incidence of total syphilis from the nationwide sexually transmitted disease surveillance system
Country Profiles of China Year 2000 2005 2006 Population, total (millions) 1,262.65 1,304.50 1,311.80 Population growth (annual %) 0.7 0.6 0.6 Surface area (sq. km) (thousands) 9,598.10 9,598.10 9,598.10 Life expectancy at birth, total (years) 70 72 72 Mortality rate, under 5 (per 1,000 live births) 37 25 24 Adult Literacy rate (%) 90.9 92.6 93 Fertility rate, total (births per women) 1.9 1.8 1.8 Immunization, measles (% of children ages 12-23 months) 85 86 93 GNI, Altas method (current US$) (billions) 1,168.88 2,275.67 2,620.95 GNI per capita, Atlas method (current US$) 930 1,740 2000 Population male/female urban/rural 51.46/48.54 37.66/62.34 % of age group 0 14 15 64 Over 65 22.89 70.15 6.96 Ethnicity Han Minority (10 thousands) 115940 10643 91.59 8.41
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)
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
HIV/AIDS epidemiologic survey in China
The Review of HIV/AIDS Epidemic in Mainland China 1985 1988: The entry phase 1989 1994: The spreading phase 1995 Present: The expansion phase
Eastern and Western China Population (10,000) birth rate (%0) Growth rate (%0) GDP (Yuan) US$ (100 million) Household income (Yuan) Eastern 47,922 9.86 3.96 61,393.17 7,396.77 urban 8,677.81 rural 3,686.74 Western 36,447 14.80 8.42 1,8248.44 2,198.61 urban 6,775.04 rural 1,692.96 30,339,344 (6.3%) 31,610,599 (8.7%) No. of beds (10,000) Health workers (10,000) 134.4 235.2 83.5 119.6
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 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993.2004
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) 80 60 40 20 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
MMT patients in Lingcan county, China (20100531 ) 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
HIV and HCV in MMT, in Lingcan HIV tested 2005 2006 2007 2008 2009 2010 3 67 90 65 78 16 HIV (+) 3 58 14 56 50 10 2005 2006 2007 2008 2009 2010 HCV tested 3 51 55 60 75 16 HCV (+) 3 48 62 57 63 11
Methadone Maintenance Treatment Methadone Heroin
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: http://www.gcim.org/mm/file/regional%20study%202.pdf