7 th IAS Conference on HIV Pathogenesis, Treatment and Prevention Tracking the HIV/AIDS epidemic in Asia and the Pacific Mr. J.V.R. Prasada Rao UN Secretary General Special Envoy on HIV/AIDS in Asia Pacific 3 July 213 Kuala Lumpur, Malaysia
1. Epidemic and response 2. Financing AIDS response 3. Legal environment 4. HIV/AIDS and post 215 development agenda
Epidemic and response
State of the epidemic: Global and Asia-Pacific Global Asia-Pacific People living with HIV 34,, [31,4, 35,9,] 4,9, [3,9, 6,1,] Women living with HIV 15,, 1,6, [13,9, 15,7,] [1,2, 2,1,] New HIV infections Adult HIV prevalence 2,5, [2,2, 2,8,].8 % [.7%.8%] 37, [25, 55,].2 % [.2%.2%] AIDS-related deaths 1,7, [1,5, 1,9,] 31, [24, 4,] Source: Prepared by www.aidsdatahub.org based on HIV estimates and projections data for UNAIDS (212). Global Report: UNAIDS Report on the Global AIDS Epidemic 212
Epidemic and response: Asia-Pacific and Sub Saharan Africa Type of epidemic Populations affected by AIDS Burden of epidemic Prevention interventions Asia-Pacific Concentrated among key populations Sex workers and their clients, Men who have sex with men, Transgender, People who inject drugs, and all of their intimate partners 4.9 million People living with HIV 37, New infections Relatively smaller populations but more difficult to reach due to stigma and legal barriers Sub-Saharan Africa Generalized General population: men, women, and young people 23.5 million People living with HIV 1.8 million New infections Larger population sizes but relatively easier to reach
Disease burden: Asia and Sub-Saharan Africa Death (%) 16% 3.2% 5.6% South-East Asia, East Asia, and Oceania South Asia Sub-Saharan Africa Source: http://www.healthmetricsandevaluation.org
New HIV infections in Asia-Pacific region New HIV in nfections (Number) 5 4 3 2 1 18 % decline Stagnated decline between 28 and 211 21 22 23 24 25 26 27 28 29 21 211 Significant decline in new HIV infections in the last decade, but slow-down between 28 and 211 Source: Prepared by www.aidsdatahub.org based on HIV estimates and projections data for UNAIDS (212). Global Report: UNAIDS Report on the Global AIDS Epidemic 212
Example of countries with declining new HIV infections Cambodia Myanmar 21 69% decline 28 42% decline 211 21 57% decline 28 27% decline 211 Nepal PNG 21 73% decline 28 48% decline 211 21 28% decline 28 19% decline 211 Same is true for countries where the epidemic is slowing down Source: Prepared by www.aidsdatahub.org based on HIV estimates and projections data for UNAIDS (212). Global Report: UNAIDS Report on the Global AIDS Epidemic 212
Estimated annual new HIV infections by population group, Asian Epidemic Model MSM Half of all new infections among MSM by 22 if business as usual - Commission on AIDS in Asia Source: Commission on AIDS in Asia. (28). Redefining Aids in Asia: Crafting an Effective Response.
HIV prevalence among MSM vs. adults Rising HIV epidemic among MSM in many regions across the world Source: Beyrer, C., Baral, S. D., Griensven, F. v., Goodreau, S. M., Chariyalertsak, S., Wirtz, A. L., & Brookmeyer, R. (212). Global epidemiology of HIV infection in men who have sex with men. Lancet, 38(9839), 367-377.
Key populations reached by prevention services, regional median, 211 Prevention pr rogramme coverage (%) 1 8 6 4 2 51 Female sex workers 37 Male sex workers 57 Men who have sex with men 118 People who inject drugs 5 4 3 2 1 Number of need dles and syringes distributed per PWID per year Key populations are central to the epidemic but not enough are reached by prevention services Source: Prepared by www.aidsdatahub.org based on UNAIDS. (212). Global Report: UNAIDS Report on the Global AIDS Epidemic 212
Proportion of consistent condom use and HIV prevalence among MSM consistent condom use % 1 8 6 4 2 Mumbai, India (24-29) 9,2 8 25 2 15 1 5 HIV prevalence % Consistent condom use HIV prevalence consistent condom use % 1 8 6 4 2 China (National), 25-211 43 6,3 25 26 27 28 29 21 211 Consistent condom use HIV prevalence 25 2 15 1 5 HIV prevalence % Stagnating consistent condom use among MSM - impact on HIV prevalence Source: Prepared by www.aidsdatahub.org based on 1) Mishra, R. M., Dube, M., et al. (212). Changing epidemiology of HIV in Mumbai: an application of the Asian epidemic model. Glob J Health Sci, 4(5), 1-112.; 2) Lan, W., Lu, W., et al. (212). HIV Prevalence and Influencing Factors Analysis of Sentinel Surveillance among Men who have Sex with Men in China, 23-211. Chinese Medical Journal, 125(11), 1857-1861.; 3) Data from UNAIDS Country Office Thailand. consistent condom use% 1 8 6 4 2 Thailand (Bangkok, Chiangmai, Phuket), 25-21 25 27 29 21 Consistent condom use HIV prevalence 2 7 25 2 15 1 5 HIV prevalence %
Consistent condom use among female sex workers with their clients % 1 Cambodia, 1997-21 94 83 89 82 1 % Thailand, 24-28 8 94 5 FSW with 2 or less client/day FSW with more than 2 clients/day Direct FSW Beer Promoters 6 4 2 % Andhra Pradesh, India, 26-21 1 8 6 75 % Mumbai, India, 24-29 1 8 6 95 4 4 2 2 Source: Prepared by www.aidsdatahub.org based on 1) Chhorvann, C. (211). Behavioral Sentinel Surveillance 21. Power Point Presentation. National Center for HIV/AIDS Dermatology and STD; 2) Thailand UNGASS Report 21; 3) Erausquin, J. T., Biradavolu, M., et al. (212). Trends in condom use among female sex workers in Andhra Pradesh, India: the impact of a community mobilisation intervention. J Epidemiol Community Health, 66(2), 211-2511; 4) Mishra, R. M., Dube, M., et al. (212). Changing epidemiology of HIV in Mumbai: an application of the Asian epidemic model. Glob J Health Sci, 4(5), 1-112.
Correlation between safe injecting and HIV prevalence among PWID Safe injection in the past week(%) 1 8 6 4 2 Nepal, Kathmandu (22-211) 68 78 88 93 97 54 6,3 8 6 4 2 HIV prevalence (%) Safe injection in the past month(%) 1 8 6 4 2 Pakistan, Lahore (25-211) 3,8 45 43 3,8 28 35 3 25 2 15 1 5 HIV prevalence (%) 1 8 6 4 2 % 28 Consistent use of sterile injecting equipment * 31 36 38 45 47 5 HIV prevalence 58 14 16 Pakistan (Lahore, 211) Indonesia (211) Bangladesh (Dhaka, India 211)** (Maharastra, Myanmar 29-1) (Yangon, 212)*** Nepal (Kathmandu, 211) 97 6 * Duration of consistent use of sterile injecting equipment varies from last week to last 6 months; ** Behavioral data for 26-7, Never used used-needles and syringes; *** Behavioral data for 28 Source: Prepared by www.aidsdatahub.org based on National HIV Sentinel Surveillance reports, Integrated Biological and Behavioral Surveillance reports and other reports
Prevention of mother-to-child transmission coverage, by region, 21 and 211 % 1 8 6 4 2 21 211 Middle East and North Africa South and South-East Asia East Asia and Oceania Caribbean Sub-Saharan Africa Latin America Low- and middle-income countries Only one in five pregnant women living with HIV received effective ART regimens for PMTCT in South and South-East Asia Source: 212 country progress reports (www.unaids.org/cpr) and UNAIDS estimates.
HIV testing coverage among key populations, regional median, 211 HIV te esting coverage (%) 1 8 6 4 44 44 33 29 2 Female sex workers Male sex workers Men who have sex with men People who inject drugs Though HIV is concentrated among key populations, less than half of them know their HIV status Source: Prepared by www.aidsdatahub.org based on UNAIDS. (212). Global Report: UNAIDS Report on the Global AIDS Epidemic 212
Number and proportion of eligible people receiving ART at the end of 211 Milliers 1 2 1 8 6 4 2 Number of people receiving ART 1.1 million 1% 8% 6% 4% 2% % Recent trends in global and Asia-Pacific ART coverage 54% 46% 46% 36% 37% 18% Global Asia-Pacific 29 21 211 1.1 million people are receiving antiretroviral therapy lagging behind global trend Source: Prepared by www.aidsdatahub.org based on 1)UNAIDS. (212). Global Report: UNAIDS Report on the Global AIDS Epidemic 212.; 2) www.aidsinfoonline.org
Correlation between high level of treatment coverage and decline in new infections Number (in thousands) of people on ART 2 15 1 5 Botswana 44% of people currently on ART have been on treatment since 26 24 25 26 27 28 29 21 211 Number (in thousands) of people on ART 6 5 4 3 2 1 Kenya 23% of people currently on ART have been on treatment since 26 24 25 26 27 28 29 21 211 People receiving ART People receiving ART Number of new HIV infections 2 15 1 5 New HIV infections 36% decline in new HIV infections Number of new HIV infections 14 15 7 35 New HIV infections 17% decline in new HIV infections 24 25 26 27 28 29 21 211 24 25 26 27 28 29 21 211 Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org
HIV-1 drug resistance in ARV-naïve populations SDRM = Surveillance Drug Resistance Mutations As ART coverage continues to grow, there is evidence of drug resistance emerging Source: Stanford University HIV Drug Resistance Database at http://hivdb.stanford.edu/surveillance/map/
Financing AIDS response
Trends in domestic public and international AIDS spending, global and the Asia-Pacific Global Asia-Pacific 211 51% 211 66% 21 5% 21 57% 29 44% 29 51% 28 43% 28 5% 49% 5% 56% 57% 34% 43% 49%5% Domestic public (%) International (%) Decreasing dependence on external aid Source: Prepared by www.aidsdatahub.org based on 1) UNAIDS. (212). Global Report: UNAIDS Report on the Global AIDS Epidemic 212.; 2) www.aidsinfoonline.org
HIV expenditure from domestic sources, Asia-Pacific Malaysia (211) China (211) Thailand (211) Sri Lanka (21) Philippines (211) Indonesia (21) Pakistan (211) Mongolia (211) PNG (21) Fiji (211) Viet Nam (21) India (211-12) Myanmar (211) Lao PDR (211) Bangladesh Cambodia (29) Nepal (29) Afghanistan 25 5 75 1 4 3 1 4 37 31 24 21 17 1 9 7 53 52 94 9 85 Upper-middle income Lower-middle income Low income 9% Committed for NACP IV % Investing in AIDS: Shared responsibility in Asia-Pacific Source: Prepared by www.aidsdatahub.org based on 1) UNAIDS. (212). Global Report: UNAIDS Report on the Global AIDS Epidemic 212.; 2) www.aidsinfoonline.org 23
Total AIDS spending and amount spent on key populations prevention programmes US$ in millions 1 4 1 2 1 8 6 1 332 4 346 2 Total AIDS spending Prevention spending 67 Key populations prevention spending 12 22 33 MSM prevention spending Sex workers and clients prevention spending PWID prevention spending AIDS spending in Asia Pacific low on High Impact Prevention Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org
Legal environment
Adverse legal environment -Why the law matters?
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HIV/AIDS in post 215 development agenda
Millennium Development Goal 6: Global progress by region, 212 Goal 6: Combat HIV/AIDS, malaria and other diseases Goals and Targets Northern Africa Sub- Saharan Eastern South- Eastern Asia Southern Western Oceania Latin America & Caribbean Caucasus& Central Asia Halt and begin to reverse the spread of HIV/AIDS Low incidence High incidence Low incidence Low incidence Low incidence Low incidence Low incidence Low incidence Low incidence Halt and reverse the spread of TB Low mortality High mortality Low mortality Moderate mortality Moderate mortality Low mortality High mortality Low mortality Moderate mortality The progress chart operates on two levels. The word in each box indicate the present degree of compliance with the target. The colours show progress towards the target according to the legend below: Target already met or expected to be met by 215. Progress insufficient to reach the target if prevailing trends persist. No progress or deterioration. Sources: Statistics Division, Department of Economic and Social Affairs, United Nations. (212). Millennium Development Goals: 212 Progress Chart.
Status of progress towards MDG targets in Asia-Pacific, 21-11 Country MDG Goal 6 Asia Pacific Cambodia China India Indonesia Lao PDR Malaysia Myanmar Nepal Pakistan Philippines Thailand Viet Nam HIV prevalence TB incidence TB prevalence Early achiever On track Slow Regressing/No progress Source: Prepared by www.aidsdatahub.org based on UNESCAP, ADB, & UNDP. (212). Accelerating Equitable Achievement of the MDGs : Closing Gaps in Health and Nutrition Outcomes, Asia- Pacific Regional MDG Report 211/12. Bangkok.
Post 215 development agenda UNSG s High Level Panel of Eminent Persons Rio + 2 Conference on Sustainable Development Task Team for Global Thematic Consultation on Health Is HIV/AIDS a priority?
HLP report - Proposed new health MDGs: Post 215 4a. End preventable infant and under-5 deaths, 4b. Increase by x% the proportion of children, adolescents, at-risk adults and older people that are fully vaccinated 4c. Decrease the maternal mortality ratio to no more than x per 1, 4d. Ensure universal sexual and reproductive health and rights 4e. Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and priority non-communicable diseases
MDG on AIDS 215 and 23 Millennium Development Goal of 215 Goal 6: Combat HIV/AIDS, malaria and other diseases Target 6.A: Have halted by 215 and begun to reverse the spread of HIV/AIDS Post 215 4e. Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and priority noncommunicable diseases Target 6.B: Achieve, by 21, universal access to treatment for HIV/AIDS for all those who need it Target 6.C: Have halted by 215 and begun to reverse the incidence of malaria and other major diseases
33 Country support in UN General Assembly for a specific MDG for ending AIDS by 23. Donors and UN agencies need to support the call to end AIDS by 23. Civil society pressure crucial
Diapositive 36 33 We need powerful summary slides (Global and region) Sai Subhasree Raghavan; 22/6/213
Global response to HIV/AIDS is delicately balanced. We need to firmly tilt it towards the goal of elimination.
Thank you