“Today, we have a chance to end this epidemic once and for all.
Overall, the regional epidemic is stabilizing. An estimated 4.9 million people were living with HIV in Asia and the Pacific in 2009: 4.8 million adults and 160 000 children younger than 15 years. The number of people living with HIV has not changed substantially over the past five years. The number of people newly infected with HIV in 2009 was estimated at 360 000, 20% fewer than the 450 000 new infections estimated to have occurred in 2001. An estimated 1.7 million women in Asia and the Pacific were living with HIV in 2009. The proportion of women living with HIV increased from 21% in 1990 to 36% of all adults in 2002, and since then, it has stabilized at about 37%, substantially below the global average of 52%.
However, low national HIV prevalences mask serious epidemics concentrated (i.e., higher than 0.5%) in some geographical areas and amongst high risk populations such as people who use drugs (PWID), sex workers (SW), and men who have sex with men (MSM). Among these groups, infection rates are high and rising and in many areas there is strong evidence that the epidemic is more rapidly diffusing into the general population. Widespread poverty, huge economic disparities, low literacy, deep-rooted social norms, the low levels of women’s empowerment, and large mobile and migrating populations, are all now combining potently to spread the epidemic into the general population.
There is no single epidemic in the region, but a diversity of epidemics. The two interlinked generalizations that can be made are that across Asia the epidemics have all followed a similar pattern, and that the virus has spread mostly through identifiable risk behaviours that the majority of the population does not engage in. The epidemic starts among a few behaviorally linked at-risk groups such as people who inject drugs (PWIDs), men who have sex with men (MSM), and female sex workers and their clients and then spreads to their lower-risk partners and through them to infants through mother-to-child transmission. Such delayed epidemics now include much of Nepal and Pakistan where HIV levels have grown more gradually and do not yet exceed 0.5 per cent. Afghanistan, Bhutan, the Maldives and Sri Lanka have yet to see extensive HIV spread and still have national prevalence rates below 0.1 per cent, but there is evidence that risk behaviours are increasing. South Asian countries are still at relatively early stages of the epidemic curve, so there is still an opportunity to reverse the spread of HIV/AIDS if carefully targeted and scaled-up prevention work is done now.
South Asia's young people are now moving to the centre of AIDS epidemic. A growing number of young people aged 15-24 are HIV-positive. Young people below the age of 25 years constitute a significant percentage of the key populations at higher risk in South Asia. For example, in Pakistan, HIV prevalence among young people who inject drugs is 23% . Adolescent girls suffer a great disadvantage because in South Asia's environment of pervasive gender bias and harmful social norms such as early (often forced) marriage to much older men. Young girls are susceptible to many forms of abuse and exploitation and therefore are more vulnerable to infection through their spouses/partners, even though evidence suggests that boys engage in high-risk behaviours more than girls.
Tremendous progress has already been made. Infection rates have dropped in most countries in the region and increasing HIV prevention coverage is resulting in safer sexual and injecting behaviours. There are now more women living with HIV who access PMTCT services than in 2005 (25% in 2010 compared to 7% in 2005). Most countries in South Asia either have moved to these more efficacious regimens, or are in the process of doing so, adopting the 2010 WHO guidelines for preventing of mother-to-child transmission. An increasing number of countries in the region have embraced the principle of harm reduction, and have initiated or are expanding HIV prevention and treatment programmes for people who inject drugs, including young people. These life-saving gains must be consolidated, expanded and sustained.
Critical challenges remain. There are still insufficient and inadequate HIV programmes for key populations most at risk and their partners, including young people at higher risk,including migrants. Access to early HIV diagnosis, although critical for prompt initiation of antiretroviral therapy in HIV-positive children, is extremely limited in South Asia. Stigma and discrimination are widespread and present a forbidding barrier throughout South Asia. Almost all countries in the region have laws, policies and practices that hamper the AIDS response and compromise the human rights of key affected communities. All this occurs in a context where donor funding for AIDS is declining, and national funding remains meager in most places.
Countries in Asia and the Pacific are at a crossroads in the AIDS response. More people than ever before have access to HIV services across the region, but most countries are a long way from achieving universal access targets for HIV prevention, treatment, care and support. Important progress has been achieved, but more national and regional resources need to be invested to maintain the momentum that has been built.
ROSA’s commitment to “Getting to Zero” and “AIDS Free Generation”. At this critical juncture in the region’s response, UNICEF ROSA is committed to inspire and support countries in the region to take actions that will halt HIV and get South Asia ‘to Zero’ thereby contributing to AIDS Free Generation in the region.