Key Affected Populations in Asia: Where are we and

what is the way forward?

Dr. Sai Subhasree Raghavan SAATHII, India

Governing Council Member, IAS

HIV Epidemic in the Region• People living with HIV: 4,900,000• Women living with HIV: 1,600,000• New HIV infections: 370,000• Adult HIV prevalence: 0.2 %

Concentrated Epidemic • Sex workers and their clients, Men who have sex with men, Transgender, People who inject drugs, and all of their intimate partners

The region made progress in containing the epidemic

There are rising HIV prevalence trends in regions/cities in 6 countries: China, Indonesia, Philippines, Thailand and

Viet Nam

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

10

20

30

40

China China (Chengdu, Sichuan)Indonesia Indonesia (Jakarta)Philippines (Metro Manila-calibrated) Philippines (Cebu)Thailand Thailand (Bangkok)Viet Nam Viet Nam (Hanoi)

%

Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveillance reports, Integrated Biological and Behavioral Surveillance reports and other reports

Made Significant Progress in Reducing HIV prevalence among female sex workers in Some Countries (India,

Thailand, Vietnam, Cambodia, Myanmar)

Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveillance Surveys and Integrated Biological and Behavioural Surveys

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

5

10

15

20

25

30

35

40

Myanmar National data Cambodia National data

Indonesia National data, DFSW (from IBBS) India National data

Thailand National data Viet Nam National data

%

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

10

20

30

40

50

0

20

40

60

80

100

41

51.145

7280

Female sex workers: HIV prevalence, behaviour and prevention coverage

Prevention coverage(Regional median)

Condom use at last sex(Regional median)

Cambodia (National trend)

Indonesia (Direct female sex workers)

Indonesia (Bali, Direct female sex workers)

Myanmar (Yangon)

HIV

pre

va

len

ce

(%

)%

Female sex workers (FSW): Progress but still at high prevalence in geographic ‘hotspots’

Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveillance Surveys , Integrated Biological and Behavioural Surveys, Country UNGASS Progress reports, and Global AIDS Response Progress Reports

HIV prevalence among MSM, countries where data is available, 2008-2009

6

China

India

Japan

(Toka

i)

Mal

aysi

a (K

uala

Lumpur)

Mal

dives

( 2

isla

nd citi

es)

Mongolia

Mya

nmar

( 2 c

ities

)

Nepal

(Kat

hman

du)

Philippin

esPNG

Singap

ore

Sri Lan

ka

Thaila

nd

Viet N

am (4

citi

es)

0

5

10

15

20

25

30

35

57.3

4 3.9

01.8

28.8

3.81

4.42.6

0.5

13.5

16.7

Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2008 & 2010

Country data are not strictly comparable because methods and sampling varied. In addition, many surveys were conducted in a few large urban areas & it might not necessarily reflect prevailing conditions at the national level.

Countries with stabilizing and declining HIV prevalence trend among PWID

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

15

30

45

60

75

Bangladesh (male, Dhaka) China India Myanmar

Nepal (Kathmandu Valley) Thailand Viet Nam

%

Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveillance Surveys and Integrated Biological and Behavioural Surveys

Countries with rising HIV prevalence trend among PWID

2005 2006 2007 2008 2009 2010 20110

15

30

45

60

75

Indonesia Indonesia (Jakarta) Pakistan

Pakistan (Karachi) Philippines (Cebu)

%

Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveillance Surveys and Integrated Biological and Behavioural Surveys

Percentage (median) of key populations at higher risk who received an HIV test in the past 12 months and know the results, 2008-2010

9Source: Prepared by www.aidsdatahub.org based on WHO, UNAIDS, & UNICEF. (2011). Global HIV/AIDS Response: Epidemic Update and Health Sector Progress Towards Universal Access.

# of reporting countries Sex Workers – Global - 52 East, South and South-East Asia - 16MSM - Global - 41 East, South and South-East Asia - 14PWID - Global - 26 East, South and South-East Asia -10

Key populations are central to the epidemic but not enough are reached by prevention services

0

20

40

60

80

100

0

100

200

300

400

500

51

37

57

118

Pre

ve

nti

on

pro

gra

mm

e c

ov

era

ge

(%

)

Nu

mb

er

of

ne

ed

les

an

d s

yri

ng

es

d

istr

ibu

ted

pe

r P

WID

pe

r y

ea

r

Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012

Key populations reached by prevention services, regional median, 2011

Total regional AIDS spending by spending category, 2011

Total AIDS spending Care and treatment spending

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

1,200,000,000

1,400,000,000

362951114.6

345774484

623,274,401

149,933,790

213017325

Others

ART spending

Prevention spending

Care and treatment spending

Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Estimated antiretroviral therapy coverage among people living with HIV by region, based on 2010 WHO guidelines, 2010

12Source : Prepared by www.aidsdatahub.org based on WHO, UNAIDS, & UNICEF. (2011). Global HIV/AIDS Response: Epidemic Update and Health Sector Progress Towards Universal Access.

Estimated number of people eligible for ART, receiving ART, and ART coverage by region, 2010

13Source : Prepared by www.aidsdatahub.org based on WHO, UNAIDS, & UNICEF. (2011). Global HIV/AIDS Response: Epidemic Update and Health Sector Progress Towards Universal Access.

14

Way Forward• Focus on countries with high burden • Focus on key populations

• Prevention • Testing • Linkages to care and treatment

• Remove legal barriers• Reduce stigma

Acknowledgements

• UNAIDS Data Hub Team• Mr. Steve Krauss and Mr Pradeep Kakkattil,

UNAIDS• Mr. JVR Prasada Rao, UN Envoy for Asia

pacific