Trends in HIV/AIDS epidemic in Asia, and its challenge

Taro YamamotoInstitute 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 mortalityGoal 5. Improve maternal health Goal 6. Combat HIV/AIDS, malaria and other diseasesGoal 7. Ensure environmental sustainability

Goal 8. Develop a global partnership for development

Total: 33 million (30 – 36 million)

Western & Central Europe

730 000730 000[580 000 – 1.0 million][580 000 – 1.0 million]

Middle East & North Africa380 000380 000

[280 000 – 510 000][280 000 – 510 000]

Sub-Saharan Africa22.0 million22.0 million

[20.5 – 23.6 million][20.5 – 23.6 million]

Eastern Europe & Central Asia1.5 million 1.5 million [1.1 – 1.9 million][1.1 – 1.9 million]

South & South-East Asia4.2 million4.2 million

[3.5 – 5.3 million][3.5 – 5.3 million]

Oceania74 00074 000

[66 000 – 93 000][66 000 – 93 000]

North America1.2 million

[760 000 – 2.0 million]

Latin America1.7 million1.7 million

[1.5 – 2.1 million][1.5 – 2.1 million]

East Asia740 000740 000

[480 000 – 1.1 million][480 000 – 1.1 million]Caribbean230 000

[210 000 – 270 000]

Adults and children estimated to be living with HIV

Estimated number of adults and children newly infected with HIV

Western & Central Europe

27 00027 000[14 000 – 49 000][14 000 – 49 000]

Middle East & North Africa40 00040 000

[20 000 – 66 000][20 000 – 66 000]

Sub-Saharan Africa1.9 million1.9 million

[1.6 – 2.1 million][1.6 – 2.1 million]

Eastern Europe & Central Asia

110 000 110 000 [67 000 – 180 000][67 000 – 180 000]

South & South-East Asia330 000330 000

[150 000 – 590 000][150 000 – 590 000]

Oceania13 00013 000

[12 000 – 15 000][12 000 – 15 000]

North America54 000

[9600 – 130 000]

Latin America140 000140 000

[88 000 – 190 000][88 000 – 190 000]

East Asia52 00052 000

[29 000 – 84 000][29 000 – 84 000]Caribbean20 000

[16 000 – 25 000]

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

Year

Mill

ions

0

1.5

2.0

2.5

3.0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

0.5

1.0

Number and percentage of HIV-positive receiving antiretroviral treatment, 2004–2007

2004 20062005

Number of HIV-positive pregnant women receiving antiretrovirals

Year

400 000

500 000

600 000

0

100 000

200 000

300 000

% of HIV-positive pregnant women receiving antiretroviral

0

5

30

35

15

20

25

40

10

2007

Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries.

HIV prevalence (%) among pregnant women attending antenatal clinics in Sub-Saharan Africa, 1997–2007

NOTE: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region)

Southern Africa

0

10

20

30

40

Med

ian

HIV

pre

vale

nce

(%)

50 BotswanaLesothoMozambiqueNamibiaSouth AfricaSwazilandZimbabwe

1997–1998

1999–2000

2001 2002 2003 2004 2005 2006 2007

West Africa

0

5

10

15

20M

edia

n H

IV p

reva

lenc

e (%

)

0

5

10

15

20

Med

ian

HIV

pre

vale

nce

(%)

Eastern Africa

1997–1998

1999–2000

2001 2002 2003 2004 2005 2006 2007 1997–1998

1999–2000

2001 2002 2003 2004 2005 2006 2007

Ethiopia

Kenya

Burkina FasoCôte d'IvoireGhanaSenegal

2008 2001

Adult & child deaths due to AIDS

Adult prevalence (%)

TOTAL 2.0 million

[1.7 – 2.4 million]

1.9 million [1.6 – 2.2 million]

0.8% [<0.8% –

0.8%]

0.8% [<0.8% –

0.8%]

2008 2001

North America

Eastern Europe & Central Asia

Latin America

South and South–East Asia

Sub–Saharan Africa

Oceania

Western & Central Europe

Caribbean

East Asia

Middle East & North Africa

87 000[72 000 – 110 000]

25 000[20 000 – 31 000]

77 000[66 000 – 89 000]

270 000[220 000 – 310 00]

1.4 million[1.1 – 1.7 million]

2000[1100 – 3100]

13 000[10 000 – 15 000]

12 000[9300 – 14 000]

59 000[46 000 – 71 000]

20 000[15 000 – 25 000]

26 000[22 000 – 30 000]

19 000[16 000 – 23 000]

66 000[56 000 – 77 000]

260 000[210 000 – 320 000]

1.4 million[1.2 – 1.7 million]

<1000

[<500 – 1200]

7900

[6500 – 9700]

20 000[17 000 – 23 000]

22 000[18 000 – 27 000]

11 000[7800 – 14 000]

0.6% [0.5% – 0.7%]

0.5% [0.4% – 0.5%]

0.5% [<0.5% – 0.6%]

0.3% [<0.3% – 0.4%]

5.8% [5.5% – 6.0%]

0.2% [<0.2% – 0.3%]

0.2% [<0.2% – 0.3%]

1.1% [1.0% – 1.2%]

<0.1% [<0.1%]

0.2% [0.1% – 0.2%]

0.6% [0.5% – 0.7%]

0.7% [0.6% – 0.8%]

0.6% [0.5% – 0.6%]

0.3% [0.2% – 0.3%]

5.2% [4.9% – 5.4%]

0.3% [<0.3% – 0.4%]

0.3% [0.2% – 0.3%]

1.0% [0.9% – 1.1%]

0.1% [<0.1%]

0.2% [<0.2% – 0.3%]

Regional HIV and AIDS statistics2008 and 2001

The incidence of syphilis in China

Reported incidence of total syphilis from sentinel sites

Reported incidence of total syphilis from the nationwide sexually transmitted disease surveillance system

0

5

10

15

20

25

30

35

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Inc

ide

nc

e (

pe

r 1

00

00

0)

Year 2000 2005 2006

Population, total (millions) 1,262.65 1,304.50 1,311.80Population growth (annual %) 0.7 0.6 0.6Surface area (sq. km) (thousands) 9,598.10 9,598.10 9,598.10Life expectancy at birth, total (years) 70 72 72Mortality rate, under 5 (per 1,000 live births) 37 25 24Adult Literacy rate (%) 90.9 92.6 93Fertility rate, total (births per women) 1.9 1.8 1.8Immunization, measles (% of children ages 12-23 months) 85 86 93GNI, Altas method (current US$) (billions) 1,168.88 2,275.67 2,620.95GNI per capita, Atlas method (current US$) 930 1,740 2000

Country Profiles of China

Population ：

Ethnicity ：　

51.46/48.54 37.66/62.34

male/female urban/rural

% of age group 0-14 15-64 Over 65

22.89 70.15 6.96

(10 thousands) Han Minority

115940 　　　 10643

91.598.41

People living with HIV

AIDS cases

New HIV infections

AIDS deaths

(Derived from: “A joint assessment of HIV/AIDS prevention, treatment and care in China 2007”, UNAIDS)

Current situation of HIV/AIDS epidemic in China

Cumulative Reported cases Estimated cases

223,501

62,838

22,205

700,000

85,000

(550,000~850,000)

(80,000~90,000)

50,000 (40,000~60,000)-

20,000 (15,000~25,000)

Prevalence of HIV infection (%) 0.05 (0.04~0.07)-

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

1995-Present: The expansion phase

1985-1988: The entry phase

1989-1994: The spreading phase

Eastern Western

Population (10,000)

birth rate (%0)

Growth rate (%0)

47,922

9.86

3.96

36,447

14.80

8.42

GDP (Yuan)US$ (100 million)

Household income (Yuan)

61,393.177,396.77

urban ： 8,677.81rural ： 3,686.74

1,8248.442,198.61

urban ： 6,775.04rural ： 1,692.96

Illiteracy rate 30,339,344 (6.3%) 31,610,599 (8.7%)

No. of beds (10,000)Health workers (10,000)

134.4235.2

83.5119.6

Eastern and Western China

Thailand HIV/AIDS EpidemicsThailand HIV/AIDS Epidemics

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 ………………………………….2004

Homo/Bisexuals

Injection DrugUsers (IDUs)

Prostitutes

Male withMultiple Partners

Pregnant Women

From specificto generalpopulations

Children

Youth and

mobile populatio

n

Median percentage of population reached with HIV prevention serviceswithin the specified legal environment

Sex workers(N=42)

Injecting drugusers (N=17)

Men having sex with men

(N=28)

0

20

40

60

80

100

Median percentage of population reached with HIV prevention services (UNGASS indicator 9)

Countries reporting having non-discrimination laws/regulations with protection for this population

Countries reporting NOT having non-discrimination laws/regulations with protection for this population

Source: UNGASS Country Progress Reports 2008

MMT 230

HIV (+) 89 HIV (-) 41

CD4 <300 （ 143）

CD4 300< （ 35）

ART HIV/TB/HCV/RPR coinfection

Follow up

CD4ART adherence

MMT patients in Lingcan county, China (20100531-)

MMT 363

HIV(+) 302

HIV(-) 61

Drop-out 113

Care 189

Care 41

Drop-out 22

KABP +sex network

HIV and HCV in MMT, in Lingcan

2005 2006 2007 2008 2009 2010

HCV tested 3 51 55 60 75 16

HCV (+) 3 48 62 57 63 11

2005 2006 2007 2008 2009 2010

HIV tested

3 67 90 65 78 16

HIV (+) 3 58 14 56 50 10

Methadone

Heroin

Methadone Maintenance Treatment

Migration of sex workers 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

Migration of workers without visa in Asia