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Regional HIV Overview:
Asia and the Pacific
Steven J. Kraus
Director
UNAIDS Regional Support Team, Asia and the Pacific
A regional overview of trends in HIV
infections and AIDS deaths
Source: Prepared by www.aidsdatahub.org based on UNAIDS 2013 Estimates for UNAIDS. (2014). The Gap Report.
HIV and AIDS in Asia and the Pacific
1990-2013
People living with HIV
4.8 million
Women living with
HIV
1.7 million
New HIV
Infections
350,000
Deaths
250,000
2013 “zoom-in”
Children living with HIV
210,000
4,800,000
1,700,000
210,000
350,000
250,000
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
Number
People living with HIV (Estimate) Women living with HIV (Estimate)
Children living with HIV (Estimate) New HIV infections (Estimate)
AIDS-related deaths (Estimate)
350,000
0
100,000
200,000
300,000
400,000
500,000
2001 2005 2009 2013
NewHIVinfections(Number)
New HIV infections
New HIV infections have declined
significantly since 2001, but remain largely
unchanged in past 5 years
Estimated new HIV infections in Asia and the Pacific, 2001-2013
Source: Prepared by www.aidsdatahub.org based on UNAIDS 2013 Estimates for UNAIDS. (2014). The Gap Report.
30% decline
0
5,000
2005 2013
Number
Cambodia
0
20,000
2005 2013Number
Myanmar
0
100,000
2005 2013
Number
Indonesia
0
15,000
2005 2013
Number
Pakistan
0
10,000
2005 2013
Number
Malaysia
0
5,000
2005 2013
Number
Philippines
Mixed progress in new HIV infections
trends across countries in the region
Source: Prepared by www.aidsdatahub.org based on UNAIDS 2013 Estimates for UNAIDS. (2014). The Gap Report; and Philippines HIV Estimations and Projections
2014 (Unpublished document).
Countries that account for >90% PLHIV and new
infections and high national HIV prevalence in key
populations
People
living with
HIV
(2013)
New HIV
infections
(2013)
National HIV
prevalence
> 5 %
among MSM
National HIV
prevalence
> 5% among
PWID
National HIV
prevalence
> 5% among
FSW
India* 2,100,000 130,000
Indonesia 640,000 80,000
China* 780,000 48,000
Viet Nam 250,000 14,000
Pakistan 68,000 14,000
Thailand 440,000 8,200
Malaysia 86,000 8,000
Myanmar 190,000 6,700
Philippines 22,000 3,400
Papua New Guinea 32,000 2,200
Cambodia 75,000 1,300
Nepal 39,000 1,300
Source: Prepared by www.aidsdatahub.org based on UNAIDS Estimates 2013; Philippines HIV Estimations and Projections 2014 (Unpublished document);
National HIV Sentinel Surveillance Surveys; and Integrated Biological and Behavioural Surveys
= Yes
* 2011 estimates
Female sex workersMen who have sex with
men
People who
inject drugs
Transgender
National prevalence masks high prevalence
geographical areas
*Direct FSW; **Indirect FSW
HIV prevalence among key populations in geographical areas
Note: Countries with national HIV prevalence less than 5% for MSM and FSW, and less than 10% for
PWID are presented here. For TG, any available high prevalence geographical locations are included.
Source: Prepared by www.aidsdatahub.org based on HIV sentinel surveillance reports and integrated biological and behavioral surveillance reports
5.8 6.5
13.6 14.8 15 15.7
18.3
21.1
6.6
12 12.1
18.6 19 19
22 22.5
9.3
14.9
18.8
30.8
0
5
10
15
20
25
30
35
40
HIVprevalence(%)
1.56 million
0
300,000
600,000
900,000
1,200,000
1,500,000
1,800,000
2003 2008 2013
NumberofpeoplereceivingART
Treatment in Asia and the Pacific:
1.56 million people living with HIV are now
accessing treatment
Source: Prepared by www.aidsdatahub.org based on 1)UNAIDS. (2013). Global Report: UNAIDS Report on the Global AIDS Epidemic 2013.; 2) www.aidsinfoonline.org;
and 3) UNAIDS.(2014). The Gap Report.
People receiving antiretroviral therapy in Asia and the Pacific, 2003-2013
25% increase
between 2012 and 2013
13% increase
between 2011 and 2012
-
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2003 2007 2011 2015
NumberofpeoplereceivingART
Number of people receiving ART by 2013
Number of people receiving ART by 2015 (with current pace)
Estimate 2013:
1.56 million
More and more people are on treatment, but even at
the current pace, only one out of two people living
with HIV will have access to treatment by 2015
Estimated 2.4 million PLHIV
will receive ART in 2015
at current pace of scale up 25%
Source: Prepared by www.aidsdatahub.org based on 1)UNAIDS. (2013). Global Report: UNAIDS Report on the Global AIDS Epidemic 2013.; 2) www.aidsinfoonline.org;
and 3) UNAIDS.(2014). The Gap Report.
2013
0
200,000
400,000
2001 2005 2009 2013
AIDS-relateddeaths(Number)
AIDS-related deaths [Estimate]
1.56
million
0
1,560,000
2005 2013
PeopleonARTTreatment saves lives: AIDS-related deaths
are declining in Asia and the Pacific
~9 folds
increase
since 2005
26% decline
since 2005
AIDS-related deaths, Asia and the Pacific, 2001-2013
Source: Prepared by www.aidsdatahub.org based on UNAIDS 2013 Estimates for UNAIDS. (2014). The Gap Report.
People receiving ART
Ambitious, but achievable, new targets
By 2020…
90%
of all people
living with HIV
will know their
HIV status
90%
of all people
diagnosed with
HIV will receive
sustained
antiretroviral
therapy.
90%
of all people
receiving
antiretroviral
therapy will
have durable
suppression.
The objective
“Maximize the effectiveness of existing
tools to virtually eliminate progression
to AIDS, premature death and HIV
transmission, and thereby transform
the HIV pandemic into a low level
sporadic endemic.”
The result
three-fold increase
over current estimates
72%of all people living with HIV
will be virally suppressed
3
Key challenges
1. Societal
2. Diversity of facility costs
3. Gaps in the treatment cascade
4. Delivery challenges
5. Financing
6. Addressing the epidemic in adolescents
and children
Financing
Normative/
Technical
Advocacy/
Political
R&D
Partnering for success
Key achievements - Malaysia
 Prevention of vertical transmission of HIV – Option B+ provided for
all HIV infected mothers including both documented and
undocumented migrants since 2011 – overall 86% (62%->95%)
PMTCT coverage in 2013
 Treatment - Scaling up ART coverage (over 7000 people initiated ART
in the past year) including the availability of ART for prisoners and
closed settings
 Community based HIV testing – Partnering with NGOs and CBOs,
community based HIV testing is initiated in MSM community in
Penang and Kuala Lumpur
 Harm reduction programmes - Significant success in Needles and
Syringes Exchange Programme (NSEP), and the Opiate Substitution
Therapy (OST) programme expanded to 18 prisons by 2013
100%
96%
88%
85%
53%
42%
40%
36%
32%
31%
18%
10%
7%
1%
16%
10%
9%
5%
1%
0% 25% 50% 75% 100%
Fiji (2013)
Malaysia (2013)
China (2012)
Thailand (2011)
Sri Lanka (2010)
Indonesia (2012)
Philippines (2013)
Pakistan (2013)
Viet Nam (2012)
Mongolia (2011)
Papua New Guinea (2012)
Bangladesh (2013)
India (2011-12)
Cambodia (2012)
Myanmar (2011)
Lao PDR (2011)
Afghanistan (2013)
Nepal (2009)
Timor-Leste (2009)
Upper middle income
Lower middle income
Low income
Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org, India Global AIDS Response Progress Report 2012, and Kumar,
U. A., „Azad Launches Rs 14,295 Crore Phase IV of NACP‟, The New Indian Express, 13 February, 2014).
HIV expenditure from domestic sources,
Asia and the Pacific, latest available year, 2009-2013
63% Committed for NACP IV
Malaysia AIDS spending snapshot
Source: Prepared by www.aidsdatahub.org based on www.aisdinfoonline.org
12%
70%
15%
0.2%
3%
Malaysia AIDS spending by
major spending categories, 2012
Prevention
Care and treatment
Programme management and admin
Enabling environment
Others
5 M
3 M 3 M
0.01 M
2 M
2 M
1 M
1 M
0
1
2
3
4
5
6
7
8
Total
prevention
spending
Key
populations
prevention
spending
PWID
prevention
spending
Sex
workers
prevention
spending
MSM
prevention
spending
US$Millions
Malaysia prevention spending, 2012
Domestic International
PWID
18.9%
FSW
4.2%
MSM
12.6%
HIV prevalence
Post 2015 Agenda
Key processes feeding into the post -2015
development agenda
Source: IPPF. (2014). Post-2015 made simple – Shaping the future of sexual and reproductive health rights
Positioning AIDS in the post-2015
development agenda
 AIDS in the post-2015 development agenda
 Political commitment for ending AIDS
 Progress towards ending the AIDS epidemic will spur progress on a
range of development, gender equality and human rights challenges
 AIDS under the Sustainable Development
Goals (SDG) for health
 Situating “ending AIDS” as critical to advancing global
health in the post-2015 development agenda
 Ensure that the health goal continues to include targets on ending
the AIDS epidemic as a public health threat by 2030
Positioning AIDS in the post-2015
development agenda
 Human rights
 Ending AIDS: A beneficiary of and catalyst for human
rights
 Support elimination of discriminatory laws, policies and practices
 Key populations in the AIDS response
 Leaving no one behind is critical to ending AIDS by 2030
 Promote strategic investment in HIV programming for those most
affected by HIV, including key populations
 Gender, sexual and reproductive health, and
rights
 Ending AIDS can be a catalyst for gender-transformative
action which puts people at the centre of development
 Call for gender equality and the full realization of women’s rights
THANK YOU
www.aidsdatahub.org

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Regional Overview in HIV by Steve Kraus

  • 1. Regional HIV Overview: Asia and the Pacific Steven J. Kraus Director UNAIDS Regional Support Team, Asia and the Pacific
  • 2. A regional overview of trends in HIV infections and AIDS deaths Source: Prepared by www.aidsdatahub.org based on UNAIDS 2013 Estimates for UNAIDS. (2014). The Gap Report. HIV and AIDS in Asia and the Pacific 1990-2013 People living with HIV 4.8 million Women living with HIV 1.7 million New HIV Infections 350,000 Deaths 250,000 2013 “zoom-in” Children living with HIV 210,000 4,800,000 1,700,000 210,000 350,000 250,000 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 Number People living with HIV (Estimate) Women living with HIV (Estimate) Children living with HIV (Estimate) New HIV infections (Estimate) AIDS-related deaths (Estimate)
  • 3. 350,000 0 100,000 200,000 300,000 400,000 500,000 2001 2005 2009 2013 NewHIVinfections(Number) New HIV infections New HIV infections have declined significantly since 2001, but remain largely unchanged in past 5 years Estimated new HIV infections in Asia and the Pacific, 2001-2013 Source: Prepared by www.aidsdatahub.org based on UNAIDS 2013 Estimates for UNAIDS. (2014). The Gap Report. 30% decline
  • 4. 0 5,000 2005 2013 Number Cambodia 0 20,000 2005 2013Number Myanmar 0 100,000 2005 2013 Number Indonesia 0 15,000 2005 2013 Number Pakistan 0 10,000 2005 2013 Number Malaysia 0 5,000 2005 2013 Number Philippines Mixed progress in new HIV infections trends across countries in the region Source: Prepared by www.aidsdatahub.org based on UNAIDS 2013 Estimates for UNAIDS. (2014). The Gap Report; and Philippines HIV Estimations and Projections 2014 (Unpublished document).
  • 5. Countries that account for >90% PLHIV and new infections and high national HIV prevalence in key populations People living with HIV (2013) New HIV infections (2013) National HIV prevalence > 5 % among MSM National HIV prevalence > 5% among PWID National HIV prevalence > 5% among FSW India* 2,100,000 130,000 Indonesia 640,000 80,000 China* 780,000 48,000 Viet Nam 250,000 14,000 Pakistan 68,000 14,000 Thailand 440,000 8,200 Malaysia 86,000 8,000 Myanmar 190,000 6,700 Philippines 22,000 3,400 Papua New Guinea 32,000 2,200 Cambodia 75,000 1,300 Nepal 39,000 1,300 Source: Prepared by www.aidsdatahub.org based on UNAIDS Estimates 2013; Philippines HIV Estimations and Projections 2014 (Unpublished document); National HIV Sentinel Surveillance Surveys; and Integrated Biological and Behavioural Surveys = Yes * 2011 estimates
  • 6. Female sex workersMen who have sex with men People who inject drugs Transgender National prevalence masks high prevalence geographical areas *Direct FSW; **Indirect FSW HIV prevalence among key populations in geographical areas Note: Countries with national HIV prevalence less than 5% for MSM and FSW, and less than 10% for PWID are presented here. For TG, any available high prevalence geographical locations are included. Source: Prepared by www.aidsdatahub.org based on HIV sentinel surveillance reports and integrated biological and behavioral surveillance reports 5.8 6.5 13.6 14.8 15 15.7 18.3 21.1 6.6 12 12.1 18.6 19 19 22 22.5 9.3 14.9 18.8 30.8 0 5 10 15 20 25 30 35 40 HIVprevalence(%)
  • 7. 1.56 million 0 300,000 600,000 900,000 1,200,000 1,500,000 1,800,000 2003 2008 2013 NumberofpeoplereceivingART Treatment in Asia and the Pacific: 1.56 million people living with HIV are now accessing treatment Source: Prepared by www.aidsdatahub.org based on 1)UNAIDS. (2013). Global Report: UNAIDS Report on the Global AIDS Epidemic 2013.; 2) www.aidsinfoonline.org; and 3) UNAIDS.(2014). The Gap Report. People receiving antiretroviral therapy in Asia and the Pacific, 2003-2013 25% increase between 2012 and 2013 13% increase between 2011 and 2012
  • 8. - 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 2003 2007 2011 2015 NumberofpeoplereceivingART Number of people receiving ART by 2013 Number of people receiving ART by 2015 (with current pace) Estimate 2013: 1.56 million More and more people are on treatment, but even at the current pace, only one out of two people living with HIV will have access to treatment by 2015 Estimated 2.4 million PLHIV will receive ART in 2015 at current pace of scale up 25% Source: Prepared by www.aidsdatahub.org based on 1)UNAIDS. (2013). Global Report: UNAIDS Report on the Global AIDS Epidemic 2013.; 2) www.aidsinfoonline.org; and 3) UNAIDS.(2014). The Gap Report. 2013
  • 9. 0 200,000 400,000 2001 2005 2009 2013 AIDS-relateddeaths(Number) AIDS-related deaths [Estimate] 1.56 million 0 1,560,000 2005 2013 PeopleonARTTreatment saves lives: AIDS-related deaths are declining in Asia and the Pacific ~9 folds increase since 2005 26% decline since 2005 AIDS-related deaths, Asia and the Pacific, 2001-2013 Source: Prepared by www.aidsdatahub.org based on UNAIDS 2013 Estimates for UNAIDS. (2014). The Gap Report. People receiving ART
  • 10.
  • 12. By 2020… 90% of all people living with HIV will know their HIV status 90% of all people diagnosed with HIV will receive sustained antiretroviral therapy. 90% of all people receiving antiretroviral therapy will have durable suppression.
  • 13. The objective “Maximize the effectiveness of existing tools to virtually eliminate progression to AIDS, premature death and HIV transmission, and thereby transform the HIV pandemic into a low level sporadic endemic.”
  • 14. The result three-fold increase over current estimates 72%of all people living with HIV will be virally suppressed 3
  • 15. Key challenges 1. Societal 2. Diversity of facility costs 3. Gaps in the treatment cascade 4. Delivery challenges 5. Financing 6. Addressing the epidemic in adolescents and children
  • 17. Key achievements - Malaysia  Prevention of vertical transmission of HIV – Option B+ provided for all HIV infected mothers including both documented and undocumented migrants since 2011 – overall 86% (62%->95%) PMTCT coverage in 2013  Treatment - Scaling up ART coverage (over 7000 people initiated ART in the past year) including the availability of ART for prisoners and closed settings  Community based HIV testing – Partnering with NGOs and CBOs, community based HIV testing is initiated in MSM community in Penang and Kuala Lumpur  Harm reduction programmes - Significant success in Needles and Syringes Exchange Programme (NSEP), and the Opiate Substitution Therapy (OST) programme expanded to 18 prisons by 2013
  • 18. 100% 96% 88% 85% 53% 42% 40% 36% 32% 31% 18% 10% 7% 1% 16% 10% 9% 5% 1% 0% 25% 50% 75% 100% Fiji (2013) Malaysia (2013) China (2012) Thailand (2011) Sri Lanka (2010) Indonesia (2012) Philippines (2013) Pakistan (2013) Viet Nam (2012) Mongolia (2011) Papua New Guinea (2012) Bangladesh (2013) India (2011-12) Cambodia (2012) Myanmar (2011) Lao PDR (2011) Afghanistan (2013) Nepal (2009) Timor-Leste (2009) Upper middle income Lower middle income Low income Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org, India Global AIDS Response Progress Report 2012, and Kumar, U. A., „Azad Launches Rs 14,295 Crore Phase IV of NACP‟, The New Indian Express, 13 February, 2014). HIV expenditure from domestic sources, Asia and the Pacific, latest available year, 2009-2013 63% Committed for NACP IV
  • 19. Malaysia AIDS spending snapshot Source: Prepared by www.aidsdatahub.org based on www.aisdinfoonline.org 12% 70% 15% 0.2% 3% Malaysia AIDS spending by major spending categories, 2012 Prevention Care and treatment Programme management and admin Enabling environment Others 5 M 3 M 3 M 0.01 M 2 M 2 M 1 M 1 M 0 1 2 3 4 5 6 7 8 Total prevention spending Key populations prevention spending PWID prevention spending Sex workers prevention spending MSM prevention spending US$Millions Malaysia prevention spending, 2012 Domestic International PWID 18.9% FSW 4.2% MSM 12.6% HIV prevalence
  • 21. Key processes feeding into the post -2015 development agenda Source: IPPF. (2014). Post-2015 made simple – Shaping the future of sexual and reproductive health rights
  • 22. Positioning AIDS in the post-2015 development agenda  AIDS in the post-2015 development agenda  Political commitment for ending AIDS  Progress towards ending the AIDS epidemic will spur progress on a range of development, gender equality and human rights challenges  AIDS under the Sustainable Development Goals (SDG) for health  Situating “ending AIDS” as critical to advancing global health in the post-2015 development agenda  Ensure that the health goal continues to include targets on ending the AIDS epidemic as a public health threat by 2030
  • 23. Positioning AIDS in the post-2015 development agenda  Human rights  Ending AIDS: A beneficiary of and catalyst for human rights  Support elimination of discriminatory laws, policies and practices  Key populations in the AIDS response  Leaving no one behind is critical to ending AIDS by 2030  Promote strategic investment in HIV programming for those most affected by HIV, including key populations  Gender, sexual and reproductive health, and rights  Ending AIDS can be a catalyst for gender-transformative action which puts people at the centre of development  Call for gender equality and the full realization of women’s rights