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OVERVIEW OF HIV/AIDS EPIDEMIC IN ASIA

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This PPT is very much useful for all people who are directly and indirectly related to HIV/AIDS.

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OVERVIEW OF HIV/AIDS EPIDEMIC IN ASIA

  1. 1. OVERVIEW OF HIV/AIDS EPIDEMIC IN ASIA GAYATRI KHANAL LECTURER,CHITWAN MEDICAL COLLAGE,BHARATPUR,CHITWAN,NEPAL
  2. 2. THEME OF DEC 1, 2014, WORLD AIDS DAY
  3. 3. 3 COUNTRIES IN ASIA: SOUTH-EAST ASIA & SOUTH ASIA
  4. 4. OUTLINES OF THE PRESENTATION  Key facts  Description of the epidemic  What is the burden of the HIV epidemic in Asia?  Prevalence, Incidence, Women, Children  In different MARPs  What is the transmission dynamics of HIV in Asia?  What are the Vulnerabilities?  MARPs (type, size, behaviour)  Health sector response to the epidemic  Prevention  Care, support and treatment
  5. 5. KEY FACTS (QUICK VIEW)  Having claimed more than  39 million  Sub-Saharan Africa-the most affected region, with 24.7 [23.4–26.2] million PLWH in 2013.  Incidence -Sub-Saharan Africa accounts 70% of the global new HIV cases.  HIV diagnosis- detecting HIV antibodies in blood.  There is no cure for HIV infection.
  6. 6.  Effective treatment with ART can control the virus  In 2013, 12.9 million (37%) PLWH were receiving (ART)  93% (32.6 million) PLWH come from low- and middle- income countries.  36% (11.7 million) PLWH are receiving ART in low- and middle-income countries.  11.7 million (90%) were receiving ART in low- and middle- income countries.  Access of ART is low in pediatric age group as compared to adults.(1:4 vs 1:3)
  7. 7. The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. Regional HIV and AIDS statistics and features2013
  8. 8. About 6000 new HIV infections a day in 2013  About 4080 (68%) are in Sub Saharan Africa  About 700(12%) are in children under 15 years of age  About 5 200(88%) are in adults aged 15 years and older, of whom: ─ almost 47% are among women ─ about 33% are among young people (15-24)
  9. 9. 2013 global HIV and AIDS estimates Children (<15 years) Children living with HIV 3.2 million [2.9 million – 3.5 million] New HIV infections in 2013 240 000 [210 000 – 280 000] Deaths due to AIDS in 2013 190 000 [170 000 – 220 000]
  10. 10. Middle East & North Africa 16 000 [11 000 – 22 000] Sub-Saharan Africa 2.9 million [2.6 million – 3.2 million] Eastern Europe & Central Asia 14 000 [13 000 – 14 000] Latin America 35 000 [27 000 – 54 000] Caribbean 17 000 [14 000 – 20 000] Children (<15 years) estimated to be living with HIV2013 Total: 3.2 million [2.9 million – 3.5 million] Asia and the Pacific 210 000 (7%) [190 000– 270 000] North America and Western and Central Europe 2800 [2300 – 3600]
  11. 11. Middle East & North Africa 1300 [<1000 – 2000] Sub-Saharan Africa 180 000 [150 000 – 200 000] Eastern Europe & Central Asia <500 [<200 – <1000] Latin America 1500 [<1000 – 4200] Caribbean <1000 [<1000 – 1100] Estimated deaths in children (<15 years) from AIDS2013 Total: 190 000 [170 000 – 220 000] Asia and the Pacific 14 000(7%) [12 000 – 19 000] North America and Western and Central Europe <200 [<100 – <200]
  12. 12. Middle East & North Africa 2300 [1500 – 3400] Sub-Saharan Africa 210 000 [180 000 – 250 000] Eastern Europe & Central Asia <1000 [<1000 – 1200] Latin America 1800 [<1000 – 7400] Caribbean <1000 [<500 – <1000] Estimated number of children (<15 years) newly infected with HIV2013 Total: 240 000 [210 000 – 280 000] Asia and the Pacific 22 000(9%) [18 000– 32 000] North America and Western and Central Europe <500 [<200 – <500]
  13. 13. 18 BETTER TO REMEMBER, WHAT YOU ARE DEALING WITH  HIV Epidemic in Asia started around 1990s  National adult HIV prevalence in most of the Asian countries are actually low (<1%)  (Ban, Mal, SL, <0.1%; Bh, TL, 0.1%; Ino, 0.2%; In, 0.3%, Np, 0.4%; Myr, 0.6%; Th 1.4%)  However, large population sizes (60% of world popln) means even with low prevalence, large number of people are infected  Accounting for 15% of people living with HIV globally Source: WHO 2009, WHO 2010; UNAIDS Global Report 2010
  14. 14. 19 HIV IN ASIA- A COMPARISON OF 2001 VS 2009 Source: WHO, UNAIDS, Global Report 2010
  15. 15. 20 HIV BURDEN IN ASIA Of the total HIV burden in Asia:  India 60%  India and Thailand 70% S. No. Country Estimated Number of People living with HIV/AIDS 1 India 2,400,000 2 Thailand 530,000 3 Indonesia 310,000 4 Vietnam 280,000 5 Myanmar 240,000 6 Malaysia 100,000 7 Pakistan 98,000 8 Nepal 64,000 9 Cambodia 63,000 10 Philipines 8,700 11 Lao PDR 8,500 12 Japan 6,400 13 Bangladesh 6,300 14 Republic of Korea 5,200 15 Singapore 3,400 16 Sri Lanka 2,800 17 Bhutan 999 18 Mongolia 100 19 Maldives 99 Source: WHO, UNAIDS, Global Report 2010, (Note: China, between 0.24 to 0.47 million)
  16. 16. 21 “OVERALL”, THE HIV EPIDEMIC IN ASIA IS, STABLE  An estimated 4.9 million people were living with HIV in 2009  Overall, it is stable around this figure Source: WHO, UNAIDS, Global Report 2010, (Note: China, between 0.24 to 0.47 million)
  17. 17. 22 HIV PREVALENCE, ASIAN COUNTRIES Source: HIV prevalence curves generated by Spectrum using surveillance data reported by Ministries of Health, SEAR countries WHO,
  18. 18. 23 HISTORICALLY LOW PREVALENCE COUNTRIES  HIV prevalence is increasing in low-prevalence countries: Bangladesh Pakistan (mainly IDU driven) Indonesia Philippines
  19. 19. 24 HIV INCIDENCE IN ASIA (“OVERALL TREND”)  Overall incidence shows a declining trend Source: WHO, UNAIDS, Global Report 2010, (Note: China, between 0.24 to 0.47 million)
  20. 20. 25 INCIDENCE RATES VARY BY COUNTRIES Source: WHO, 2010: Number of new infections estimated by Spectrum model using surveillance data reported by national AIDS programmes, Member countries, South-East Asia Region.
  21. 21. 26 HIV INCIDENCE IN ASIA (2001 AND 2009 )  DECREASE by more than 25% in: India (60%), Nepal and Thailand  However, the epidemic remained STATIC during this time in: Malaysia and Sri Lanka  INCREASED by 25% in: Bangladesh and Philippines (otherwise low % level)
  22. 22. 27 HIV BURDEN IN WOMEN (SEA)  Except Bhutan and Timor-Leste, F:M ratio < 1  Reasons for higher vulnerability of women: barrier (access) to health care; stigma, gender inequality,
  23. 23. 28 HIV BURDEN IN CHILDREN (S&SEA)  Prevalence:  Estimated no of children (<15 yrs) living with HIV increased from 140,000 (yr 2005) to 160,000 ( yr 2009)  Incidence:  Estimated number of children (<15 yrs) getting newly infected with HIV 22,000 (yr 2009) from 26,000 (yr 1999) 15% decline  Reason: increasing access to PMTCT of HIV  drop in number of children getting infected  AIDS related deaths among children declined from 18,000 (yr 2004) to 15,000 (yr 2009)
  24. 24. 29 AIDS RELATED MORTALITY Number of deaths have largely stabilized Almost 50% of these deaths occurred in India (estimated 172,000) Source: WHO, UNAIDS, Global Report 2010, (Note: China, between 0.24 to 0.47 million)
  25. 25. 30 TILL NOW… 1. HIV prevalence in Asia: overall declining 2. HIV incidence in Asia: overall declining 3. Magnitude differs greatly between countries 4. Some showing decline (India, Thailand, Nepal) 5. Some showing increase (Bangladesh, Philippines, Indonesia, Pakistan) MESSAGE
  26. 26. ROUTES OF TRANSMISSION image
  27. 27. MODE OF TRANSMISSION, SEA COUNTRIES  Unsafe sex and injecting drug use are the main risk behaviors driving the HIV epidemic in South-East Asia Source: National AIDS programme, Ministry of Health, SEAR countries, 2007
  28. 28. 33 MOST AT RISK POPULATION (MARP/HRGS)  Although the overall HIV prevalence is around 0.3%, certain population groups are highly infected  These include:  Female Sex Workers (FSW)  Injecting Drug Users (IDU)  Men who have Sex with Men (MSM), & TG (Trans gender)
  29. 29. 34 HIV PREVALENCE BY POPULATION GROUP, MYANMAR AND THAILAND, 2009 Source: National AIDS Program, 2009 HIV sentinel surveillance report
  30. 30. FSW
  31. 31. 36 PERCENTAGE OF FEMALE SEX WORKERS INFECTED WITH HIV, SOUTH-EAST ASIA REGION, 2007–2010 Source: WHO SEAR Office Of 281 sentinel sites for FSW, in 33% sites, HIV prev was <1%, 39% sites it was 1-5%, 25% sites it was 5-20%; highest is noted in Southern India
  32. 32. 37 HIV PREVALENCE IN FSW, 2010  Indonesia: Tanah Papua (16%), Bali (14%), and Batam (12%)  Myanmar: all five sites >5%  Thailand: all of 51 sites had <5%, except four sites  <5% in Bangladesh, Maldives, Nepal and Timor  No HIV detected in FSW in Sri Lanka
  33. 33. MSM
  34. 34. 39 HIV PREVALENCE, SEAR 2003–2009 Source: Sentinel surveillance reports, national AIDS programmes, South-East Asia Region.
  35. 35. 40 HIV IN IDU  Estimated 4.5 million people in Asia inject drugs  More than half of them are in China  Other large no are in India, Vietnam and Pakistan  On an average, HIV prev = 16% (with variations)  Myanmar= 19- 38%, Thailand = 30-50%, Vietnam = 32-58%, China= 7-13%, India = 0-56%
  36. 36. 41 HIV PREVALENCE AMONG INJECTING DRUG USERS, SOUTH-EAST ASIA, 2007- 2009
  37. 37. 42  MARPs HIV are , FSW, MSM+TG, IDU  Level of HIV prevalence is very high among MARP  Changing trend of HIV at MARPS seen in countries  Large variations exists within countries  MESSAGE
  38. 38. 43 DYNAMICS OF HIV TRANSMISSION IN ASIA females Male Clientsmales MSM IDUs FSW Children Spouses (Adopted from Tim Brown’s)
  39. 39. 44 CASUAL SEX IN GENERAL POPULATION, BUT, BY COMMERCIAL SEX Source: Commission of AIDS: Redefining AIDS in Asia,
  40. 40. 45 MESSAGE OF THIS SECTION… Main drivers of the epidemic, globally 1. Heterosexual intercourse 2. Commercial Sex work 3. Injecting drug use 4. Unprotected anal sex between 5. Men who have sex with men Main drivers African Main drivers of the Asian epidemic Main drivers African Main drivers of the Asian epidemic
  41. 41. THE HEALTH SECTOR RESPONSE TO THE HIV EPIDEMIC Next part of my presentation…
  42. 42. 47 WHY SHOULD WE UNDERSTAND RESPONSE?  Strategically Planned and Effectively Implemented Response can halt and reverse the HIV epidemic  Timing of Response has major impact on the course and magnitude of HIV epidemic  Consolidation of Lessons Learnt will help improve the Future Response  Understanding of past and current response sets a baseline for future action
  43. 43. 48 WHAT CONSTITUTES PROGRAM RESPONSE?  Prevention among General Population  Prevention Programmes for MARPs  Care and Support Programmes for PLHA  Improving the Social Environment
  44. 44. 49 WHAT IS THE CRUCIAL (STRATEGIC) INFORMATION WE NEED TO KNOW?  What are the drivers of the epidemic?  Which GROUP are the (particular) MARPs  What is their size?  What is their profile? (dual risk?)  What are the vulnerabilities?  STIs (levels, trends, geo distribution, by popl grps)  Risk behavior (levels, changes by intervn, by pop grps)  Other vulnerabilities (e.g. migration)  Specific geographic vulnerabilities

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