HIV REMAINS CONCENTRATED AMONG KEY POPULATIONS AND IN CITIES
This is an extract from the report ‘HIV in Asia and the Pacific: UNAIDS Report 2013′. Get the full report here.
The fastest-growing epidemics in the region are among men who have sex with men; these epidemics are typically concentrated in major cities. Estimates based on country information indicate that the regional population of men who have sex with men who are at risk of HIV infection ranges from 10.5–27 million. HIV prevalence among men who have sex with men is more than 10% in at least 10 major urban centres. 3 For example, the national prevalence for men who have sex with men in Thailand is estimated to be 7.1%; in Bangkok, levels are estimated to be 24.7%. 4 See the special feature on the issue of men who have sex with men and HIV (page 33).
An estimated 3–4 million people living in Asia inject drugs. In three countries with expanding epidemics — Indonesia, Pakistan and the Philippines — injecting drug use has been a significant factor in the spread of HIV. In 2012, HIV prevalence among people who inject drugs was 36.4% in Indonesia, 27.2% in Pakistan and 13.6% in the Philippines. 5
National trends sometimes mask significant geographical variations in HIV prevalence among injecting drug users. In the Philippine province of Cebu, prevalence among people who inject drugs was estimated at 53.8% in 2011 compared with 13.6% nationally. 6 In the province of Thai Nguyen in Viet Nam, the prevalence among this group was reported to be 38.8% in 2012, compared with national prevalence of 11.6%. 7
There has been progress in reducing new HIV infections among female sex workers across the region. National prevalence has declined in the early epidemics of Cambodia, India, Myanmar and Thailand, and has been kept low in some countries including China, Nepal and the Philippines.
Nevertheless, challenges remain. Based on a global systematic review in low- and middle-income countries, the burden of HIV infection was disproportionately high among female sex workers, who are 13.5 times more likely to acquire HIV than the rest of the adult female population. The highest was observed among female sex workers in Asia and the Pacific, with a 29-fold increase in odds of living with HIV compared with all women of reproductive age. 8
As observed with other key populations, there are geographical areas with higher HIV prevalence — for example Hanoi, where prevalence among female sex workers was 22.5% in 2012 9 or Jayawijaya, Indonesia, 10 with 25% prevalence the same year. Even when national HIV prevalence trends among female sex workers have declined, for example in India and Myanmar, there are specific high-prevalence areas; 22% of female sex workers surveyed in Mumbai, India, and 15% surveyed in Pathein, Myanmar, were living with HIV. 11, 12
Data on male and transgender sex workers are scarce, but where available demonstrate high HIV prevalence. For example, 18% of surveyed male sex workers in Indonesia and Thailand tested HIV-positive, 13 as did 31% of transgender (waria) sex workers in Jakarta 14 and 19% in Maharashtra. 15 This underscores both the need for better data regarding male and transgender sex workers and for HIV programmes that address the needs of female, male and transgender sex workers.
Clients of sex workers are the largest population at risk of HIV infection in Asia and the Pacific. According to population-based surveys, 0.5% 16 –15% 17 of men in the region bought sex in the previous year. This population’s risk behaviour determines the extent of the spread of HIV, but there are limited data available on prevalence trends among clients of sex workers, and they are underserved by current HIV programmes. This emphasizes the need for more prevention efforts among key populations and reaching the female partners of men at higher risk both through key population programming and mainstreaming sexual and reproductive health services.
While evidence indicates that the majority of women in the region are acquiring HIV through their partners who engage in high-risk behaviour (including as sex work clients, through male-to-male sex or injecting drug use), policies and programmes to address intimate partner transmission are limited. 18, 19, 20
Research conducted in Asia and the Pacific suggests that the transgender population in the region is around 9–9.5 million, made up predominantly of transgender women. 21 Little research has been done on their specific risk factors and data on HIV prevalence among transgender people is limited regionally, but global studies have found that transgender women are 50 times more likely to acquire HIV than adult males and females of reproductive age. The available data for the region indicate high HIV prevalence among transgender women in cities: 30.8% in Jakarta, 22 23.7% in Port Moresby 23 and 18.8% in Maharashtra, India (2010–2011 data). 24
More young people aged 15–24 live in Asia and the Pacific than in any other region. 25 In 2012, an estimated 690 000 young people were living with HIV (among which 46% are female). 26 The epidemic in this age group is driven mainly by unprotected sex and injecting drug use, as it is among adult populations. 27
Although there has been a 28% reduction of new HIV infections among children since 2001, recent rates of decline appear to be slowing. Between 2010 and 2012, infections among children decreased by 8%.
The fastest-growing epidemics in the region are among men who have sex with men; these epidemics are typically concentrated in major cities. Estimates based on country information indicate that the regional population of men who have sex with men who are at risk of HIV infection ranges from 10.5–27 million. HIV prevalence among men who have sex with men is more than 10% in at least 10 major urban centres. 3 For example, the national prevalence for men who have sex with men in Thailand is estimated to be 7.1%; in Bangkok, levels are estimated to be 24.7%. 4 See the special feature on the issue of men who have sex with men and HIV (page 33).
An estimated 3–4 million people living in Asia inject drugs. In three countries with expanding epidemics — Indonesia, Pakistan and the Philippines — injecting drug use has been a significant factor in the spread of HIV. In 2012, HIV prevalence among people who inject drugs was 36.4% in Indonesia, 27.2% in Pakistan and 13.6% in the Philippines. 5
National trends sometimes mask significant geographical variations in HIV prevalence among injecting drug users. In the Philippine province of Cebu, prevalence among people who inject drugs was estimated at 53.8% in 2011 compared with 13.6% nationally. 6 In the province of Thai Nguyen in Viet Nam, the prevalence among this group was reported to be 38.8% in 2012, compared with national prevalence of 11.6%. 7
There has been progress in reducing new HIV infections among female sex workers across the region. National prevalence has declined in the early epidemics of Cambodia, India, Myanmar and Thailand, and has been kept low in some countries including China, Nepal and the Philippines.
Nevertheless, challenges remain. Based on a global systematic review in low- and middle-income countries, the burden of HIV infection was disproportionately high among female sex workers, who are 13.5 times more likely to acquire HIV than the rest of the adult female population. The highest was observed among female sex workers in Asia and the Pacific, with a 29-fold increase in odds of living with HIV compared with all women of reproductive age. 8
As observed with other key populations, there are geographical areas with higher HIV prevalence — for example Hanoi, where prevalence among female sex workers was 22.5% in 2012 9 or Jayawijaya, Indonesia, 10 with 25% prevalence the same year. Even when national HIV prevalence trends among female sex workers have declined, for example in India and Myanmar, there are specific high-prevalence areas; 22% of female sex workers surveyed in Mumbai, India, and 15% surveyed in Pathein, Myanmar, were living with HIV. 11, 12
Data on male and transgender sex workers are scarce, but where available demonstrate high HIV prevalence. For example, 18% of surveyed male sex workers in Indonesia and Thailand tested HIV-positive, 13 as did 31% of transgender (waria) sex workers in Jakarta 14 and 19% in Maharashtra. 15 This underscores both the need for better data regarding male and transgender sex workers and for HIV programmes that address the needs of female, male and transgender sex workers.
Clients of sex workers are the largest population at risk of HIV infection in Asia and the Pacific. According to population-based surveys, 0.5% 16 –15% 17 of men in the region bought sex in the previous year. This population’s risk behaviour determines the extent of the spread of HIV, but there are limited data available on prevalence trends among clients of sex workers, and they are underserved by current HIV programmes. This emphasizes the need for more prevention efforts among key populations and reaching the female partners of men at higher risk both through key population programming and mainstreaming sexual and reproductive health services.
While evidence indicates that the majority of women in the region are acquiring HIV through their partners who engage in high-risk behaviour (including as sex work clients, through male-to-male sex or injecting drug use), policies and programmes to address intimate partner transmission are limited. 18, 19, 20
Research conducted in Asia and the Pacific suggests that the transgender population in the region is around 9–9.5 million, made up predominantly of transgender women. 21 Little research has been done on their specific risk factors and data on HIV prevalence among transgender people is limited regionally, but global studies have found that transgender women are 50 times more likely to acquire HIV than adult males and females of reproductive age. The available data for the region indicate high HIV prevalence among transgender women in cities: 30.8% in Jakarta, 22 23.7% in Port Moresby 23 and 18.8% in Maharashtra, India (2010–2011 data). 24
More young people aged 15–24 live in Asia and the Pacific than in any other region. 25 In 2012, an estimated 690 000 young people were living with HIV (among which 46% are female). 26 The epidemic in this age group is driven mainly by unprotected sex and injecting drug use, as it is among adult populations. 27
Although there has been a 28% reduction of new HIV infections among children since 2001, recent rates of decline appear to be slowing. Between 2010 and 2012, infections among children decreased by 8%.
