Regional Overview of Progress on

Universal Access in Asia-PacificSteve Kraus, Regional Director

UNAIDS Regional Support Team for Asia and the Pacific

Bangkok, Thailand30 March 2011

1

Estimated number of adults and children living with HIV, new infections and AIDS deaths, 1990-2009

Source: UNAIDS RST Asia-Pacific, based on data compiled for the UNAIDS Report on the Global AIDS Epidemic, 2010

The Asia-Pacific epidemic is stabilizing: declining new infections and deaths leveling off

300,000

4.9 million

360,000

2

But significant variations in the region: increasing, stabilizing and declining country epidemic patterns

Source: UNAIDS RST AP, Country epidemic patterns from HIV estimates and projections data for the UNAIDS Report on the Global Epidemic 2010

Epidemic Pattern

Adults and children newly

Infected

Adults and children living

with HIV

Adults and children AIDS

Deaths

Countries

I Thailand, Cambodia, India

II Myanmar, Nepal, PNG*, China**

III Indonesia, Vietnam, Malaysia, Pakistan

IV<200

Philippines, Laos, Bangladesh

* Number of people living with HIV appears to be leveling off.**Likely trend from the available data. UNAIDS EPP-Spectrum projections not available for China.

3

Important geographic variations within countries should inform programming

Sichuan

Yunnan

Xinjiang

Tibet

Gansu

Qinghai

Neimenggu

Guangxi Guangdong

Chongqing

HunanGuizhou

Hubei

Henan

Jiangxii

Fujian

Anhui

Zhejiang

Jiangsu

Shandong

Shaanxi

Shanxi

Hebei

Liaoning

Jilin

Heilongjiang

Beijing

Tianjin

Shanghai

Taiwan

Hainan

Ningxia

IDU expanding to sexual

IDU concentrated

Blood transmission expand to sexual partners

MSM concentrated

Low epidemic

Source: China Global Fund consolidated RCC proposal, 2008 4

Getting to zero in Asia and the Pacific: Responses informed by evidence

5Source: Commission on AIDS in Asia. 2008. Redefining AIDS in Asia: Crafting an Effective Response.

75 million

Men in Asia visit sex workers

(2-20% of adult men)

4 million Men who

inject drugs

10 million Women sell sex

16 million

Men who have sex with men

50 million Women married to men who visit

sex workers 1 million

infants and children

Men Women

6

HIV prevalence among female sex workers, countries where data is available, 2001-2009

Source: www.aidsdatahub.org based on Sentinel surveillance data reported by National AIDS programs; Magnani R, Riono P, Nurhayati, et al. Sexual Risk Behaviors, HIV and Other Sexually Transmitted Infections among Female Sex Workers in Indonesia. Sex Transm Infect. 2010 Oct;86(5):393-9. Epub 2010 Jun 3

Progress in reducing infections among female sex workers, but may be masking high prevalence in some locations

Source: www.aidsdatahub.org based on data reported by National AIDS Programs from HIV Sentinel Surveillance

Prevalence among people who inject drugs remains high in several countries

HIV prevalence among people who inject drugs, countries where data is available, 2001-2009

7

MSM epidemics are on the increase around the region

Source: www.aidsdatahub.org, based on data reported by National AIDS programs from HIV Sentinel Surveillance; China Centre for Disease Control and Prevention; Viet Nam IBBS; and Thailand population-based surveys

HIV prevalence among MSM, from selected cities, 2002-2009

8

Proportion of all infections in women has stabilized at around 35% in last ten years

Estimated number of women and adults (15+) living with HIV, 1990-2009

Source: UNAIDS RST Asia-Pacific, based on data compiled for the UNAIDS Report on the Global AIDS Epidemic, 2010

35%

9

HIV prevalence data indicate high quality interventions addressing young people at risk are required

Source: www.aidsdatahub.org based on DHS and youth surveys reported in UNGASS Country Progress Reports 2006, 2008, 2010

Young people who inject drugs and their older counterparts

Young sex workers and their older counterparts

10

Source: www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008, 2010

* Manipur** 2009 Kathmandu

Insufficient reach of key affected populations

People who inject drugs

Female sex workers

Men who have sex with men

11

Number of syringes/needles distributed per IDU per year (2009)

Source: www.aidsdatahub.org based on Towards Universal Access:

Scaling up Priority HIV/AIDS interventions in the health sector, 2010

Access to sterile needles and syringes remains low throughout the region

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Source: www.aidsdatahub.org based on UNGASS country Progress reports 2008 & 2010

Varying levels of condom use: highest among female sex workers

58

67

99

85 83

66

94

61

9096

75

43

53

65

99

92

65

78

31

86

73

58 57

21

7882

75

51

32

17

38

67

3543

36

16

3628

78

51

3122

4252

0

20

40

60

80

100%

FSW (with most recent client) MSM(with a male partner) PWID

% of condom use at last sex among key populations, most recent data, 2007-2009

13

% of key affected populations receiving an HIV test in the last 12 months and who know the results, 2007-2009

Source: www.aidsdatahub.org based on UNGASS Country Progress Reports 2008 & 201014

Missed opportunities for HIV testing and counseling…

The number of people on treatment has increased steadily in the region, but slower than in the rest of the world

Source: www.aidsdatahub.org based on Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector, 2006-2010 15

Number of people receiving antiretroviral therapy in Asia- Pacific vs total low- and middle-income countries, 2003-2009

Estimated ART coverage among adults and children in Asia- Pacific vs. total low- and middle-income countries, 2008-2009

16Source: www.aidsdatahub.org based on Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector, 2010

Coverage of ART is increasing,but remains well below universal access

PPTCT coverage in East, South and South-East Asia vs.all low-and middle-income countries, 2005-2009

Source: www.aidsdatahub.org based on Towards Universal Access: Scaling up priority HIV/AIDS interventions in

the health sector, 2010

PPTCT coverage in Asia lags the global average even more than for ART…

Quality antenatal care coverage(4 visits) remains low in many countries

Source: www.aidsdatahub.org based on national surveys cited in WHO and UNICEF Countdown to 2015.Decade report (2000-2010) : Taking stock of maternal , newborn and child survival 2009

Antenatal care coverage at 4 or more visits, in countries where data are available

% of estimated HIV-positive incident TB cases that received treatment for TB and HIV, countries where data is available, 2007-2009

Source: www.aidsdatahub.org based on UNGASS Country Progress Reports 2010; Countries collected the data using ART patient registers and estimates from WHO STOP TB Data Base except Afghanistan ART Data Base, Indonesia ART Monitor and Reports, Japan Nagoya Medical Center & International Medical Center of Japan (ACC) Database, PNG National Department of Health Program Monitoring

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Tuberculosis is the first cause of death among PLHIV and coverage is low

Middle Income Countries contribute too little to the AIDS response

52%48%

Middle income countriesShare of domestic funding

Share of international funding

5%

95%

Low income countriesShare of domestic fundingShare of international funding

Source: UNGASS 2010 Indicator 1 data setMarshall Islands

Micronesia

Palau

Viet Nam

Vanuatu

India*

Fiji

Philippines

Mongolia

Tonga

Sri Lanka

Indonesia

China

Samoa

Pakistan

Thailand

Malaysia

0,0%

0,0%

0,0%

2,1%

6,5%

9,0%

11,8%

16,2%

24,8%

26,5%

33,2%

40,0%

76,0%

78,1%

78,4%

93,3%

98,4%

Share of domestic funding, middle income countries, 2009

Proportion of domestic funding, MICS, 2009

And still too little funding goes to high impact prevention

Source: UNGASS country progress reports 2010

Spending by impact category (%)

19

8

44

50

1 2

3741

SAARC SEA SAARC SEA SAARC SEA SAARC SEA

High impact - lowcost

High impact - highcost

Low impact - lowcost

Low impact - highcost

Most MIC need to spend less than 0.2% of their GNI to fund their response…

0,00% 0,10% 0,20% 0,30% 0,40%

Malaysia

China

Sri Lanka

Philippines

Indonesia

Fiji

Thailand

India

Pakistan

Mongolia

Vietnam

Papua New Guinea

Share of Gross National Income

current spending as a share of GNI

estimated resource needs as a share of GNI

Source: UNGASS 2010; World Data Bank

Regional evidence-base summary:

• Asia-Pacific HIV epidemic stabilizing, but considerable variation in the country and sub-national epidemics

• HIV still concentrated among key populations at risk and their partners, and at high levels in many locations.

• PWID and MSM interventions generally well below UA target of 80% coverage; FSW coverage better and programmes largely miss out on clients.

• Below global average on treatment for those in need and worse for PPTCT.

• Coverage of HIV-TB low and for HIV–HCV co-infection non-existent.

• Systematic combined reviews of epidemic, programme and expenditure data to adjust programming and funding, and programme evaluations to inform scale-up, remain the exception.

• International funding represents the majority of funding.

• In 2010, all Asian MIC would need to spend less than 0.5% of their GNI to fully fund a targeted response.

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ZERO NEW HIV INFECTIONS.

ZERO DISCRIMINATION.

ZERO AIDS-RELATED DEATHS.

Thank you