AIDS Alert International
UNAIDS report focuses on Asia and cites growing epidemic in the East, particularly China, Indonesia, Vietnam
HIV has spread to all 31 China provinces
The world’s fastest growing HIV epidemic now is in East Asia where the virus is rapidly spreading in China, Indonesia, and Vietnam, international health officials say.
"In East Asia, the number of new infections increased from 120,000 in 2002 to 290,000 in 2004," says Swarup Sarkar, MBBS, MD, MS, programme development advisor for the UNAIDS Regional Support Team, Asia and Pacific, headquartered in Bangkok, Thailand.
While this increase is not worse than predicted, it does show that the epidemic is now taking off in the region, and it is a greater increase than what is seen in Eastern Europe and Africa, he points out.
"In the same period, Eastern Europe and Central Asia recorded 210,000 new infections in 2004, compared with 190,000 in 2002," Sarkar notes.
Also, sub-Saharan Africa’s new infection rate was 3.1 million in 2004 vs. 2.9 million in 2002, he says.
The epidemic’s current growth in Asia will result in an additional 12 million people infected with HIV in Asia and the Pacific within the next five years, says J.V.R. Prasada Rao, MSC, director of UNAIDS Regional Support Team, Asia and Pacific, who spoke about the epidemic in July at the Seventh International Council on AIDS in Asia and the Pacific (ICAAP), held in Kobe, Japan.
With a rapid scaling up of HIV prevention and care programs, at least half of these infections could be prevented, Rao says.
Drugs, sex contributing factors
A variety of factors have contributed to the epidemic’s rise, according to a recent UNAIDS report.1
Population mobility is associated with increased vulnerability to HIV infection; and in Asia, an estimated 5% to 10% of the population moves within each five-year period.
Mobile workers are more vulnerable, with domestic workers sometimes at risk of sexual coercion and workers who travel routinely at risk due to more frequent contact with sex workers.
In China, where HIV has spread to all 31 provinces, much of the spread of the epidemic is due to injecting drug use and paid sex with the country’s dramatic economic changes and new migratory patterns as additional factors, UNAIDS officials say.
"Contributing factors to rising infection rates in China are known to be those associated with transitional economies, rapid growth of the economy, fast growing incomes, population movement, and a changing of social values towards commercialization and entertainment, etc.," Sarkar says.
Also, despite the well-known harm reduction methods for preventing HIV infection through injection drug use (IDU), such as needle exchange programs, these prevention programs have not played a significant role in combating the Asian HIV epidemic, he adds.
"In spite of known evidence on harm reduction, it requires a change in policy, decriminalization, detailed operational plans, and human and financial resources," Sarkar explains. "As a result, the overall coverage for harm reduction programs aimed at injection drug users has remained at only 5% in the region."
There are 3 million injection drug users in Asia, and all countries in the region now report IDU problems, he says.
UNAIDS data show that in some Indian cities, the epidemic’s spread through the IDU community has been brutally rapid: In Chennai, for instance, 26% of drug injectors were infected with HIV when a sentinel site was started in 2000, but by 2003, 64% were infected.
Also in Jakarta, Indonesia, one-half of injection drug users test positive, and more than 70% of IDUs test positive in Pontianak, Indonesia, according to UNAIDS data.
"Injecting drug use is widespread throughout the region, and introduction of HIV into drug user networks can mean a rapid spread of the virus into the general population, through sex with partners or commercial sex work to pay for drugs," Rao says.
"HIV has been reported in almost all countries reporting IDU problems with the exception of Laos and Cambodia," Sarkar says. "Out of 13 countries surveyed, only seven have IDU policies, and only three had an operational plan to support the policy."
As a result, the overall resources for IDUs are less than 10% of what is required, Sarkar says.
Despite taboos and social constraints, HIV prevention work and resources should be concentrated to impact the vulnerable populations of injection drug users and sex workers, Rao points out.
"ICAAP provided a focus for harm reduction, which — as we all know — has faced major scrutiny in the past few months, with battles raging around terminology and morality," he says. "There is now consensus on harm reduction in Asia and the challenge will lie in scaling up."
Government efforts critical
It can be done with governmental backing. For example, in Malaysia, needle exchange is government policy, despite strong religious opposition, Rao says.
International financial assistance for HIV prevention and care in Asia has been increasing, with an estimated rise from just under $700 million in 2003 to an expected $1.6 billion in 2007.1
However, Asian governments and communities will need to provide strong leadership in order to present the epidemic from becoming a disaster, Rao says.
"AIDS responses must be anchored in the community and owned by the community if they are to work in the long term," Rao says. "Without the participation of civil society and of those most directly affected by the epidemic, responses will not work."
For instance, in China, Indonesia, and Vietnam, where the epidemic is growing among the fastest in Asia, the three countries have demonstrated increased political commitment at the very top level, Sarkar says.
"In all three countries resources have increased to almost double during the last two years," he says. "These countries have taken steps towards decriminalization of the most vulnerable populations, including IDUs, and, in some countries, for sex workers and men who have sex with men."
In China, the government has taken decisive action, and progress has been made in HIV prevention and treatment, including these measures, Sarkar says:
- methadone treatment programs for drug users;
- adoption and implementation of provincial policies, including condom promotion;
- calls for greater involvement of nongovernmental organizations and private sector companies in the fight against AIDS.
"The China Cares Project, with the help of the Global Fund to Fight AIDS, TB, and Malaria, managed to get 15,000 people on antiretroviral treatment by May 2005," Sarkar says.
In Vietnam, the government declared 2005 as the "Year of HIV Implementation," and provided a 75% increase in national spending on AIDS programs, plus receiving more than five times the international assistance between 2003 and 2006.1
And the Viet Nam Women’s Union, which has 12 million members, is leading national efforts to reduce HIV stigma and discrimination while improving HIV education among women and girls.
Also, Cambodia and Bangladesh have demonstrated political commitment and strong policy to supporting prevention programs for sex workers and IDUs, Sarkar reports.
UNAIDS data show that Bangladesh has reduced the spread of HIV among sex workers and other vulnerable groups through HIV prevention interventions. While it was entirely likely HIV prevalence among sex workers would have been as high as 10%, it’s current level is 1%, UNAIDS officials say.
And Cambodia has joined China, India, and Indonesia to dramatically expanding access to HIV treatment, according to UNAIDS information.
While these improvements provide a reason for optimism, work still needs to be done to prevent millions more HIV infections, officials say.
This will require even countries with low prevalence rates, including Bangladesh, Japan, and the Philippines, to commit to HIV prevention programs and funding, Sarkar says.
"All these countries can prevent the spread of the epidemic by early intervention, saturation of prevention programs for vulnerable communities and young people, political commitment, and increased or continued funding on HIV prevention programs," Sarkar says. "HIV is increasing in Japan among MSM and IDU communities, but the policies and programs have not been developed to reflect this increase."
It also will be a challenge for countries such as Thailand to prevent AIDS complacency from taking hold and resulting in a rebound of the epidemic.
"Success factors and a consequent slipping in prevention programs have been seen in the U.S. and in many European countries where more emphasis has been put on care," Sarkar explains. "The solution lies in continued prevention efforts both by governments and civil society, monitoring the changing dynamics of the epidemic and adjusting the response accordingly."
Meantime, the international community should continuously monitor and discuss the HIV epidemic at all high political forums, including G-8 summits, he suggests.
Reference
- A scaled-up response to AIDS in Asia and the Pacific. Produced by UNAIDS and UNAIDS Regional Support Team for Asia and the Pacific, Bangkok, Thailand. June 2005; 1-40. Web: www.unaids.org.
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