1.10. HIV/AIDS

Although the first cases of AIDS in Asia were reported Over the past decade, many countries in the Asia/ in 1984 and 1985, the more extensive spread of HIV began Pacific region responded to HIV/AIDS successfully and inci- late compared with the rest of the world, occurring in dence rates have declined. Between 2001 and 2012, new Cambodia, India, Myanmar and Thailand in the early 1990s incidence cases were reduced by half in Nepal, Cambodia, (Ruxrungtham et al., 2004). Asia is second only to sub-Saharan Myanmar, Thailand and India and these countries also Africa as the region with the greatest number of people reduced prevalence rates (UNAIDS, 2013b; Figure 1.10.3). with HIV.The UN set a MDG target to halt the spread of HIV However, prevalence rates had increased rapidly in Pakistan, by 2015. and also in Indonesia, the Lao PDR and the Philippines dur- In the Asia/Pacific region, the prevalence of HIV infec- ing the same period. tion was 217 per 100 000 population in 2012 (Figure 1.10.1, Targeted efforts are needed to contain the spread of left panel). Prevalence in Pacific countries was generally very HIV in the region as most of Asia’s epidemics occur among low, although Papua New Guinea was an exception at 349 per sex workers and their clients, men who have sex with men, 100 000 population. Thailand and Cambodia had an HIV prev- transgender persons and injecting drug users. In Cambodia alence exceeding 500 per 100 000 population. Myanmar and Thailand, the majority of female sex workers have also has a comparatively high rate of close to 400 per reported the consistent use of condoms since the early 100 000 population. This is in contrast to countries where 2000s, and this wide coverage has contributed to substan- rates are less than one-tenth of that figure – Bangladesh, tial reductions in new HIV cases in these countries in recent Japan, Sri Lanka, the Philippines and the Republic of Korea years (UNAIDS, 2013b). HIV is also spreading through trans- – with the rate less than 40 per 100 000 population. mission to the sexual partners of those at risk, often Although the prevalence of HIV is low, the absolute unknowingly. Hence, HIV testing and counselling need to be number of HIV infections was high at 4.8 million in 2012, expanded in countries. because of Asia’s large population (Figure 1.10.1, right panel). More than 40% of them (about 2.1 million people) were in India. China, Indonesia, Thailand, Viet Nam and Definition and comparability Myanmar also face significant disease burdens. In 2012, Human immunodeficiency virus (HIV) is a retrovirus there were about 350 000 new infections and 260 000 deaths that destroys or impairs the cells of the immune in the region and a high number of new cases and deaths system. As HIV infection progresses, a person were observed in India (130 000 and 140 000, respectively) becomes more susceptible to infections. The most and Indonesia (76 000 and 27 000 ) (UNAIDS, 2013b). advanced stage of HIV infection is acquired Expanded access to antiretroviral therapy (ART) has immunodeficiency syndrome (AIDS). It can take increased the survival rates of people living with HIV, but 10-15 years for an HIV-infected person to develop about half of the people eligible for HIV treatment do not AIDS, although antiretroviral drugs can slow down the receive it worldwide (UNAIDS, 2013a). Among people living process. with HIV eligible for ART, less than 20% in Pakistan and The HIV prevalence rate is the total number of Indonesia received ART treatment in 2012 (Figure 1.10.2). In persons estimated to be living with the disease at a India, the country with the greatest disease burden, only particular time, per 100 000 population. In some half of the people living with HIV eligible for ART received countries, only upper and lower limit estimates are the treatment. In Hong Kong, China; Japan; Papua New available. Guinea and Cambodia, however, ART coverage was high at over 80%.

32 HEALTH AT A GLANCE: ASIA/PACIFIC 2014 © OECD/WHO 2014 1.10. HIV/AIDS

1.10.1. Estimated persons living with HIV, 2012

Upper limit Estimate Lower limit Prevalence (all ages) Living with HIV (all ages)

659 Thailand 440 511 Cambodia 76 379 Myanmar 200 349 Papua New Guinea 25 286 Viet Nam 260 280 Malaysia 82 247 Indonesia 610 217 Asia14 4 722 181 Lao PDR 12 178 Nepal 49 India Fiji 0 Australia 57 China 780 Pakistan Singapore New Zealand 0 Korea, Rep. 16 Philippines 15 14 Sri Lanka 3 Japan 5 Bangladesh 8 1 000 800 600 400 200 0 0 1 000 2 000 3 000 4 000 5 000 Per 100 000 population Number

Source: UNAIDS (2013a).

1.10.2. Estimated antiretroviral therapy coverage among 1.10.3. Changes in estimated new cases of HIV infections people with advanced HIV infection, 2012 and people living with HIV, 2001-12

Incidence Prevalence

Hong Kong, China 97 Bangladesh 100 Japan 96 Pakistan 726 Papua New Guinea 84 770 Indonesia 162 Cambodia 82 635 China 76 Lao PDR 264 Thailand 76 Philippines Philippines 76 178 Viet Nam -58 Viet Nam 58 63 Asia16 55 Sri Lanka 58 Australia 55 Malaysia 19 Lao PDR 54 52 Papua New Guinea India 51 14 Myanmar 46 Asia9 -33 4 Fiji 42 Nepal -87 Malaysia 41 -2 Myanmar -72 Sri Lanka 35 -9 Nepal 33 India -50 -13 Bangladesh 27 Cambodia -77 Indonesia 18 -31 -63 Pakistan 14 Thailand -33 020406080100 -100100 300 500 700 900 % %

Source: UNAIDS (2013a); Ministry of Health, China (2012). Source: UNAIDS (2013a). 1 2 http://dx.doi.org/10.1787/888933152606

HEALTH AT A GLANCE: ASIA/PACIFIC 2014 © OECD/WHO 2014 33 From: Health at a Glance: Asia/Pacific 2014 Measuring Progress towards Universal Health Coverage

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Please cite this chapter as:

OECD/World Health Organization (2014), “HIV/AIDS”, in Health at a Glance: Asia/Pacific 2014: Measuring Progress towards Universal Health Coverage, OECD Publishing, Paris.

DOI: https://doi.org/10.1787/health_glance_ap-2014-14-en

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