Satudunia, Bali. AIDS is widely acknowledged as a global health and development emergency and is one of the defining issues of our time. In the early to mid-1980s, while the other parts of the world were beginning to deal with serious HIV and AIDS epidemics, Asia remained relatively unaffected by this newly discovered health problem. By the early 1990s, however, AIDS epidemics had emerged in several Asian countries and by the end of that decade; HIV was spreading rapidly in many areas of the continent.
According to the UNAIDS Global AIDS Epidemic Report, there are 5 million people living with HIV in Asia (1,2). The epidemic varies considerably across this diverse region, in terms of the populations most affected, transmission patterns, and other factors. Prevalence rates (the percent of the population living with HIV) in Asia are highest in South-East Asia, and range by country, from 0.1% or less in a number of countries, including Bhutan, China, the Republic of Korea, and Mongolia, to a high of 1.4% in Thailand (1,2). While prevalence rates in the region are relatively low, Asia accounts for 15% of all people living with HIV and AIDS worldwide, largely due to epidemics in the populous countries of China and India where even small rates translate into high numbers of people. Smaller countries such as Thailand, Cambodia, and Myanmar face more intense epidemics, with higher prevalence rates, although each of these countries has experienced declines in recent years. Others, including Indonesia, Pakistan, and Vietnam, face growing epidemics (1,3,4).
Several factors complicate country responses to the epidemic in Asia, including poverty, stigma, discrimination, gender inequalities, human trafficking, worker migration, and lack of access to education and health care (1,3,4,5). Also, inadequate HIV and AIDS surveillance systems and limited government capacity and/or attention to HIV and AIDS have hindered responses in some countries (5,6). Despite these challenges, several countries have made remarkable strides in treatment and prevention efforts. Country responses have included the creation of national AIDS coordinating bodies, national strategic plans, and participation in regional network (5,6).
HIV in Asia is spread primarily through sex, with commercial sex largely driving transmission in much of the region. Injecting drug use is a major risk factor in several Asian countries and there is growing concern about the overlap of sex work and injecting drug use as well as the transmission of HIV to the partners of those infected through commercial sex1. Finally, sex between men contributes to HIV transmission, particularly in Thailand and Vietnam. Regional data show prevalence rates among men who have sex with men (MSM) are also high in parts of Indonesia, Cambodia, and India, but more research is needed to understand the extent of its impact.
Mostly in the countries like Nepal, Cambodia Thailand, India, and Indonesia female sex workers are the most affected group. Male having sex with male also face the significant risk of HIV although much study has not been carried out. Data show prevalence rate among this population range from a low of 0.2% in Bangladesh to more than 20% in Thailand (1,7). Injecting drug use plays a major role in the epidemics of Afghanistan, Bangladesh, India, Pakistan, and Vietnam. Also, nearly half of those living with HIV and AIDS in China are believed to have been infected through injecting drugs and more than two-thirds of HIV infections to date in Malaysia have been among injecting drug users (1). More than one-third (35%) of adults (aged 15 and older) living with HIV and AIDS in Asia are women, a proportion that has remained relatively stable in recent years 1. In 2007, an estimated 147,800 children under the age of 15 were living with HIV in Asia; 23,000 were newly infected in 2007 (1,2).
The HIV and AIDS epidemic in the Asian Region is not only a serious health problem but also has important economic and social implications. Since young people and children are more likely to be infected by HIV, the potential loss of human capital and earning potential is immense. The spread of HIV is linked with poverty through both cause and effect. While widespread poverty and unequal distribution of income stimulate the spread of the disease, HIV infection in households exacerbates poverty and social inequality, creating conditions for a larger epidemic in the Region. Breaking the vicious circle is essential for improving the quality of life across the Region (9).
HIV related stigma and discrimination undermine Asia’s responses to the epidemic, preventing people from using a range of important services. Discrimination among people living with HIV affects their access to employment, housing, insurance, social service, education, health and inheritance rights for men and women. In some countries, a strong prejudice against people living with HIV has been found in health services.
By: THE 9th ICAAP at Nusa Dua, Bali
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