HIV/AIDS IN ASIA 

An estimated 700,000 adults, 450,000 of them men, have become infected in South and South-East Asia in the year 2000. East Asia and the Pacific is mostly still keeping HIV at bay, with some 130,000 new infections this year. Overall, as of end 2000, the two regions combined are estimated to have 6.4 million people living with HIV/AIDS.

• In comparison with the rates of HIV infection in Africa, those in the general population of Asia are still low. The prevalence among 15-49-year-olds exceeds 1% in only three countries - Cambodia, Myanmar and Thailand. In other countries, it is often far lower. In Indonesia, the world's fourth most populous country, fewer than 5 people in 10,000 are living with HIV. In the Philippines, the rate of HIV infection is 7 per 10,000.
• Epidemics driven by unsafe drug-injecting practices dominate in some provinces of China, Malaysia, Nepal and Viet Nam. Recent reports suggest that a similar situation is emerging in Indonesia, notably Jakarta.
• According to some estimates, there are 3 million drug users in China. Needle-sharing appears common, with more than 45% of injectors sharing needles. HIV infection is reported among injecting drug users from 25 provinces. In both China and Viet Nam, 65-70% of detected HIV infections have been among injectors.
• In parts of north-east India, too, widespread injecting drug use provided an early entry point for HIV. In Manipur, the prevalence of HIV infection among injecting drug users shot up from virtually nothing in 1988 to over 65% just four years later. It has remained at these high levels ever since. Most cases of infection among women appear to have been acquired from husbands who had been infected in turn by sex workers, themselves part of a longer chain of transmission. In other parts of the country, there is evidence that unsafe sex is spreading HIV within the general population.

• With 100 million people or more on the move, China is experiencing population movement that dwarfs any other in recorded history. In addition, having practically eradicated sexually transmitted infections by the 1960s, China is now seeing a steep rise in these rates over the last several years. Reported cases increased from 5,800 in 1985 to over 836,000 in 1999.
• China and India between them account for around 36% of the world's population. With such huge populations, even low HIV prevalence rates translate into huge numbers of infections. In India, where only 7 adults in 1000 are infected, 3.7 million people were living with HIV/AIDS at the beginning of the millennium - more than in any other country in the world except South Africa. In both China and India, the epidemic varies widely from region to region, both in size and in method of transmission.
• Countries where HIV has spread significantly through unsafe sex include Cambodia, Myanmar and Thailand.
• Thailand's well-publicized success in curbing a rampant heterosexual epidemic has brought to light other routes of transmission against which HIV prevention programmes have been far less successful. HIV continues to spread virtually unchecked through the sharing of drug-injecting equipment and through unprotected sex between men.
• Myanmar is already in the throes of a major epidemic while Cambodia has the highest HIV prevalence rates in the region, fuelled by sexual transmission against a background of social and economic fragility.
• Viet Nam's HIV epidemic, until now largely confined to the south and the central provinces, has expanded to the northern provinces as well. There, as in the rest of the country, the virus is spread through injecting drug use and there is ample evidence of steadily increasing sexual transmission.
• A number of factors have played a significant role in the spread of HIV in Asia and are likely to continue having an impact: injecting drug use, commercial sex, literacy, dependency, access to information and services, migration and population mobility.

December 2000

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