HIV prevention and Antiretroviral treatment in Asia

HIV prevention in Asia

HIV prevention sign in Ho Chi Minh City, Vietnam

Asia has been the base for some extremely successful large-scale HIV prevention programmes. Well-funded, politically supported campaigns in Thailand and Cambodia have led to significant declines in HIV-infection levels, and HIV prevention aimed at sex workers and their clients has played a large role in these achievements. In Tamil Nadu, India, HIV prevention initiatives have had a substantial impact.
High-profile public campaigns discouraged risky sexual behaviour, made condoms more widely available, and provided STI testing and treatment for people who needed them. These efforts resulted in a large decline in risky sex.¹
Successes such as these prove that interventions can change the course of Asia's AIDS epidemics. As HIV infection rates continue to grow however, it's clear that more needs to be done. The groups most at risk of becoming infected – sex workers, IDUs, and MSM – are all too often being neglected. For instance, although injecting drug use is one of the most common HIV transmission routes in Asia, it is estimated that less than one in ten IDUs in the region have access to prevention services.² Similarly men who have sex with men are overlooked and poorly monitored by most governments, even though it is firmly established that this group play a significant role in some countries’ epidemics.³

"In countries without laws to protect sex workers, drug users, and men who have sex with men, only a fraction of the population has access to prevention. Conversely, in countries with legal protection and the protection of human rights for these people, many more have access to services. As a result, there are fewer infections, less demand for antiretroviral treatment, and fewer deaths. Not only is it unethical not to protect these groups: it makes no sense from a health perspective." - Secretary-General Ban Ki-moon, speaking at the opening address to the International AIDS Conference⁴

It is not only legal barriers that are preventing people from accessing effective HIV prevention; problems also arise when prevention programmes do not contain information that will be most useful. For example, young people in Asia are generally not taught about the kinds of behaviours that put this group most at risk: unprotected sex through sex work, injecting drug use, and sex between men. Instead they focus on heterosexual transmission and reproductive health, which have a limited impact on preventing new HIV infections among young people in Asia.⁵
The coverage of prevention of mother-to-child transmission (PMTCT) services is also very low in Asia. In East, South and South-East Asia, around 12% of pregnant women were offered an HIV test in 2008 - a very low percentage compared to other regions of the world such as Europe and Central Asia (65%) and sub-Saharan Africa (28%).⁶ In 2008 across East, South and South-East Asia, only 25% of HIV-infected pregnant women received ARVs to prevent mother-to-child transmission of HIV.⁷
See our HIV prevention around the world page for more about efforts to stem the spread of HIV in Asia and other parts of the world.
Due to the stigma that often surrounds those groups most at risk of HIV infection, coverage of HIV voluntary counselling and testing (VCT) services in South-East Asia remains very low. An estimated 0.1% of the adult population in the region received testing and counselling in 2005.⁸ Certain countries are making progress, however; testing services in India have been expanded with about 3600 testing centres now open to the public.⁹ Even so, far more needs to be done across Asia to ensure VCT is available to those most at risk of acquiring HIV.

Antiretroviral treatment in Asia

An HIV positive man sitting at home in Cambodia
before taking his antiretroviral treatment

The availability of antiretroviral treatment more than tripled between 2003 and 2006 in Asia.¹⁰ Although this seems encouraging, only just over a third of people in the region who are in need of HIV treatment are receiving it.¹¹ In addition, access to HIV treatment varies widely across the region. Cambodia and Thailand have an estimated treatment coverage of between 50-75 percent, whilst estimated treatment coverage in Malaysia and the Philippines ranges between 31-50 percent.¹²
A major barrier to treatment access is the high cost of antiretroviral drugs, as both first- and second-line drugs are still unaffordable to many governments. Cheaper generic drugs are now produced by a number of pharmaceutical manufacturers in Asia, and together with the increasing availability of lower-cost branded ARVs, it will be easier for governments to obtain and distribute the drugs. Yet even where drugs are available, the poor state of healthcare in many Asian countries, particularly a shortage of trained doctors, is hindering governments' abilities to organise life-long treatment programmes for millions of people living with HIV.¹³

Sources:

1. MAP (2004) 'AIDS in Asia: Face the Facts'
2. Reuters (2007, May 14th) 'Asian drug users need more HIV prevention help'
3. UNAIDS (2008) ‘Report on the global AIDS epidemic’
4. UN News Centre (2008) 'Address to the International AIDS Conference', Secretary-General Ban Ki-moon's speech.
5. UNICEF (2009), ‘Preventing HIV with young people: the key to tackling the epidemic’
6. WHO/UNAIDS/UNICEF (2009) 'Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector'
7. WHO/UNAIDS/UNICEF (2009) 'Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector'
8. WHO (2007), 'HIV/AIDS in the South-East Asia Region' [PDF]
9. UNAIDS (2007) 'ASIA; AIDS epidemic update Regional Summary' [PDF]
10. UNAIDS (2006) 'Asia factsheet'.
11. WHO/UNAIDS/UNICEF (2009) 'Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector'
12. WHO (2008), "Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector"
13. AMFAR/TREAT Asia (2004), ‘Expanded Availability of HIV/AIDS Drugs in Asia Creates Urgent Need for Trained Doctors’