How is HIV transmitted in Asia?

 In the early to mid-1980s, while other parts of the world were beginning to deal with serious HIV and AIDS epidemics, Asia remained relatively unaffected. By the early 1990s, however, AIDS epidemics had emerged in several Asian countries, and by the end of the decade, HIV was spreading rapidly in many areas of the continent.

Activists campaigning against HIV-related discrimination in India

Today, around 4.7 million people are living with HIV in Asia.¹ Although national HIV prevalence rates in Asia appear to be relatively low, the populations of some Asian countries are so vast that these low percentages actually represent very large numbers of people living with HIV. India, for example, has an estimated HIV prevalence of 0.3%, which seems low when compared to prevalence rates in some parts of sub-Saharan Africa. However, with a population of around one billion, this actually equates to 2.5 million people living with HIV in India.²
Although it is useful to understand the overall impact that AIDS is having on the Asian region as a whole, there is no single ‘Asian epidemic’; each country in the region faces a different situation. Progress has been made in countries such as Cambodia, Myanmar and Thailand, where there has been evidence of a decline in HIV prevalence. On the other hand, in Indonesia, Pakistan and Vietnam the number of people living with HIV has increased.³
Some have warned that epidemics in Asia could escalate to the extent of rivaling those in some parts of Africa. Others, however, argue that Asia's epidemics are on a different trajectory to those found in Africa, as HIV infection in Asia is still largely concentrated among members of 'high-risk' groups.

There are three main HIV transmission routes in Asia:

• Unprotected paid (and unpaid) sex. Unprotected sex, both paid and unpaid, accounts for a significant share of new HIV infections in many Asian countries. A large number of men buy sex regularly and the level of condom use during paid sex in many countries is still low. These factors have contributed to a high HIV prevalence among sex workers and their clients across Asia. In addition, an increasing number of women who are married and considered ‘low-risk’ of HIV infection are becoming infected with HIV.⁴ Estimates suggest that around 25-40 percent of new HIV infections in several Asian countries are among wives and girlfriends of men who became infected through paid sex, having sex with other men or injecting drugs.⁵

• Injecting drug use. Injecting drug use is a major driving factor in the spread of HIV throughout Asia, notably in China, Indonesia, Malaysia and Vietnam. In China, nearly half of all people infected with HIV are believed to have become infected through injecting drug use, and in North-East India injecting drug use is the most common HIV transmission route.⁶ There is often an overlap between communities of IDUs and communities of sex workers in Asia, as those who sell sex may do it to fund a drug habit, or they may have become involved in sex work first before turning to drug use.

• Sex between men. Sex between men accounted for some of the earliest recorded cases of HIV in Asia, and transmission through this route is still a prominent feature of many countries’ epidemics. Most men who have sex with men (MSM) in Asia do not identify themselves as gay because of cultural norms that discourage homosexuality; in some cases they may even be heads of families, with children.⁷ This means that MSM can serve as a ‘bridge’ for HIV to spread into the broader population. HIV outbreaks are becoming evident among MSM in Cambodia, China, Nepal, Pakistan, Thailand and Vietnam.⁸

Mother-to-child transmission is also a significant HIV transmission route in Asia. At the end of 2007, it was estimated that 140,000 children in South and South-East Asia, and 7,800 children in East Asia, were living with HIV, most of whom became infected through mother-to-child transmission.⁹

Sources:

1. UNAIDS (2009) ‘Report on the global AIDS epidemic’
2. UNAIDS (2008) ‘Report on the global AIDS epidemic’
3. UNAIDS (2008) ‘Report on the global AIDS epidemic’
4. UNAIDS (2009) 'HIV transmission in intimate partner relationships in Asia'
5. The Commission on AIDS in Asia (2008) ‘Redefining AIDS in Asia: Crafting an effective response’.
6. UNAIDS (2008) ‘Report on the global AIDS epidemic’
7. UNAIDS (2006) 'HIV and men who have sex with men in Asia and Pacific'
8. UNAIDS (2008) ‘Report on the global AIDS epidemic’
9. UNAIDS (2008) ‘Report on the global AIDS epidemic’