… BUt the Gains are UneVen and fraGile
Cambodia, india, myanmar and thailand have reduced their hiv infection rates with intensive, wide-reaching hiv prevention programmes among people who buy and sell sex.
in many other countries, increasing hiv prevention coverage and trends toward safer sexual and injecting behaviours are being observed.
Wider access to services that prevent new hiv infections among children has led to an overall 15% decrease in new hiv infections among children in asia and the Pacific since 2006. malaysia
and thailand are on track to eliminate new hiv infections among children.
the number of people receiving antiretroviral treatment in the region has tripled since 2006, reaching some 740 000 people at the end of 2009. Cambodia is one of only eight countries in the world that provides antiretroviral therapy to more than 80% of the people eligible for it.
there are courageous examples of legal and policy reforms aimed at reducing discrimination and stigma, and at building a more enabling
environment for effective action against the epidemic.
evidence shows that the most successful hiv programmes, policies and plans in the region are those that meaningfully involve key populations at higher risk and people living with hiv in their design and implementation.
Countries are increasingly responding to that evidence.
China, malaysia, Pakistan, samoa and thailand are funding the bulk of their response from domestic resources.
the hiv epidemic continues to outpace the response—there are still nearly two new hiv infections for every person who starts antiretroviral treatment.
sex work is continually evolving.
many interventions are missing new categories of mobile and informal sex workers. Critically, prevention programmes seldom reach out to clients of sex workers.
most programmes to protect men who have sex with men, people who inject drugs and their intimate partners from hiv infection are inadequate in size and scale—despite the strong examples of programmes that can effectively protect those populations against hiv.
Few specific hiv prevention programmes exist for young people among key populations at higher risk,
transgender people, migrants and intimate partners of people who have unsafe sex or who inject drugs.
access to antiretroviral therapy and prevention of new hiv infections among children lags behind global averages. less than one third of people who are eligible for these services were receiving them at the end of 2009; in south asia, where the largest number of people in need live, coverage was lower then elsewhere in the region.
access to affordable drugs and diagnostics for antiretroviral therapy and prevention of new hiv infections among children could be affected by the terms of free trade agreement negotiations.
stigma and discrimination against people living with hiv and key
populations at higher risk remains rife, including among health-care workers.
most (90%) countries in the region retain laws and policies or allow practices that effectively prevent people living with hiv, and key populations at higher risk, from accessing life-saving hiv services.
at around Us$ 1.1 billion at the end of 2009, aids spending in asia and the Pacific amounted to approximately one third of estimated funding needed to achieve universal access to hiv services.
international funding for aids is declining, yet many countries in asia and the Pacific depend heavily on foreign funding, particularly for provision of antiretroviral therapy.
HIV IN ASIA AND THE PACIFIC : GETTING TO ZERO 20
Philippines
safe behaviour in key populations at higher risk
32 94
Percentage of surveyed population who used a condom at last sex
female worKersseX
Percentage of female sex workers reporting the use of a condom with their most recent client
male worKersseX
Percentage of male sex workers reporting the use of a condom with their most recent client
men who have seX with men
Percentage of men who have sex with men reporting the use of a condom the last time inject drugs reporting the use of a condom the last time they had sexual intercourse
Percentage of people who inject drugs that used sterile injecting equipment at last use
Percentage of people who inject drugs reporting the use of sterile injecting equipment the last time they injected indonesia
all data are as reported in the UNAIDS Global Report on the AIDS Epidemic 2010, based on 2010 UNgass Country Reports.
it should be noted that although countries generally cited data from surveys in 2009, some countries cited data from 2007 and 2008.
the BiG pictUre
2003 2004 2005 2006 2007 2008 2009
1 million 2 million 3 million 4 million 5 million 6 million 7 million 8 million 9 million 10 million 11 million 12 million 13 million 14 million 15 million
receiving art receiving art
Public domestic funding
intnernational funding
eligible for art eligible for art
Proportion of public domestic and international funding in asia and the Pacific, low- and middle-income countries
number of people receiving and eligible for antiretroviral therapy (art) in asia and the Pacific versus total low - and middle-income countries, 2003-2009
53 %
47 %
east, soUth, soUth-east asia
total low- aNd middle-iNCome CoUNtRies
HIV IN ASIA AND THE PACIFIC : GETTING TO ZERO 22
the BiG pictUre
bold political leadership, country ownership and broad partnerships are critical for successful aids responses.
People living with hiv, and key populations at higher risk, need to be at the heart of responses.
to halt new hiv infections, countries must urgently expand prevention efforts and resources that focus on key populations at higher risk.
to end new hiv infections among children, comprehensive hiv prevention and treatment services need to be scaled up and use anti-retroviral regimens as recommended in the 2010 Who Guidelines.
to end aids-related deaths, countries must accelerate the expansion of access to antiretroviral therapy.
recent developments provide countries with a unique opportunity to catalyze a new phase in antiretroviral treatment.
— the treatment 2.0 approach, which aims to make antiretroviral therapy simpler and more effective, is a critical opportunity to catalyze a new phase in aids treatment.
— the 2010 World health organization (Who) treatment guidelines recommend initiations of antiretroviral therapy and improved treatment regimens.
— new evidence confirms that timely antiretroviral therapy greatly reduces hiv transmission.
to seize these opportunities, decisive and urgent action is needed to secure and expand affordable access to antiretroviral drugs.
Punitive and discriminatory laws, policies and practices that undermine the aids response and increase stigma must be removed. services must be responsive to the needs of women, men and transgender people of all ages.
aids funding is a shared
responsibility, across the region and globally. declines in international funding must be reversed, and all countries, in particular middle-income countries, in asia and the Pacific need to increase domestic public funding for aids, as well as for health and social protection in general.