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Transcript of May 24, 2010
May 24, 2010
JVR Prasada RaoSpecial Advisor to UNAIDS Executive DirectorInternational Epidemiological Association Meeting, Colombo
May 24, 2010
Can Asian Countries halt and reverse Can Asian Countries halt and reverse the AIDS epidemic by 2015?the AIDS epidemic by 2015?
2May 24, 2010
There is an increased understanding of There is an increased understanding of the Asian epidemicsthe Asian epidemics
The principal modes of HIV transmission HIV is generally concentrated among certain populations. Infections appear first among IDUs, SWs and Clients, and MSM, but
then it spreads to wives and children The driving forces of Asian epidemics
sharing of needles during Injecting Drug Use – kick-starts and accelerates the epidemic
unprotected Commercial sex – gives it range and power Sexual networking among Asian men markedly higher than women
Projections into the future based on various scenarios
UNAIDS
3May 24, 2010UNAIDS
The HIV epidemic in Asia The HIV epidemic in Asia appears to be slowing down overallappears to be slowing down overall
Adults and children living with HIV
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
# H
IV+
in T
ho
usa
nd
s
Year
Adults & Children S & SE Asia Adults & Children East Asia
Source: 2009 AIDS Epidemic Update. UNAIDS, WHO, 2009
4May 24, 2010UNAIDS
However, new infections However, new infections in different countries and their sub-regions differin different countries and their sub-regions differ
Indonesia
0
50,000
100,000
150,000
200,000
New
infe
ctio
ns in y
ear
Cambodia
0
5,000
10,000
15,000
20,000
New
infe
ctio
ns in
yea
r
0
100,000
200,000
300,000
400,000
Clients Sex workers MSM IDU
Lo-risk male Lo-risk female Children
Myanmar
0
25,000
50,000
75,000
Ne
w in
fectio
ns in
ye
ar ..based on how effectively
prevention targets new infections
Source: Commission on AIDS in Asia 2008
5May 24, 2010UNAIDS
For the first time the CAA For the first time the CAA estimated the large numbers of people at risk of estimated the large numbers of people at risk of HIV infection in AsiaHIV infection in Asia
Asian Population: 3.3 billion
WomenMen
75 million Men in Asia visit
sex workers
(2-20% of adult men)
50 million Women married to men who visit
sex workers
4 millionMen who
inject drugs
16 millionMen who have sex with men
10 millionWomen sell sex
1 million infants and
children
6April 19, 2023UNAIDS
A causal model showing linkages A causal model showing linkages among factors that influence HIV transmission among factors that influence HIV transmission in intimate partners relationshipsin intimate partners relationships
7May 24,2010UNAIDS
“ “People on the Move” in Asia’s fastest growing economies - People on the Move” in Asia’s fastest growing economies - China, India, Indonesia, Malaysia, Thailand, and VietnamChina, India, Indonesia, Malaysia, Thailand, and Vietnam
Asia was host to 26.3 million migrants, or about 13.8 per cent of the world's total migrant stock, in 2005 (University of Sussex and the World Bank) Malaysia and Thailand are expected to absorb large numbers of foreign
workers considering the economic growth prospects Asia an important source of international migration, sending 54.2 million
migrants abroad or 28.4 per cent of the world's total (ibid) By 2030, India and China are projected to account for 40 per cent of the
global workforce (World Migration Report 2008) Sri Lanka, Philippines and Indonesia contribute a large female work force
working abroad Gendered dimension of migration – the numbers of women migrating from
the six countries will continue to rise - particularly as domestic workers, care givers, service employees, moving across borders and within the country
Source: AIDS 2031. UNAID, 2009
8May 24, 2010UNAIDS
This migration and mobility This migration and mobility exposes migrants to HIV risk .. particularly exposes migrants to HIV risk .. particularly internal rural-urban migrationinternal rural-urban migration• Commercial sex work is concentrated in
areas of circular migrants – more Clients• Large numbers of rural female migrants
moving to urban areas engage in the entertainment industry – more FSWs
• Expands the triangular sexual networks of migrants, both the men and the women
• Lack of access to health services, particularly those living outside their countries
9May 24, 2010UNAIDS
Mobile men can be more Mobile men can be more vulnerable to HIV infectionvulnerable to HIV infection
Percentage of non-mobilenon-mobile / mobilemobile men paying for sex in the past 12 months (FHI 2006)
China Cambodia Indonesia Viet Nam
9%
15%
4%2%
33% 33%
21%
32%
10May 24,2010UNAIDS
The epidemic data show this emerging The epidemic data show this emerging dynamic of HIV spread - about 200,000 more Asian dynamic of HIV spread - about 200,000 more Asian women are living with HIV in 2008 compared to 2001women are living with HIV in 2008 compared to 2001
Regional Trends in People living with HIV
180 290
1,200 1,300
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
# H
IV +
in
Th
ou
san
ds
YearWomen S&SE Asia Women East AsiaAdults & Children S&SE Asia Adults & Children East Asia
Source: 2009 AIDS Epidemic Update. UNAIDS, WHO, 2009
11May 24, 2010UNAIDS
People are still dying of People are still dying of AIDSAIDS in Asia – in Asia – an estimated 330,000 deaths in 2008 an estimated 330,000 deaths in 2008
HIV-related Deaths of Adults and Children
-
50
100
150
200
250
300
350
1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
# D
ea
ths
in
Th
ou
sa
nd
s
Year
Deaths Adults & Children S & SE Asia Deaths Adults & Children East Asia
Source: 2009 AIDS Epidemic Update. UNAIDS, WHO, 2009
12May 24, 2010UNAIDS
The Asia Commission projections suggest that we The Asia Commission projections suggest that we are at a cusp in the epidemic progression…are at a cusp in the epidemic progression…
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
New
infe
ctio
ns in
yea
r
Clients Sex workers MSM IDU
Lo-risk male Lo-risk female Children
where a resurgent epidemic …
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
New
infe
ctio
ns in
yea
r
Clients Sex workers MSM IDU Lo-risk male Lo-risk female Children
can be avoided if prevention and treatment reach universal coverage
Source: Commission on AIDS in Asia 2008
13May 24, 2010UNAIDS
Better information but the response Better information but the response is laggingis lagging
• Response is a mixed picture country to country and provinces within the same country ( in India and China ).
• There are excellent prevention efforts, but not to scale.
• Babies are still getting infected - PM TCT coverage in the region is very low ( 25%)
• If reducing the new infections to half by 2015 is the goal, many countries need to act fast.
14May 24, 2010UNAIDS
HIV prevalence among IDUs in Bangkok, 2000-2009
HIV prevalence among MSM in Thailand, 2003-2007
Source: Bureau of Epidemiology, Thailand Ministry of Public Health
Thailand's early successes in reducing sex work-related infections, have given way to increasing infections among IDUs and MSM
15May 24, 2010
UNAIDS
HIV prevention coverage among IDUs, HIV prevention coverage among IDUs, 2005-20092005-2009
* Calculated median value
Source: UNGASS country progress report_2006, 2008 & 2010
2009 data is provisional
16May 24, 2010UNAIDS
HIV prevention coverage among MSM HIV prevention coverage among MSM 2005-20092005-2009
Source: UNGASS country progress report_2006, 2008 & 2010
* Calculated median value
2009 data is provisional
17May 24, 2010UNAIDS
PMTCT coverage, 2006-2009PMTCT coverage, 2006-2009
Source: UNGASS country progress report_2006, 2008 & 2010
2009 data is provisional
18May 24, 2010UNAIDS
Enabling environment and unseen Enabling environment and unseen challengeschallenges
• Political leaders in Asia must be credited for seeing the danger of a looming epidemic and acting early ...
• But, the political rhetoric is often not translated into measurable programme outputs which have an IMPACT on the epidemic.
• Disturbing trend of reversal of earlier gains – new legislations in countries like Cambodia which enhance stigma. New conservatism around issues like sex work, male to male sex …
• Impact mitigation is the missing piece. No effective measure to mitigate the effects of stigma and discrimination. No earmarked funding.
19May 24, 2010UNAIDS
No country spends enoughNo country spends enough
Vietnam
Thailand
Sri LankaBangladesh Pakistan
Nepal MyanmarChina IndiaIndonesia
Cambodia
Philippines0
1
2
3
0.00% 0.50% 1.00% 1.50%
HIV prevalence (%)
reso
urce
per
cap
ita (
$)
With a normative value of $1 per capita, 9 countries still fell short on resource commitment to AIDS programmes
The region needs $ 3.2 bn for reversing the epidemic, The region needs $ 3.2 bn for reversing the epidemic, but availability hovers around $ 1.2 bn.but availability hovers around $ 1.2 bn.
Source :Commission on AIDS in Asia 2008
20May 24, 2010UNAIDS
SourcesSources of AIDS funding, selected countries of AIDS funding, selected countries
Source: UNGASS country progress report 2010
21May 24, 2010UNAIDS
Percent distribution of Percent distribution of AIDS spending per key area, selected countriesAIDS spending per key area, selected countries
Source: UNGASS country progress report 2010
22May 24,2010UNAIDS
The brighter side The brighter side • Countries understand the need for information and are starting
to generate more data and fill data gaps.• Behavioral surveys are identifying and characterising the risk
factors.• Successful interventions which can bring down new infections
effectively have been demonstrated. • Stronger health system support for treatment and PMTCT
programmes is resulting in fast scale up. Treatment coverage increased impressively to 565,000
• Good scale up in resources - GF and PEPFAR and BGMF as new donors have added much needed resources.
• Social environment changing in countries like India and Nepal with a proactive judiciary leading the way to social reforms.
23May 24, 2010UNAIDS
Strategic information systems are improving across Strategic information systems are improving across the region and risk factors better understoodthe region and risk factors better understood
% of countries with HIV prevalence surveys among populations at higher risk, in the last 2 years (2009)
24May 24, 2010UNAIDS
HIV prevention coverage is improving HIV prevention coverage is improving across most the regionacross most the region
* Calculated median value
Source: UNGASS country progress report_2006, 2008 & 2010
2009 data is provisional
25May 24, 2010UNAIDS
ART coverage is scaling up fast ART coverage is scaling up fast in many countriesin many countries
ART coverage among adults and children, 2006-2009
Source: UNGASS country progress report_2006, 2008 & 20102009 data is provisional
* Only for adults
26May 24, 2010UNAIDS
The MARPs agenda- opening the doors The MARPs agenda- opening the doors for social sector reform for social sector reform
• Acceleration of gender and HIV activities in the region By the end of 2009, 3 countries had gender reviews of their
NSPs and 2 policies for systematic inclusion of gender. 4 more countries currently working on them.
Regional Report on Intimate Partner Transmission of HIV was launched at 9th ICAAP based on analysis in 13 countries
27May 24, 2010UNAIDS
The MARPs Agenda – opening the doors for The MARPs Agenda – opening the doors for social sector reform .. ( cont’d )social sector reform .. ( cont’d )
• UNAIDS Agenda for Women and Girls to be promoted in 2010 to support engendering of new National Strategic AIDS Plans and Global Fund Grants.
• Social environment changing in countries like India and Nepal with a proactive judiciary leading the way to social reforms.
• Establishment or improvement of remedial instruments and legal reform, and agencies where PLHIV can seek redress and legal services.
28May 24, 2010UNAIDS
Empowerment of positive peopleEmpowerment of positive people
• Strong networking of PLHAs in most Asian countries and linking with Regional body APN+
• Representation on NACs and CCMs at national level.• Core funding for organizational development to APN+ from
UNAIDS• Involvement in development of strategies for prevention of Intimate
Partner Transmission • HIV Bill in India to guarantee the rights of positive people• Stigma Index roll out commenced in 2008 with PLHIV groups
involvement. Five countries completed the index and are disseminating
findings (Sri Lanka, Bangladesh, China, Myanmar and Thailand). Seven more countries (Cambodia, Fiji, Malaysia, Pakistan,
Philippines, PNG and Viet Nam) implementing index through PLHIV networks with universities support.
29May 24, 2010UNAIDS
Global Fund Round 6 & 8 HIV spending in Global Fund Round 6 & 8 HIV spending in Asian countries: Priority areasAsian countries: Priority areas
30May 24, 2010UNAIDS
Global Fund Round 9 HIV spending in Global Fund Round 9 HIV spending in 6 Asian countries: Priority areas6 Asian countries: Priority areas
Source: Global Fund Round 9 budget tracking_2010
Treatment &
31April 19, 2023UNAIDS
Why is this the right Why is this the right time to act?time to act?
32
Country MDG Goal 4 MDG Goal 5 MDG Goal 6
Under-5 mortality
Maternal mortality
Antenatal care
At least once birth by skilled
professional
HIV prevalence
TB incidence
TB prevalence
China
India
Indonesia
Myanmar
Thailand
Vietnam
May 24, 2010UNAIDS
Countries with highest prevalence in Asia show Countries with highest prevalence in Asia show good progress on MDG 6 targets for HIV and TB, good progress on MDG 6 targets for HIV and TB, but less progress on infant and maternal targets MDGs 4 & 5but less progress on infant and maternal targets MDGs 4 & 5
Early achiever On track Slow Regressing/No progress
Source: UNESCAP, ADB & UNDP_ Achieving the millennium development goals in an era of global uncertainty_2010
33May 24, 2010UNAIDS
Source: UNESCAP, ADB & UNDP_ Achieving the millennium development goals in an era of global uncertainty_2010
With 2015 MDG targets approaching, With 2015 MDG targets approaching, HIV and AIDS interventions should be integrated into HIV and AIDS interventions should be integrated into Health Systems strengtheningHealth Systems strengthening
34May 24, 2010UNAIDS
UN is reinforcing its roleUN is reinforcing its role
• AIDS affords an opportunity for the UN system to deliver as ONE
• The one programme where this has been successfully done was the AIDS programme where the secretariat and the 10 Co-Sponsors work together in a joint programme to provide support to countries.
• This needs to be intensified, taking advantage of the Outcome Frame Work of UNAIDS and the Division of Labour between agencies.
35May 24, 2\010UNAIDS
What needs to be done in Asia and the Pacific?What needs to be done in Asia and the Pacific? In the next 5 years,• Understand the characteristics of the epidemic and tailor the response.• AIDS should get to the top of the agenda for activists and social reformers
It provides a platform for civil society no other movement was able to provide earlier.
• Focus on programmes that produce impact and results, and don’t waste money on low impact interventions.
• Coverage and scale up is the Mantra - Attempt and attain more than 80% coverage of populations who need prevention and treatment services.
In the long term,• impact mitigation is the key
special focus on orphans and women. AIDS related stigma and discrimination should be wiped out. CAA estimated that for the entire Asia they are not going to cost more
than $ 300 m per year.
36May 24, 2010UNAIDS
Thank you!Thank you!
Acknowledgements
• UNAIDS RST• HIV and AIDS Data Hub for Asia and the
Pacific www.aidsdatahub.org