The Status and Trends of HIV/AIDS/STI Epidemics in Asia and the Pacific

HIV/AIDS in Asia and the Pacific

Since its relatively late introduction in the Asia Pacific region, HIV has made substantial inroads. Yet the epidemic situation still varies dramatically between and within countries.

The extent of HIV infection among pregnant women is often used as an indicator of HIV's penetration into the population at large. By this yardstick, several Asian countries have seen serious epidemics. India now has many surveillance sites with more than two percent of pregnant women infected, some rising as high as six percent. Myanmar as well has recorded prevalence rates of up to five percent among pregnant women in some areas in the country. In Thailand, prevention efforts curbed new infections so that prevalence among pregnant women peaked at just over two percent nationally. Infection levels in Cambodia reached above three percent before rates began falling thanks to prevention efforts similar to those in Thailand.

Other parts of Asia have seen only limited HIV spread thus far. In Bangladesh, Hong Kong, Laos, Philippines and South Korea, HIV levels in 2000 were still low in virtually all groups. Unfortunately, there is no guarantee that HIV will remain low indefinitely. After more than a decade of comparatively low HIV infection levels in most population groups, there is recent evidence of rapidly growing epidemics in some populations and geographic areas. A number of countries -- e.g., China, Indonesia and Vietnam -- are now experiencing explosive epidemics in different population groups.

Some find reassurance in the fact that only three Asian countries -- Cambodia, Myanmar and Thailand -- have registered nationwide prevalence rates over one percent thus far, as compared with national rates ten or more times higher in some African countries. Unfortunately, national averages are not particularly meaningful in the Asian context where epidemics may have yet to mature. First of all, they mask the uneven geographic spread of HIV. Because of the typical pattern of individual-to-individual spread of the virus through sex and needle sharing, HIV epidemics always begin as geographically localized outbreaks and only later diffuse out over wider areas of the country. Secondly, when an epidemic is concentrated in a certain group, it is misleading to take HIV prevalence in the general population as an indicator of severity. In Myanmar, for example, national HIV rates currently registered in injecting drug users and sex workers are as high as 60 percent and 40 percent, respectively, compared with an estimated national prevalence of only 2 percent.

Lastly, national figures are meaningless in huge countries such as China, India and Indonesia where some states and provinces have more inhabitants than most nations of the world. In India, for example, the states of Maharashtra, Andhra Pradesh and Tamil Nadu each have more than 55 million inhabitants and have registered HIV rates over three percent in pregnant women in some sentinel sites and greater than 10 percent in STD patients, far exceeding the national average of 0.7 percent.

Rather than national averages, it is local data, combined with an understanding of how HIV epidemics evolve, that provide a more realistic basis for assessing the future course of the region's epidemics.

Preceding the 6th International Congress on AIDS in Asia and the Pacific, members of the MAP Network met from September 30 until October 2, 2001 to discuss the current status and trends of the HIV epidemics in Asia and the Pacific. This report is the result of those discussions and is based on the experience and work of national and international experts in the region.

• MAP Report 2001
  "The Status and Trends of HIV/AIDS/STI Epidemics in Asia and the Pacific"
  Full report (PDF)

• MAP Report 2000
  "The Status and Trends of the HIV/AIDS Epidemics in the World"
  Introduction (PDF)
  Full report (PDF)