UNAIDS calls for greater focus on key populations and geographical areas and smarter investment on AIDS in the region



HIV test at commune health station in Dien Bien small textHa Noi, 21 November 2013 - Launched at the 2013 International Congress on AIDS in Asia and the Pacific (ICAAP11), the new UNAIDS regional report "HIV in Asia and the Pacific: Getting to Zero", found that more people than ever before have access to HIV services across the region. However, inadequate focus on key populations at higher risk of HIV infection and geographical areas with higher HIV burden mean that most countries in the region are not progressing fast enough to reach global targets on HIV prevention, treatment, care and support.

“The pace of progress needs to be redoubled to sustain past achievements, drive results and meet global AIDS targets,” said UNAIDS Director of the Regional Support Team for Asia and the Pacific, Steven Kraus. “Efforts should be more focused on smart investments in the right places and on programmes to reach the people in greatest need. Communities of people living with HIV and key populations at higher risk must continue to be central to the region’s AIDS response—as agents of change,” he said.

Emerging trends
According to the report, an estimated 4.9 million people were living with HIV in Asia and the Pacific in 2012. Twelve countries account for more than 90% of people living with HIV and of new HIV infections in the region, with Viet Nam being one of them.
Regionally, numbers of new HIV infections have fallen by 26% since 2001. But emerging epidemics are becoming evident: between 2001 and 2012, new HIV infections increased 2.6 times in Indonesia; Pakistan has seen an eight-fold increase and new infections in the Philippines have more than doubled. There are high HIV prevalence levels in some geographical areas within countries and among key populations, even in countries where national HIV prevalence rates are falling.

The number of people accessing antiretroviral treatment in the region has increased to 1.25 million people at the end of 2012. Numbers of AIDS-related deaths have declined by 18% since 2005 to 270 000 in 2012, largely thanks to this increased access to treatment. However, in 2012, nearly half of people in Asia and the Pacific who were eligible for treatment were not accessing it and rate of increased access is slowing down (up 13% in 2011-2012 compared to 20% in 2010-2011).
New infections among children have declined by 28% since 2001. However, regional coverage of HIV services to prevent new HIV infections in children remains low at 19%.

Key populations at higher risk of HIV infection
According to the report, new HIV infections in the region remain concentrated among key populations: people who buy and sell sex, people who inject drugs, men who have sex with men, and transgender people. In Viet Nam for example, people who inject drugs make up the majority of people living with HIV, with HIV prevalence at 11%. Two among three provinces with the highest numbers of people living with HIV and highest HIV prevalences in 2012 are provinces with HIV epidemics driven by drug injection (Thai Nguyen and Dien Bien provinces).
The fastest-growing epidemics in the region are among men who have sex with men. These epidemics are typically concentrated in major cities, with HIV prevalence among men who have sex with men is over 10% in at least 10 Asian metropolitan areas. In Viet Nam, the HIV prevalence among men who have sex with men in 2009 was up to 19.8%, standing at 14% for Ho Chi Minh City.
Most programmes to protect key populations and their intimate partners from HIV infection are inadequate in size and scale. Only an estimated 8% of overall AIDS spending in the region is for HIV prevention among key populations at higher risk

A number of countries in the region have made strides to address stigma and discrimination towards people living with HIV, with legal reform and developments including the revision and removal of some laws and policies affecting people living with HIV and key affected populations in ten countries since 2010. Viet Nam ended the compulsory detention of sex workers in 2012.

Smarter investments to maximize returns
The region has seen important developments in domestic financing for AIDS. Domestic public spending in Asia and the Pacific is approximately US$1.3 billion—59% of total regional AIDS spending in 2012. Among the countries most affected by HIV in the region, Malaysia funds 97% of its AIDS response, China funds 88% and Thailand 85%. For Viet Nam, the Prime Minister recently approved a project on resource mobilization to ensure the financial sustainability of the national HIV response in 2013-2020.

Total estimated HIV spending in the region (domestic and international resources) in 2012 was US$2.2 billion, up 5% from 2011. Despite these gains, the AIDS response in Asia and the Pacific remains underfunded. To achieve the 2015 annual investment target in low- and middle-income countries in Asia and the Pacific, UNAIDS estimates that approximately US$5.4 billion must be mobilized—US$3.2 billion more than was spent last year. As well as need for increased investment, more efforts are needed to ensure funding is directed to where it will have the greatest impact.

More information?
Read the full UNAIDS regional report in pdf
UNAIDS also launched two new global reports: Location, location – Connecting people faster to HIV services and AIDS by the numbers
Read the global press release Ahead of World AIDS Day 2013 UNAIDS reports sustained progress in the AIDS response