Choryok Kang, RN-BSN, MPH Researcher Seoul Center for Infectious Disease Control

Contents Contents Introduction Ⅰ Introduction Overview of the epidemic Ⅱ Overview of the epidemic Control strategies and policies Ⅲ Control strategies and policies Challenges ahead Ⅳ Challenges ahead 2

3 Introduction

4 Introduction Ⅰ Introduction Seoul is the capital and largest metropolis of South Korea, with a population of more than 10 million(South Korea : 50 million). Seoul is divided in to 25 gu (district), the gu vary greatly in area (10-47km 2 ) and population(140, ,000).

Figure. Number of reported cases of HIV infection, (Including all nationalities living in Korea) 5 Introduction Ⅰ Introduction Status at a glance Status at a glance The number of reported cases of new HIV infection has increased.

6 Introduction Ⅰ Introduction As of the end of 2012, a total of 10,452 cases of HIV infection were reported. And, recently, the number of reported cases of new HIV infection remains at around 900 cases per year. Seoul remained residential area with high levels of infection, representing 3,456cases(37% of total) of HIV infection.

7 Introduction Ⅰ Introduction To monitor the trends of HIV epidemic effectively, To monitor the trends of HIV epidemic effectively, the web-based national HIV/AIDS Surveillance System the web-based national HIV/AIDS Surveillance System titled HASnet established and operating nationwide titled HASnet established and operating nationwide since since  HIV/AIDS Supporting Network [HASnet] HASnet is promptly collecting data of HIV/AIDS incidence and mortality on the real time basis. The epidemiological variables are collected by jurisdictional PHCs of people newly diagnosed HIV infection. Epidemiological variables : - sex, age, nationality - route of confirming HIV infection - transmission route - CD4+Tcells, viral load - AIDS defining illness

8 Overview of the epidemic

9 Overview of the epidemic Ⅱ Overview of the epidemic Transmission routes of reported cases of HIV infection Transmission routes of reported cases of HIV infection Sexual intercourse is the major route of transmission including homosexual contact. Infection through injecting drug use, mother to child and blood transfusion/products were very rare(sum of these routes : 0.6%).

10 Overview of the epidemic Ⅱ Overview of the epidemic The epidemiological investigation grasp the sexual intercourse if it's a homosexual or heterosexual. But this data is not to be trust, because this reported to have similar occurring proportion(approximately 50% respectively). People newly diagnosed HIV infection probably does not report frankly because they don't want to be identified their sexual orientation.

11 Overview of the epidemic Ⅱ Overview of the epidemic Reported cases of new HIV infection by sex, Reported cases of new HIV infection by sex,

12 Overview of the epidemic Ⅱ Overview of the epidemic The number of new HIV infection cases has been continuously increasing. The increase occurred dominantly among males. Male cases make a total of 90%, and 94% were in Seoul. This trend means MSM remains the group at highest risk of acquiring HIV in Korea.

13 Overview of the epidemic Ⅱ Overview of the epidemic Reported cases of HIV infection of non-Korean, Reported cases of HIV infection of non-Korean, Reported cases of non-Korean in Seoul has been increasing since 2009.

14 Overview of the epidemic Ⅱ Overview of the epidemic The offering HIV rapid testing in a variety of outreach and community settings frequented by migrant workers in Seoul since Most HIV infected non-Korean returns to their native countries because they are unable to pay for treatment. Only a very few cases of HIV infected non-Korean can receive free HIV-related treatment if their visa status approved for nationals of Korea.

15 Overview of the epidemic Ⅱ Overview of the epidemic Distribution of reported cases of HIV infection by age Distribution of reported cases of HIV infection by age Gradually, many of reported cases of new HIV infection were in 20-30s. The age of HIV infection is been in a downward trend.

16 Overview of the epidemic Ⅱ Overview of the epidemic Trend of CD4+T cell counts with newly diagnosed HIV infection Trend of CD4+T cell counts with newly diagnosed HIV infection The proportion of CD4+T cell counts less than 200cells/uL has increased. (with the exception of unknown cases) < ~ ~499 ≥500 cells/uL

17 Overview of the epidemic Ⅱ Overview of the epidemic The downtrend of CD4+T cell counts with newly diagnosed HIV infection means HIV infected cases would be found out later.

18 Control strategies and policies

19 Korea has committed to developing a national HIV/AIDS Korea has committed to developing a national HIV/AIDS strategy with two goals strategy with two goals Control strategies and policies Ⅲ Control strategies and policies Goal 1 : To protect nationals from HIV/AIDS epidemic through reducing new HIV infection reducing new HIV infection and minimizing the spread of HIV infection. Goal 2 : the quality of life of people living with HIV To improve the quality of life of people living with HIV by increasing access to care, optimizing health outcomes and reducing HIV-related health disparities, stigma and discrimination against people living with HIV.

20 To accomplish two goals effectively, Korea has coordinated To accomplish two goals effectively, Korea has coordinated national responses with these strategies. national responses with these strategies. Control strategies and policies Ⅲ Control strategies and policies National strategies : Increasing the awareness and knowledge on HIV/AIDS prevention through continuous public campaign Detecting HIV infection early through anonymous free HIV testing and counseling services Providing early treatment services at no cost and at no access barriers Providing necessary care and support services to those are in need(care giver / hospice / long-term care etc) Promoting the human rights and dignity of PLWH

21 To enhance the awareness and knowledge on HIV/AIDS To enhance the awareness and knowledge on HIV/AIDS and HIV prevention, the awareness campaign and and HIV prevention, the awareness campaign and information center are opening. information center are opening. Control strategies and policies Ⅲ Control strategies and policies

22 Voluntary HIV counseling and testing Control strategies and policies Ⅲ Control strategies and policies Free and anonymous counseling and testing are being provided at PHCs and medical centers. Testing for high risk populations such as men who have sex with men(MSM) and migrant workers is being provided in concurrence with NGOs in Seoul. Treatment by specialized doctors and counseling services are being provided at the government-designated hospital. The deferred payment system in hospital reimbursement methods were introduced. Free HIV-related treatment is supported 100% by national medical insurance and government’s budget Medical care system and patient support

23 Network of HIV/AIDS Control in Korea Network of HIV/AIDS Control in Korea Control strategies and policies Ⅲ Control strategies and policies

24 Control strategies and policies Ⅲ Control strategies and policies According to the Korea HIV/AIDS Prevention Act, all the doctors and health workers for infectious disease have obligation to immediately report HIV/AIDS cases to their jurisdictional PHCs. The notified data on HIV/AIDS are transmitted to the provincial and central level. All people newly diagnosed HIV infection have obligation to respond to the epidemiological investigation of their jurisdictional PHCs.

25 Korea’s policy development, Korea’s policy development, Control strategies and policies Ⅲ Control strategies and policies First HIV infection Enacted Korea HIV/AIDS Prevention Act Introduction of HIV Testing and Counseling system Designation as a Class 3 of Notifiable ID Reduced patients sharing of treatment cost (50  20%) Reduced patients sharing of treatment cost (20  10%) Free HIV-related treatment is supported 100% by the government.

26 Challenges ahead

27 The HIV epidemic trends reveal the following features : The HIV epidemic trends reveal the following features : The number of reported cases of HIV infection has increased almost continuously. Sexual intercourse is the major route of transmission, especially the infection through homosexual contact has been most prominent. Approximately 50% of newly reported cases of HIV infection were in their 20s or 30s. There are falling trends in the level of CD4+T cell counts with newly diagnosed HIV infection.  These findings highlight the necessity for an expansion of early detection and early treatment programs targeted MSM and young population. Challenges ahead Ⅳ Challenges ahead

28 「 Seoul Metropolitan Government 」 and 「 Seoul Center for Infectious Disease Control 」 will develop effective intervention strategies to detect unrecognized HIV infection earlier. Challenges ahead Ⅳ Challenges ahead Pilot project for rapid HIV testing system in PHC Pilot project for rapid HIV testing system in PHC  Promoting the performance of voluntary HIV testing A study on knowledge and attitude on HIV self-testing A study on knowledge and attitude on HIV self-testing  Coming up with an effective plan for connection of HIV self-testing and immediate treatment Performing rapid HIV test instead of ELISA for HIV screening test in Public Health Center. Waiting time for test result will be shortened from 7 days to 20 minutes. Rapid testing is often cited by individuals as being preferable over conventional testing due to the ease of testing and immediacy of results, reducing the waiting time and associated anxiety. This study will assess the acceptability and feasibility of HIV self-testing.