Evaristo Marowa UNAIDS Country Coordinator Bangladesh 24 April 2005

Adults and children estimated to be living with HIV as of end 2004 Total: 39.4 (35.9 – 44.3) million Western & Central Europe 610 000 [480 000 – 760 000] North Africa & Middle East 540 000 [230 000 – 1.5 million] Sub-Saharan Africa 25.4 million [23.4 – 28.4 million] Eastern Europe & Central Asia 1.4 million [920 000 – 2.1 million] South & South-East Asia 7.1 million [4.4 – 10.6 million] Oceania 35 000 [25 000 – 48 000] North America 1.0 million [540 000 – 1.6 million] Caribbean 440 000 [270 000 – 780 000] Latin America 1.7 million [1.3 – 2.2 million] East Asia 1.1 million [560 000 – 1.8 million] map in the back of epi update

Regional HIV and AIDS statistics and features, end of 2004 * The proportion of adults [15 to 49 years of age] living with HIV in 2004, using 2004 population numbers Regional HIV and AIDS statistics and features, end of 2004 3.1 million [2.8 – 3.5 million] 700 <1 700] 16 000 [8 400 – 25 000] 6 500 [ <8 500] 60 000 [39 000 – 87 000] 36 000 [24 000 – 61 000] 95 000 [73 000 – 120 000] 51 000 [25 000 – 86 000] 490 000 [300 000 – 750 000] 28 000 [12 000 – 72 000] 2.3 million [2.1 – 2.6 million] 1.1 % [1.0 - 1.3%] 0.2 [0.1 - 0.3] 0.6 [0.3 – 1.0] 0.3 [0.2 – 0.3] 0.8 [0.5 – 1.2] 2.3 [1.5 – 4.1] 0.6 [0.5 – 0.8] 0.1 [0.1 – 0.2] 0.6 [0.4 – 0.9] 0.3 [0.1 – 0.7] 7.4 [6.9 – 8.3] 4.9 million [4.3 – 6.4 million] 5 000 [2 100 – 13 000] 44 000 [16 000 – 120 000] 21 000 [14 000 – 38 000] 210 000 [110 000 – 480 000] 53 000 [27 000 – 140 000] 240 000 [170 000 – 430 000] 290 000 [84 000 – 830 000] 890 000 [480 000 – 2.0 million] 92 000 [34 000 – 350 000] 3.1 million [2.7 – 3.8 million] 39.4 million [35.9 – 44.3 million] 35 000 [25 000 – 48 000] 1.0 million [540 000 – 1.6 million] 610 000 [480 000 – 760 000] 1.4 million [920 000 – 2.1 million] 440 000 [270 000 – 780 000] 1.7 million [1.3 – 2.2 million] 1.1 million [560 000 – 1.8 million] 7.1 million [4.4 – 10.6 million] 540 000 [230 000 – 1.5 million] 25.4 million [23.4 – 28.4 million] TOTAL Oceania North America Western & Central Europe Eastern Europe & Central Asia Caribbean Latin America East Asia South and South-East Asia North Africa & Middle East Sub-Saharan Africa Adult & child deaths due to AIDS Adult prevalence [%] * Adults & children newly infected with HIV Adults & children living with HIV The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.

Share of the Disease Burden

Estimates of per cent of adults (15-49) living with HIV/AIDS in Asia Pacific Region who are women, 2001 and 2003

HIV prevalence among men who have sex with men, in selected Asian countries: 1986-2000 15 12 9 % HIV-positive 6 3 Malaysia 1988- 1997 Japan 1986- 1997 Pakistan 1997 India 1994- 1998 Bangladesh 1998 Taiwan 1994- 1999 Cambodia 2000 Sources: Country data compiled by U.S. Census Bureau Database. Cambodia data reported in: Monitoring the AIDS Pandemic (MAP): the status and trends of HIV/AIDS/STI epidemics in Asia and Pacific (2001)

* Brothel-based only ** Street-based only Percent of female sex workers who are teenagers or are aged under 25, various countries Many sex workers across Asia are young women in their teens * Brothel-based only ** Street-based only

HIV prevalence in female sex workers, male STI patients and pregnant women at sentinel sites in Mumbai, India, 1994−2003 Where prevention services for people at highest risk are inadequate, HIV is eventually passed on to those with no high-risk behaviour

HIV prevalence for adults and pregnant women in selected states of India: 1994 – 2001 (1) Andra Pradesh Karnataka 6 6 5 5 4 4 % HIV Prevalence 3 % HIV Prevalence 3 2 2 1 1 1994 1995 1996 1997 1998 1999 2000 2001 2002 1994 1995 1996 1997 1998 1999 2000 2001 2002 Reported HIV prevalence among ANCs Median of reported HIV prevalence among ANCs HIV adult prevalence Maharashtra Mumbai 6 8 5 6 4 % HIV Prevalence 3 % HIV Prevalence 4 2 2 1 1994 1995 1996 1997 1998 1999 2000 2001 2002 1994 1995 1996 1997 1998 1999 2000 2001 2002 Source: HIV Sentinel Surveillance Report, Indian National AIDS Control Organization 01 July 2002 slide number ASIA-9

HIV prevalence among pregnant women in 5 sentinel sites in Myanmar: Mar 1992 – Mar 1999 Yangon ¤ l Mandalay Myitkyina Tachileik Bago THAILAND LAOS CHINA INDIA 15 Tachileik Myitkyina Yangon 10 Mandalay Bago Percent (%) 5 This slide shows the varying pattern of HIV prevalence among the Pregnant Women in the five different zones of Myanmar. 92M 92S 93M 93S 94M 94S 95M 95S 96M 96S 97M 97S 98M 98S 99M Year Source: Myanmar National AIDS Programme 16

HIV prevalence among injecting drug users in Kathmandu, Nepal: 1991-1999 60 50 40 % HIV-positive 30 20 10 1991 1992 1993 1994 1995 1996 1997 1998 1999 Sources: Peak A et al. (1995); AIDS. Gurubacharya RL et al. (1998); 12th World AIDS Conference, Abstract 23246. Oelrichs RB et al. (2000) J. Virol.

HIV in IDU over the rounds

Rate of sharing of injecting equipment among IDUs in the Philippines: 1997-2000 100 80 60 % sharing 40 20 1997 1998 1999 2000 Year Source: BSS, 1997-2000

SW - Sex Workers IDUs – Injecting Drug Users HIV prevalence rates among sex workers and injecting drug users in selected sites, Indonesia: 2000-2001 SW 6.4% SW 8.0% SW 6.0% IDUs 40% SW 1.5% SW 26.5% IDUs 53% IDUs 24.5% HIV prevalence rates 0 % < 1% 1 - 5 % > 5 % SW - Sex Workers IDUs – Injecting Drug Users Source: Indonesian National AIDS Commission (2001) HIV/AIDS and other sexually transmitted infections in Indonesia: challenges and opportunities for action

Source: Myanmar National Surveillance Report Percentage of IDU and Female Sex Workers Testing Positive for HIV, Myanmar 2003 Source: Myanmar National Surveillance Report

Sharing at last injection %

Rate of condom use by high-risk groups in the Philippines: 1997-2000 80 Registered female sex workers Men having sex with men Freelance female sex workers 60 40 % Consistent condom use 20 1997 1998 1999 2000 Year Source: BSS, 1997-2000

Clients (New or Regular) and Condom Use in the Last Week Female Sex Workers: Clients (New or Regular) and Condom Use in the Last Week Percentage using condoms consistently last week

Proportion of sex workers and sex workers’ clients always using condoms with commercial partners, Cambodia: 1997-1999 90 brothel-based sex workers military/police 80 motorbike taxi drivers 70 beer promotion women 60 Proportion reporting consistent condom use (%) 50 40 30 20 10 1997 1998 1999 Source: National AIDS Programme, Cambodia, and Family Health International, 2000

Increasing Condom Use and Decreasing HIV Infections in Cambodia 20 40 60 80 100 1995 1997 1999 2001 2003 % Condom use, Female sex workers HIV prevalence, female sex workers

Reported modes of transmission among HIV seropositive subjects in the Philippines: 1984-2000 10 20 30 40 50 60 Heterosexual contact Homosexual contact Bisexual contact Perinatal Blood transfusion Injecting drug use Needle prick injuries N=1,441 %   Slide 08: Most (82%) cases acquired HIV through sexual intercourse. Among these, 863 (60%) were through heterosexual contact, 242 (17%) through homosexual contact and 76 (6%) through bisexual contact (Figure 4). Source: HIV/AIDS Registry, Philippine Department of Health

Trend in HIV prevalence in 21-year-old military conscripts in Thailand: 1989-1999 5 4 3 HIV prevalence (%) 2 1 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Source: Armed Forces Research Institute of Medical Sciences, Thailand

The Five Myths Low HIV prevalence doesn’t pose a real threat AIDS is very much a male disease in South Asia Girls in South Asia are protected by Social-culture norms and marriage ABC alone will solve all the problems Girls won’t need to know much about sex

Fact of HIV/AIDS Epidemic in the South Asia Asia Pacific is home to some of the fastest growing AIDS epidemics in the world Estimated 8.2 million people infected by HIV as of end 2004 Vast and diversified epidemics - low national HIV prevalence rates and concentrated to generalized local epidemics

Low prevalence  low risk in Bangladesh 9% are IDU Rickshawpulle rs (76% married) 69% Visit MSM IDU FSW (46% married) (40% married) 33% 34% Visit Visit FSW FSW FSW This slide shows risk behavior in Bangladesh and the interactions between sex work, injecting drug use, men who have sex with men and rickshawpullers, a group of general population males. It is clear from this figure that all of these populations are closely linked in Asian settings. Similar data is seen around the region in the at risk populations. For example in Cambodia 40 percent of men who have sex with men had sex with a female partner in the last 6 months. These interactions are complex and if we don’t control the epidemics in these higher risk populations, we will face extensive HIV spread in the general population. (9% married) 2% are IDU 1% are IDU Source: Bangladesh BSS

Multiple vulnerabilities - a vicious circle Biological Cultural Economic Social Vulnerabilities

Proportion of Adolescent Girls Married by Age 15 & 18 Source: DHS Data

When prevention messages miss the point Abstain from sex Be faithful Condomize Reality Rape and forced sex, even within marriage – Women do not choose “Faithful” women infected by their partners (her situation, not behaviour, is risky) Coercion and forced sex, lack of knowledge – women cannot negotiate ABC approach insufficient

The Global Coalition on Women and AIDS -Key areas of focus Preventing HIV infection Reducing violence against women Protecting property ownership and inheritance rights Ensuring equal access care and treatment Supporting improved community-based care Promoting access to new prevention options Supporting on-going efforts towards universal education for girls- make sure girls’ complete secondary school

Thank you