The Status of the epidemic in Regional Session on Asia-Pacific   The Status of the epidemic in Asia and the Pacific August 4, 2008 Aikichi Iwamoto, M.D. Governing Council, Asia and the Pacific Islands Professor, Infectious Diseases University of Tokyo

HIV prevalence in Asia and the Pacific, 2007 Adults and children People living with HIV 5.0 M [4.1 – 6.2 M] Newly infected in 2007 380,000 [200,000 – 650,000] AIDS-related death 380,000 [270,000 – 490,000] 2008 AIDS Epidemic Update, July 29, 2008

Adult HIV Prevalence (%) in Asia and the Pacific 1 - 5 %: Thailand, PNG, 0.5-<1.0%: Cambodia, Myanmar, Viet Nam, Malaysia, Nepal, 0.1-<0.5%: India, Indonesia, Iran, Australia, Lao PDR, Pakistan, Singapore <0.1 %: Japan, China, Philippines, Korea, Bangladesh, etc.

Early waves of epidemic in Mid-to-late 1980s Political commitment ( budget) Massive campaign 100% condom policy Thailand Cambodia (Myanmar) A success story Thailand Cambodia

Sustained and growing epidemic behind the success Thailand, 1989-2005

Lessons from foregoers Tsunami waves may come successively. Complacency and political apathy are not allowed. Continuous need to fight against stigma and discrimination. IDU Female SW Male House wife Child 1984 87 90 94 96 98 04 07 MSM Migrant Elderly and the youth HIV waves in Thailand 1984-2007 Dr. Chureeratana　Bowonwatanuwong

Rapidly growing epidemic Indonesia PNG Viet Nam

Injecting drug users: 4,850,000 Many outbreaks in the region - 1980s: Sydney, Bangkok, Manipur, Yangon - early 1990s: Yunnan - late 1990s: Nepal, Hai Phong, Jakarta - early 2000s: Taiwan, etc. Male IDUs buying unprotected sex MAP report 2005

Women living with HIV Children (<15 y/o): 2007 The proportion of women has increased from 26% (2001) to 29% (2007) in Asia. Asia Children (<15 y/o): 2007 Living with HIV/AIDS: 150,000 Newly infected: 24,000 Death due to AIDS: 18,000

Scaling up of antiretroviral therapy AIDS death: 2001 2007 S & SE Asia 170,000 270,000 East Asia 12,000 32,000 Oceania <500 1,200 - The great majority of countries are in urgent need of access to and scaling up of ART. Better salvaging regimen should be available. Thailand has scaled up substantially but has to use d4T which is not used routinely used in the north. NAPHA GPOvir Regimen 1. d4T + 3TC + NVP 2. d4T + 3TC + EFV 3. d4T + 3TC + IDV

Diverse and complex HIV epidemic in Asia and the Pacific History of HIV epidemic Route of transmission / Most affected population Concentrated area in each country /rural or urban etc. 1-50 51-100 101-500 501-1000 1001-10000 10001-20000 >20000

Dense population 60% of world population in Asia and the Pacific 4 / 6.6 billion Two countries over 1 billion China: 1.3 billion India: 1.1 billion Current epi 0.05% 0.36% 1% 2% If = 24 million = 48 million

Prevention India 2005 5.7 M 2006 2.5 M (>5.5 M in SA) UNAIDS 2006 Expanded and improved surveillance system The proportion of people living with HIV in India is lower than previously estimated, but the epidemic continues to affect substantial numbers of people. AIDS epidemic update 2007 (March 2008/WHO, UNAIDS) Strong will Strong commitment Prevention

Many thanks to contributors Saphonn Vonthanak, Cambodia Chureeratana　Bowonwatanuwong, Thailand Yi-Ming Arthur Chen, Taiwan Masahiro Kihara, Japan Kah Sin Cho, UNAIDS Pascal Tanguay, Asian Harm Reduction Network Ron　MacInnis, IAS Secretariat Bernard Amahaya Kadasia, IAS Secretariat AVERT http://www.avert.org/ UNAIDS http://www.unaids.org WHO http://www.who.int/en/ Etc.