People living with HIV (PLHIV) Last updated: March 2018

CONTENT Overview Treatment - Treatment: Antiretroviral therapy - Treatment: PMTCT - Treatment: TB-HIV Co-treatment Women living with HIV and reproductive health rights Punitive laws hindering the HIV response among PLHIV

Overview

Countries in Asia and the Pacific that account for >90% of PLHIV and new infections, and percent change in new infections New HIV infections (2016) % decline of new HIV infections between 2010 and 2016 % increase of new HIV infections between 2010 and 2016 People living with HIV India 80,000 2,100,000 Indonesia 48,000 620,000 China* 45,000 850,000 Pakistan 19,000 130,000 Viet Nam 11,000 250,000 Myanmar 230,000 Philippines 10,500 56,000 Thailand 6,400 450,000 Malaysia 5,700 97,000 Papua New Guinea 2,800 46,000 Bangladesh 1,500 12,000 Nepal <1,000 32,000 Cambodia 71,000 Source: Prepared by www.aidsdatahub.org based on UNAIDS 2017 HIV Estimates *2013 HIV estimates

Regional overview of trends in HIV infections and AIDS-related deaths HIV and AIDS in Asia and the Pacific 2000-2016 Deaths 170,000 People living with HIV 5.1 million Women living with HIV 1.8 million 2016 “zoom-in” Children living with HIV 190,000 New HIV infections 270,000 Source: Prepared by www.aidsdatahub.org based on UNAIDS 2017 HIV Estimates

Trends in HIV infections and AIDS-related deaths among women in Asia and the Pacific, 1990-2016 Women living with HIV 1 800 000 New HIV infections AIDS-related deaths Women living with HIV New HIV infections among women AIDS-related deaths among women Number Number 78 000 44 000 Source: Prepared by www.aidsdatahub.org based on UNAIDS 2017 HIV Estimates

Distribution of new HIV infections by age group, 2016 A significant variation in new HIV infections trend by age group in Asia and the Pacific Distribution of new HIV infections by age group, 2016 Percent change in new HIV infections between 2010 and 2016 by age group 34% 33% 19% 6% 2% Age group (year) 270 000 new HIV infections in 2016 0 - 14 15 - 24 25 - 34 35 - 44 45 - 54 55 + Total % decrease % increase Source: Prepared by www.aidsdatahub.org based on UNAIDS 2017 HIV Estimates

A significant variation in new HIV infections trends in Asia and the Pacific countries Distribution of new HIV infections by country, 2016 Percent change in new HIV infections between 2010 and 2016 270 000 new HIV infections in Asia and the Pacific in 2016 (10,500, 4%) China India Indonesia Myanmar Pakistan Philippines Thailand Vietnam Source: Prepared by www.aidsdatahub.org based on UNAIDS 2017 HIV Estimates

Diverse epidemic trends in Asia and the Pacific Proportion of new HIV infections by risk groups Indonesia Thailand Philippines Pakistan MSM Male PWID Female sex workers Clients of sex workers Transgender MSW Currently low risk females Currently low risk males

Treatment

Treatment: Antiretroviral therapy

HIV testing coverage among key populations, 2013 - 2016 HIV testing is the entry point for prevention and treatment but about half of key populations do not know their HIV status HIV testing coverage among key populations, 2013 - 2016 Source: Prepared by www.aidsdatahub.org based on Global AIDS Monitoring (GAM) Reporting 2017

HIV testing is the entry point for prevention and treatment, but many key populations do not know their HIV status Female sex workers Male sex workers Men who have sex with men Transgender people People who inject drugs 90% 90% 90% 90% 90% Prepared by www.aidsdatahub.org based on Global AIDS Monitoring 2017; Integrated Bio-Behavioural Surveys; and Behavioural Surveillance Surveys

Availability of community-based and lay provider testing approaches in Asia and the Pacific Both community-based and lay provider HIV testing available Community-based HIV testing available Lay provider HIV testing available Not available No info Source: www.aidsdatahub.org based on Global AIDS Monitoring (GAM) 2017

Independent access to HIV testing and related services for young people in Asia and the Pacific Age of legal capacity to consent independently to an HIV test, Asia and the Pacific Source: UNICEF, UNESCO, UNFPA, UNODC, Youth LEAD, & Youth Voices Count. (2015). Adolescents Under the Radar in the Asia-Pacific AIDS Response.

Fast-Track Treatment to Reach 90–90–90 by 2020 ENDING AIDS BY 2030: Fast-Track Treatment to Reach 90–90–90 by 2020 People receiving ART in Asia and the Pacific 15% annual increase between 2013 and 2016 At current pace: 4.2 million people on ART by 2020 Fast-Track Target 2020: people on ART 2016 estimate: 2.4 million *As of June 2017, estimated 2.5 million people were receiving ART in Asia and the Pacific region Source: Prepared by www.aidsdatahub.org based on UNAIDS 2017 HIV Estimates; Global AIDS Monitoring (GAM) 2017

PLHIV know their status Tested for viral load ** Asia and the Pacific Towards 90-90-90 Fast-Track treatment targets 66% 5.1 M Countries with CD4 threshold policy for treatment initiation countries have national policy on routine viral load monitoring for antiretroviral therapy Estimated PLHIV PLHIV know their status People on ART * Tested for viral load ** Suppressed viral load Treatment cascade, 2016 treat all regardless of CD4 CD4 ≤ 500 24 CD4 ≤ 500 but treat all key populations regardless of CD4 CD4 ≤ 350 but treat all key populations regardless of CD4 25 1 5 15 6 9 2 2016 2017 71% 83% *As of June 2017, estimated 2.5 million people were receiving ART in Asia and the Pacific region ** China and India do not report viral load testing data in 2017 GAM reporting and Indonesia reported only 0.2% of people on ART tested for viral load in 2016. Estimated 52% of PLHIV who are on treatment in 18 reported countries had tested for viral load in the past 12 months. Prepared by www.aidsdatahub.org based on Global AIDS Monitoring 2017 Reporting and UNAIDS 2017 HIV Estimates

PROGRESS TOWARDS THE 90–90–90 TARGETS Global versus Asia and the Pacific, 2016 70% [51 – 84%] 77% [57 – >89%] 82% [60 – >89%] Asia and the Pacific 71% [47 – >89%] 66% [44 – >89%] 83% [55 – >89%] of people living with HIV know their status of people living with HIV who know their status are on treatment of people on treatment are virally suppressed Source: Prepared by www.aidsdatahub.org based on UNAIDS special analysis, 2017

Regional overview: 90-90-90 target and gaps 2nd 90 target PLHIV know the status 3.6 M 0.98 M 1st 90 target GAP PLHIV are on treatment * 2.4 M 1.7 M 3rd 90 target PLHIV are virally suppressed 1.97 M ACHIEVED Australia; Malaysia; Thailand NOT ON-TRACK Afghanistan; Bangladesh; Indonesia; Mongolia; Sri Lanka ACHIEVED Australia; Singapore NOT ON-TRACK Afghanistan; Bangladesh; Fiji; Indonesia; Malaysia; Pakistan; Philippines ACHIEVED Cambodia; Singapore NOT ON-TRACK Afghanistan; Fiji; Pakistan *As of June 2017, estimated 2.5 million people were receiving ART in Asia and the Pacific region Prepared by www.aidsdatahub.org based on UNAIDS special analysis 2017; UNAIDS 2017 estimates and Global AIDS Monitoring 2017

HIV testing and treatment cascade among adolescents, select countries, 2016 Estimated adolescents living with HIV Adolescents know their status On ART Tested for viral load Suppressed viral load Thailand >95% 70% 87% n/a n/a Estimated adolescents living with HIV Adolescents know their status On ART Tested for viral load Suppressed viral load Indonesia 9% Estimated adolescents living with HIV Adolescents know their status On ART Tested for viral load Suppressed viral load Philippines 84% 3% 11% n/a Prepared by www.aidsdatahub.org based on UNAIDS 2017 estimates and Global AIDS Monitoring 2017

ART coverage and treatment gap, Asia and the Pacific, 2016 Current treatment scale-up has made significant achievement but the region is lagging behind the global trend ART coverage and treatment gap, Asia and the Pacific, 2016 ART coverage (%) Treatment gap Prepared by www.aidsdatahub.org based on Global AIDS Monitoring 2017 Reporting and UNAIDS 2017 HIV Estimates

3 in 5 children living with HIV are not receiving life-saving ART Children ART coverage and treatment gap, Asia and the Pacific, 2016 2nd 90 target Prepared by www.aidsdatahub.org based on UNAIDS 2017 estimates and Global AIDS Monitoring 2017

Low level of access to treatment among key populations ART coverage: Female sex workers living with HIV vs. Female PLHIV 2X 24X 11X 81% Prepared by www.aidsdatahub.org based on Global AIDS Monitoring 2017

Low level of access to treatment among key populations ART coverage: Male key populations living with HIV vs. Male PLHIV 81% ART coverage (%) Prepared by www.aidsdatahub.org based on Global AIDS Monitoring 2017

Late diagnosis: Proportion of PLHIV with initial CD4 count <200 % Note: Lao PDR and Viet Nam reported 47% and 59% of PLHIV respectively were reported with initial CD4 count <350 Prepared by www.aidsdatahub.org based on UNAIDS 2017 estimates and Global AIDS Monitoring 2017

HIV self-testing policy landscape, 2016 As of October 2016, 4 countries in Asia and the Pacific report having policies supportive of HIV self-testing Source: WHO.(2016). Overview of the New Guidelines on HIV Self-Testing and Partner Notification: What You Need to Know

Generic competition lowers live-saving ART prices Evolution in price of different first-line regimens X 10 times lower Prepared by www.aidsdatahub.org based on Medecins Sans Frontieres (MSF) (2016). Untangling the Web of Antiretroviral Price Reductions -18th Edition

Generic ARVs and impact on government budget: Thailand example Cost saving comparing with originated product price Antiretroviral drug (GUL- Government use of license) Year Cost saving Mil THB Mil USD 2010 866.3 27.3 2011 1,732.8 56.8 2012 2,319.0 74.6 2013 2,377.1 77.3 2014 2,870.0 88.4 Total saving 10,165.2 338.8 Source: Presentation by Chutima Akaleephan presented at the Regional Experts Consultation on Access to Affordable Medicines, Diagnostics and Vaccines in Bangkok, March 2016 based on NHSO Thailand data

Newer, more effective, less toxic medicines often unaffordable for the poor and developing countries First-line regimen Second-line regimen Third-line regimen US$ per person per year Prepared by www.aidsdatahub.org based on Medecins Sans Frontieres (MSF) (2016). Untangling the Web of Antiretroviral Price Reductions -18th Edition

High out of pocket health payment in countries with highest HIV burden Out-of-pocket payment as % of total health expenditure Prepared by www.aidsdatahub.org based on http://www.who.int/gho/database/en/

Treatment: PMTCT

2020 estimate based on current trend: Falls short of target by 8 000 Estimated new HIV infections among children (0-14 years) in Asia and the Pacific: current trend and trend to Fast-Track target Estimate 2016: 16 000 2020 estimate based on current trend: 10 000 new HIV infections Fast-Track Target 2020: 1900 Falls short of target by 8 000 Source: Prepared by www.aidsdatahub.org based on UNAIDS 2017 HIV Estimates

Efforts are needed to eliminate new HIV infections among children (0-14 years) in Asia and the Pacific Prevention of mother-to-child transmission (PMTCT) coverage, Global and Asia and the Pacific, 2010-2016 Prepared by www.aidsdatahub.org based on Global AIDS Monitoring 2017 Reporting and UNAIDS 2017 HIV Estimates

46% received ARVs for PMTCT 52% early infant diagnosis Towards ending AIDS in children starts with mothers: time to improve linkages and prevent leakages Service cascade of prevention of mother-to-child transmission of HIV in Asia and the Pacific, 2016 46% received ARVs for PMTCT 52% early infant diagnosis Note: PMTCT testing and coverage of infant ARV prophylaxis are not captured in GAM 2017 reporting Prepared by www.aidsdatahub.org based on Global AIDS Monitoring 2017 Reporting and UNAIDS 2017 HIV Estimates

Regional overview: Prevention of mother-to-child transmission Pregnant women living with HIV who received ARVs to reduce the risk of mother-to-child transmission of HIV, 2016 PMTCT coverage (%) Prepared by www.aidsdatahub.org based on UNAIDS 2017 estimates and Global AIDS Monitoring 2017

Regional child new HIV infections gap Regional PMTCT gap, 2016 Regional child new HIV infections gap GAP 2020 target 95% 32000 35000 Received PMTCT (2016) 15000 1900 13000 2020 target GAP Children new infections (2016) Indonesia, 21% Pakistan, 6% Proportion of regional child new infections gap by country Proportion of regional PMTCT gap by country Indonesia, 28% Pakistan, 7% India, 60% Prepared by www.aidsdatahub.org based on UNAIDS 2017 estimates and Global AIDS Monitoring 2017

Commitment of member states on eMTCT in Asia and the Pacific

Treatment: TB-HIV Co-treatment

2/3 1/5 1/2 TB snapshot 2016 Asia and the Pacific is the home for… 852 K 7.1 M 199 K 1/5 of estimated TB-HIV co-infections globally 2/3 of estimated new TB cases globally More than 1/2 of estimated TB mortality globally (both HIV-negative and HIV-positive) Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Over a third of high TB burden countries are in Asia and the Pacific 30 high-burden countries (Tuberculosis) Angola Bangladesh Brazil Cambodia Central African Republic China Congo DPR Korea DR Congo Ethiopia India Indonesia Kenya Lesotho Liberia Mozambique Myanmar Namibia Nigeria Pakistan Papua New Guinea Philippines Russian Federation Sierra Leone South Africa Thailand UR Tanzania Viet Nam Zambia Zimbabwe Asia and the Pacific Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Estimated HIV prevalence in incident TB cases, 2016 Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Need to scale-up HIV testing among TB patients in Asia Proportion of TB patients with known HIV status, 2016 Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Need to scale-up HIV testing among TB patients in the Pacific Proportion of TB patients with known HIV status, 2016 Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

of diagnosed TB patients tested for HIV Integrated approaches need to strengthen in diagnosis, treatment, and care of TB-HIV co-infections in Asia and the Pacific Continuum of HIV testing, diagnosis, and access to ART among patients enrolled in TB programmes , 2016 47% of diagnosed TB patients tested for HIV 4% HIV positivity rate 82% of diagnosed PLHIV on ART Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

HIV-positive TB patients were Tuberculosis diagnosis and treatment continuum among HIV-positive TB patients in Asia and the Pacific, 2016 63% of estimated new TB cases who are co-infected with HIV did not know their HIV status 18% of identified HIV-positive TB patients were NOT on ART Programmatic gap 37% 82% 70% 30% Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Estimated new TB cases who are HIV- positive About 70% of people with TB-HIV co-infection did not have access to antiretroviral therapy in Asia and the Pacific, 2016 Access to antiretroviral therapy among PLHIV vs. people with TB-HIV co-infection, 2016 Denominator: Estimated total PLHIV Estimated new TB cases who are HIV- positive Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Low coverage of TB preventive treatment among PLHIV newly enrolled in HIV care in Asia and the Pacific Proportion of PLHIV newly enrolled in HIV care who were started on TB preventive treatment in 2016, countries where data is available Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

TB co-infection: preventable death among PLHIV Estimated number of AIDS-related deaths and TB deaths among PLHIV in 2016, Asia and the Pacific versus global Proportion of TB deaths among PLHIV AIDS-related deaths About 1 in 4 AIDS deaths are among people with TB-HIV co-infection 170 K Asia and the Pacific 24% 1 M About 1 in 3 AIDS deaths are among people with TB-HIV co-infection Global 37% Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

8 countries account for 95% of all TB-related deaths among PLHIV in Asia and the Pacific Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Considerably high proportion of deaths among PLHIV is attributable to TB Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

59% decline in TB deaths among PLHIV between 2010 and 2016 15% decline 59% Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Tuberculosis treatment success rate (%), 2015 cohort Low TB treatment success rate among HIV-positive TB patients underscores the importance of prevention of opportunistic infections among PLHIV Tuberculosis treatment success rate (%), 2015 cohort Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Higher rate of deaths and lower rate of treatment success among HIV-positive TB cases Outcomes of TB treatment among new and relapse TB cases versus HIV-positive TB cases, 2015 cohort Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

11 out of 12 high TB burden countries in Asia and the Pacific also have high MDR-TB burden, 2016   High TB burden High MDR-TB burden Bangladesh Cambodia China DPR Korea India Indonesia Myanmar Pakistan Papua New Guinea Philippines Thailand Viet Nam Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Estimated incidence of MDR/RR-TB in 2016 GLOBAL MDR/RR-TB burden is in ASIA-PACIFIC 97% of ASIA-PACIFIC MDR/RR-TB burden is in 11 countries MDR/RR-TB = Rifampicin Resistant (RR) -TB cases including MDR-TB cases 601,000 363,000 351,300 11 high MDR/RR-TB burden = Bangladesh, China, DPR Korea, India, Indonesia, Myanmar, Pakistan, PNG, Philippines, Thailand, Viet Nam Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Reported budget in National Strategic Plan for TB, high TB burden countries, 2017 Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

TB financing in high TB burden countries are heavily dependent on international sources Proportion of total TB budget from domestic and international sources in high TB burden countries in Asia and the Pacific, 2017 Source: Prepared by www.aidsdatahub.org based on WHO. (2017). Global TB Report 2017

Women living with HIV and reproductive health rights

Proportion of women living with HIV who had a desire to have children reported being coerced to undergo sterilization, 2012-2013 Source: Prepared by www.aidsdatahub.org based on http://apnmata.org/country-profiles/

Proportion of surveyed HIV-positive pregnant women who were asked to undergo sterilization, 2011 Source: Prepared by www.aidsdatahub.org based on Women of the Asia Pacific Network of People Living with HIV. (2012). Positive and pregnant, How dare you. A study on access to reproductive and maternal health care for women living with HIV in Asia

Number of HIV-positive pregnant women who were asked to undergo sterilization and had the option to decline, 2011 Source: Prepared by www.aidsdatahub.org based on Women of the Asia Pacific Network of People Living with HIV. (2012). Positive and pregnant, How dare you. A study on access to reproductive and maternal health care for women living with HIV in Asia

Punitive laws hindering the HIV response among PLHIV

Punitive laws hindering the HIV response among PLHIV in South Asia   Restriction on entry, stay, and residence based on HIV status Laws that specifically criminalize HIV transmission or exposure Afghanistan NO YES Bangladesh Bhutan India Maldives NO INFO Nepal Pakistan Sri Lanka Source: Prepared by www.aidsdatahub.org based on UNAIDS, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014

Punitive laws hindering the HIV response among PLHIV in South-East Asia   Restriction on entry, stay, and residence based on HIV status Laws that specifically criminalize HIV transmission or exposure Brunei YES Cambodia NO Indonesia Lao PDR Malaysia Myanmar Philippines Singapore Thailand NO INFO Timor-Leste Viet Nam Source: Prepared by www.aidsdatahub.org based on UNAIDS, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014

Punitive laws hindering the HIV response among PLHIV in East Asia   Restriction on entry, stay, and residence based on HIV status Laws that specifically criminalize HIV transmission or exposure China NO CONTRADICTORY INFO Japan NO INFO Mongolia YES DRP Korea Rep of Korea Source: Prepared by www.aidsdatahub.org based on UNAIDS, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014

Punitive laws hindering the HIV response among PLHIV in the Pacific   Restriction on entry, stay, and residence based on HIV status Laws that specifically criminalize HIV transmission or exposure Fiji NO Kiribati Marshall Islands YES FSM* Nauru NO INFO Palau Papua New Guinea Samoa Solomon Islands Tonga Tuvalu Vanuatu *Federated States of Micronesia Source: Prepared by www.aidsdatahub.org based on UNAIDS, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014

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