Asia Pacific Opportunities Investing to Avert an Crisis John Stover, Gayle Martin, Orrattai R, Ross Mcleod, Swarup Sarkar Socio-Economic Impact Joint ADB/UNAIDS Background Studies Jacques Jeugmans ICAAP, Kobe, July 2005

Progressive Epidemic 8.2 M PLWA (2.3 women) 1.2 M New Infections 0.54 M Death

Prevention Works Source: Guinness L et al. (2002). Modeling the Impact and Cost-Effectiveness of CARE-SHAKTI. HIV prevalence among sex workers and male clients with and without current programs Bangladesh

Response: Leadership commitment and Multi-sectoral program Source: UNAIDS-ADB Act Now or Pay Later: Institutional Gaps in the Asia-Pacific HIV/AIDS Response. Bangkok-Manila: Background paper, UNAIDS-ADB study series. Countries in Asia and Pacific 2004

Source: UNAIDS (2004). Act Now. Policy versus action plans: prevention interventions for most-at-risk populations in 15 countries in Asia and the Pacific 2004

Most-at-risk populations reached by targeted prevention programs 16 Asia-Pacific countries 2004

People with advanced HIV infection receiving ART (2004) Source: WHO (2004). ART - Situation December (WHO regions) Number of people receiving ART (point estimate) Estimated need Coverage (Percent) Africa3408% South-East Asia0.9109% Western Pacific0.1729% All WHO regions75812%

 GDP/GNI may not fall  LE: minimal change at national level  Work force depletion may not be critical  Very high disease burden  High(est) cause of mortality  Impact on the household and family Study Phase I: Review of the SE Impact And -Low prevalence still means large numbers -Sub-national impacts vary significantly

Low levels of prevalence in Asia still mean large numbers of people living with HIV Source: UNAIDS (2004). AIDS Epidemic Update 2004.

HIV prevalence: Sub-national variations Source: National HIV sero-surveillance data for Cambodia (2002), India and Myanmar (2003), and Thailand (2004).

Adult (15-49) deaths (/1000 pop) in Thailand and Chiang Mai -----

Year of Life Expectancy in Cambodia and Siem Reap

Poverty MDGs 1 and 6 delayed Details in Gayle Martin’s Presentation

Projected Poverty Reduction Achievements Cambodia 14.0% 16.0% 18.0% 20.0% 22.0% 24.0% 26.0% 28.0% 30.0% 32.0% without AIDSwith AIDS India 14.0% 16.0% 18.0% 20.0% 22.0% 24.0% 26.0% 28.0% 30.0% 32.0% without AIDSwith AIDS MDG GOAL: Halve Poverty by 2015 IMPACT on POVERTY-MDG Goal Erosion Source: ADB and UNAIDS (2004). Asia Pacific’s Opportunity: Investing to Avert an HIV/AIDS Crisis. Manila and Bangkok

Impact on Expenditure and Income Poverty line Household consumption expenditure Q2Q1Q3Q4Q5 Households divided into 5 income quintiles

Source of Funds

Estimated Resource Need for HIV: Asia-Pacific Countries

Source: UNAIDS (2004). Financing the Expanded Response to AIDS. Availability of resources in Asia and the Pacific 2003–2007

Baseline: current (2004) levels of prevention and care continued. Comprehensive response: Expanded antiretroviral therapy and scaled-up prevention. Source: Adapted from Stover J. et al. (2002). Updated through Effect of increased response

The cost of Inaction (by 2010) 10m4m Newly infected Between 2004 and 2010 Yearly death toll By 2010 Annual financial losses By ,000 No interventionWith prevention and care $17.5 billion 660,000 (100,000 lives saved each year) $15.5 billion ($2b saved each year)

Other Issues Issues on Adsorptive Capacity Human Resources for programming and management Fund Flow Multi-Ministerial Program Impact of livelihood on PWA, Women and Children In one study in India, more than 90% of the HIV positive women were married, monogamous and had only one sex partner in their life time

Leadership is the key … Significant measurable impact even in low prevalence areas Need for resources Support critical programs Pro-poor ART Programs National support for local response Thank you