Asia and Pacific Overview of the HIV Epidemic and Response JVR Prasada Rao Regional Support Team Asia & Pacific Bangkok ICAAP, Kobe, July 2005

What data do we know? What does the data mean? What should be done?

No let up in the relentless progress of the epidemic and time is running out to deal with this epidemic at a relatively low cost…..

1985 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women

1993 <5% High Risk Group > 5% High Risk Group

1998 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women

2004 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women 8 M HIV+ I M new Infections 0.5 M deaths

Hot spots 2004 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women

What does the data mean?

National prevalence compared to prevalence among ANC in selected sites,

Poverty reduction: projected MDG 1 erosion UNAIDS-ADB Impact of HIV/AIDS on Poverty in Cambodia, India, Thailand and Viet Nam. India Cambodia

Drivers of the epidemic: familiar pattern in countries Source: Thai Working Group on HIV/AIDS Projections, % IDU SW 26 % 90% SW Spouse 5% IDU 5% 50% Spouse SW 15% IDU 20% MTCT 15%

Epidemic closer to African pattern and potential Driven by multi-partner male-female sex Sex with more than one partner in past year >50% Male : female prevalence about equal (versus 3 : 1 in Asia) Pacific: a different epidemic Lessons from Papua New Guinea

What should be done?

Annual new HIV infection in Asia and the Pacific with and without intervention, Source: UNAIDS estimates (derived from Lancet article, July 6, 2002 with data for 2004)

Core Minimum Package Promotion of condoms, lubricants and treatment of STIs for male and female sex workers and their clients Clean needles, substitution treatment for IDUs Delay of sexual intercourse, monogamy and condom use for young people Voluntary counselling and testing Prevention of mother-to-child transmission Access to ART and other treatment

No impact can be achieved without reaching the critical threshold Coverage 60% Behaviour change of vulnerable communities 80% of ART for eligible HIV positive ( 50% by 2005)

Policy options: financial losses with different levels of care and prevention,

Expanded response impact on new infections, prevalence, death, and financial loss by 2010 Cumulative New Infections (Millions) HIV+ Adults and Children (Millions) Cumulative AIDS Deaths (Millions) Cumulative Financial Loss (Billions) Baseline: Low prevention and care Expanded response: Limited prevention with expanded ARV

Are we doing enough?

Poor coverage 1% 5.4% 8% 19% Source: WHO (2004). Coverage of Selected Services for HIV/AIDS Prevention, Care and Support in Low and Middle Income Countries in 2003

Poor coverage: proportion of people with advanced HIV infection receiving ART, 2004

Why the response is not enough

Countries with head of state leadership of national AIDS committee: 2 Countries with multisectoral policy: 9 Countries with multi ministerial programs: 3 Countries with regular surveillance: 3 Countries with national M+E: 1 Why the response is not enough: Leadership and Commitment

Why the response is not enough: Rising resource gaps US$ (Billions) Estimated Resource Available Estimated Resource Needs

We can afford it ! … Moreover, the region as a whole can well afford these investments. Even the peak resource need of US$5.1 billion annually for the years is just 4 per cent of current regional health expenditure (2001). ADB/UNAIDS (2004) Asia-Pacifics Opportunity: Investing To Avert An HIV/AIDS Crisis

Why the response is not enough: Decreasing budgets Philippines Thailand Peso (millions)Baht (millions)

Funding Government GFATM UN Agencies Bi-laterals Civil society Prevention Others Monitoring and Evaluation Care, Support and Treatment National Response Why do we need the Three Ones?

United Nations agencies –improving coordination –defining responsibilities Multilateral institutions –eliminating overlaps –concentrating on comparative advantages Civil society –speaking with one voice Why the response is not enough: Partners

We can do it!

If actions are prioritised based on solid quantitative and qualitative data If top leadership of national governments move from commitment to action If support from the international community is unified under Three Ones principle If civil society is vibrant, acting both as partner and watchdog If resources are substantially stepped up immediately If only…

The Silent Tsunami... …requires an emergency-like response in Asia and Pacific

Staying focused Sometimes the snake charmer gets so engrossed in playing the flute he forgets what is important : catching the snake or playing the flute ….