Situation of HIV Epidemic & Response in China CMT Retreat 3 February 2010

HIV Situation in China 2009 Data sources: 2009 HIV Estimation Number of people living with HIV Number of new infections in 2009 AIDS deaths in ,000 (560, ,000) 48,000 (41,000-55,000) 26,000 (22,000-30,000) PLHIV in need of ARV treatment in ,000 (260, ,000)

Sexual transmission is now the main mode Note: 2009: heterosexual 42.2%, homosexual 32.5%; 2007: heterosexual 44.7%; homosexual 12.2%; 2005: data on hetero-and homo- sexual is not available Distribution of new infections by mode of transmission, by year Data sources: 2005, 2007 Joint Assessment; National 2009 AIDS/STD Annual Meeting

Highly-varied geographic distribution Cumulative reported cases: 326,000 up to end of 2009 Cumulative AIDS patients: 107,000 Cumulative deaths: 54,000 Cumulative reported HIV positives by province as of End of 2009 Data sources: National 2009 AIDS/STD Annual Meeting

Highly-varied geographic distribution As of end 2009, 55 counties have reported having over 1000 cases, which increased from 43 in –Shangcai County in Henan Province, Yining County of Xinjiang Province, Butuo County and Zhaojue County of Sichuan Province has more than 5,000 reported HIV/AIDS positives Liangshan Prefecture of Sichuan Province is becoming the areas with most severe HIV epidemic. –Prevalence among the whole population in Butuo County and Zhaojue County is over 5%. –Average prevalence in other 14 counties was 0.83%, Meigu County: 3.44%, Jinyang County: 3.38%, Yuexi County: 1.72% and Ganluo County: 1.19%. Yi minority was most heavily affected with prevalence at 1.7%, and the prevalence was 0.69% among Miao People, 0.08% among Han People.

Different HIV Epidemic Dynamics

Key Factors Driving the Epidemics

Estimated Size of Most-at-risk Population, China Description Population size estimate (range) Injecting drug users (IDUs)1.5~3.0 million Female sex workers (FSW)1.8~4.5 million Clients of FSW17.7~37.4 million Men who have sex with men (MSM) 2.0~7.1 million Total23.0~52 million Data source: China 2007 HIV estimation; F Lu, N Wang, Z Wu, et al. Estimating the number of people at risk for and living with HIV in China in 2005: methods and results. Sex Transm infect 2006 ； 82 （ supply3 ）： Up to 50 million people in China are at high risk of exposure to HIV

IDU: keep spreading and seeding sexual transmission Source: Ning W. HIV/AIDS Surveillance System in China. National Center for AIDS/STDs Control and Prevention, China CDC. Presentation at XVI International AIDS Conference, Toronto, Canada, August 12-18, 2006 Percentage of injecting drug users having sex with female sex workers, China Sentinel Surveillance

SWs: rising epidemic, especially among lower-level location based SWs Source: LiQinghua, Xu Junjie, Wang Weijia, et al. Survey of high risk behaviors and HIV/STI infection among FSWs from different venues of Kaiyuan City. China J AIDS STD, 2009, Vol.15 No. 2: Higher risk and HIV infection among street-based sex workers, Kaiyuan, Yunnan, China, 2006

Homosexual transmission has accounted for one-third of all new infections in 2009 MSM: an alarmingly fast-growing epidemic

HIV Epidemic among MSM by Geographic Areas, Sichuan Yunnan Xinjiang Tibet Gansu Qinghai Neimenggu Guangxi Guangdo ng Chongqin g Hunan Guizhou Hube i Hena n Jiangxii Fujian Anhu i Zhejian g Jiangsu Shand ong Shaanx i Shan xi Heb ei Liaoning Jilin Heilongjiang Beijing Tianjin Shanghai Taiwan Hainan Ningxia Around Shenyang % Beijing and Tianjin % Around Shanghai % Southwest %

Evolution of HIV epidemic among MSM, Chengdu Chongqing Nanjing Beijing

2010 Universal Access Targets and MDG 6 Goals: A Difficult Target to Meet Note: (1) 2005 and 2007 achievement based on 2006 and 2008 UNGASS report ; (2) 2008 achievements data from National Comprehensive Response Management Information System (CRMIS); (3) estimated number in need of ART is 190,000 as of 2009 UNGASS indicators achievement, China,

Coverage of PMTCT is limited The number of HIV infected PW who were found is relative low all over the country –reported ： 2695 （ Jan-Sep ） –estimated ： 7500 （ HIV prevalence among PW: 0.05% ） （ Estimated HIV-infected PW during Jan-Sep 2009: 5600 ） –only 48% HIV+ PW were found Coverage of PMTCT services was very limited –ARVs % of HIV+ PW among reported cases ： 79.4% Among estimated ： 38.1%

HIV Drug-Resistance Rate at Provincial Level , China HIVDR (%) Median months of ART Henan Anhui Hubei Zhejiang12.810,5 Hebei Yunnan Xinjiang Guangxi Shanxi NA

Main Challenges in Achieving Targets National & provincial action plans are yet to be costed and strategically enhanced. Decentralization needs to be prioritized and infrastructure strengthened to ensure accountability. Resource allocation must be prioritized & balanced, with effective utilization of funds, human resources, equipments, information. Stigma and discrimination towards people living with HIV and MARPs must be eliminated. Legal and political barriers faced by non-government agencies to be removed; their capacity developed to increase effective functioning of civil society organizations. Coverage and quality of prevention & treatment interventions must be enhanced.

Severe Stigma and Discrimination Experienced by PLHIV 2 out of 5 reported having faced severe HIV-related discrimination. More than three quarter of all survey respondents reported that their family members had experienced discrimination as a result of their HIV status. More than 10 percent of women living with HIV who were diagnosed with HIV had been pressurized into terminating a pregnancy by health staff. About 15% reported having been refused employment or a work opportunity because of their HIV status. 9.1% Of those respondents with children said their children had been forced to leave school because of the HIV status of their parents. A substantial proportion of medical staff (26%), government officials (35%) & teachers (36%) changed their stance after learning of a person’s HIV positive status into a ‘discriminatory’ or ‘very discriminatory’ attitude.

Priorities for National 2009 AIDS/STD Annual Meeting (21 Jan. 2010) Carrying out final review of Action Plan Developing Five Year Action Plan for Reducing and Preventing the Spread of HIV/AIDS ( ) Improving surveillance system Scaling up prevention interventions among IDU, MSM, low-level sex workers, rural migrants, discordant couples and etc. Accelerating scale up of ART program Scaling up PMTCT and exploring ways to enhance prevention of HIV, STI and HBV by routine testing of pregnant women

Priorities for 2010 (continued…) Strengthening support to most heavily affected areas especially Liangshan prefecture of Sichuan Province, Yili Prefecture of Xinjiang and Guangxi Province Case finding and management: rapid, easy and user-friendly testing method to be applicable in community and township health care settings, strengthen health facility-based testing, and management of reported cases Public education – with special emphasis to remote, poor and ethnic minority sites; education for students and community organizations Social mobilization and adoption of specific measures to encourage volunteers and civil society participation in AIDS response.