People who inject drugs Last updated: November 2015

CONTENT Data availability and population size estimates HIV prevalence and epidemiology Risk behaviors Vulnerability and HIV knowledge National response

Data availability and population size estimates

People who inject drugs population size estimates, countries where data is available   Estimated PWID (a) Year of estimate Year of reporting HIV prevalence (b) 1 Afghanistan 36,000 2015 Male - 4.4 (2012) 2 Australia 215,000 2005 Total- 2.1 (2013) 3 Bangladesh 23,800 2009 Total- 1.1 (2011) 4 Brunei 3,000 – 4,000 2004 Not available 5 Cambodia 1,300 2012 Total- 24.8 (2012) 6 China 2,170,000 2011 2014 Total- 6 (2014) 7 India 177,000 Total- 7.2 (2010-11) 8 Indonesia 74,326 Total- 36.4 (2011) 9 Lao PDR 1,709 10 Malaysia 170,000 Male- 16.6 (2014) 11 Maldives 400 … 2010 0 (2008) 12 Myanmar 83,000 Total- 23.1 (2014) 13 Nepal 52,174 Male- 6.3 (2011) 14 Pakistan 104,848 Total- 27.2 (2011) 15 Philippines 14,400 (12,304-16,607) 2011* Total- 44.9 (2013) 16 Papua New Guinea 5,000 – 10,000 2004* 17 Singapore 10,000 – 20,000 Total-1.5 (2014) 18 Sri Lanka 423 2013 Total – 0 (2014) 19 Thailand 40,300 Total- 19 (2014) 20 Timor Leste 53 21 Viet Nam 271,506 Male- 10.5 (2014) Prepared by www.aidsdatahub.org ; Note: a) Please see next slide for references; b) National HIV Sentinel Surveillance surveys and Integrated Biological and Behavioral surveys reported in GARPR 2013 to 2015 * Year of source reference

References: People who inject drugs population size estimates Afghanistan Global AIDS Response Progress Reporting 2015 Australia Global AIDS Response Progress Reporting 2015 Bangladesh Global AIDS Response Progress Reporting 2015 based on Population Size Estimates for Most at Risk Populations for HIV in Bangladesh 2009. Aceijas, C., Stimson, G. V., Hickman, M., et al. (2004). Global Overview of Injecting Drug Use and HIV Infection among Injecting Drug Users. AIDS, 18(17), 2295-2303 Cambodia Global AIDS Response Progress Reporting 2015 based on NACD,NCHADS, and KHANA. (2014). National Population Size Estimation, HIV Related Risk Behaviours and HIV Prevalence among People Who Use Drugs in Cambodia in 2012. Ministry of Health China, WHO, and UNAIDS. (2011). 2011 Estimates for the HIV/AIDS Epidemic in China (Unpublished). National AIDS Control Organisation India, Department of AIDS Control, & Ministry of Health & Family Welfare. (2011). Annual Report 2010-11. Indonesia Global AIDS Response Progress Reporting 2015 based on Ministry of Health.(2013). Estimasi Populasi Rawan Tertular HIV di Indonesia Tahun 2012 (In Indonesian Language) Lao PDR Global AIDS Response Progress Reporting 2015 Malaysia Global AIDS Response Progress Reporting 2015 Sharma, M., Oppenheimer, E., Saidel, T., et al. (2009). A Situation Update on HIV Epidemics among People Who Inject Drugs and National Responses in South-East Asia Region. AIDS, 23, 1405–1413. Myanmar Global AIDS Response Progress Reporting 2015 Nepal Global AIDS Response Progress Reporting 2014 based on Central Bureau of Statistics, Ministry of Home Affairs. (2013). Survery Report on Current Hard Drug Users in Nepal -2069 Pakistan Global AIDS Response Progress Reporting 2015 Philippine National AIDS Council. (2011). Estimates of the Most At-Risk Population and People Living with HIV Aceijas, C., Stimson, G. V., Hickman, M., et al. (2004). Global Overview of Injecting Drug Use and HIV Infection among Injecting Drug Users. AIDS, 18(17), 2295-2303 Ibid. Sri Lanka Global AIDS Response Progress Reporting 2015 based on National STD/AIDS Control Programme and the Family Planning Association of Sri Lanka. (2013). National Size Estimation of Most at Risk Populations (MARPs) for HIV in Sri Lanka Thailand Global AIDS Response Progress Reporting 2015 Timor Leste Global AIDS Response Progress Reporting 2015 Viet Nam Global AIDS Response Progress Reporting 2014

Size estimates of PWID as proportion of adult male population (15-49) years Source: Prepared by www.aidsdatahub.org based on size estimates of PWID ( please see the information provided in the previous 2 slides) and adult male population (15-49) years is based on annual population based on UN Population Division. (2015). World Population Prospects: The 2015 Revision - Extended Dataset.

Data availability of PWID in HIV sentinel surveillance surveys conducted between 2009 and 2013 Bangladesh, China, India, Myanmar Myanmar and Viet Nam Bangladesh, China, India, and Viet Nam Bangladesh, India, Myanmar, Thailand, and Viet Nam Bangladesh, China, India, Myanmar, Thailand, and Viet Nam Source: Prepared by www.aidsdatahub.org based on National HIV Sentinel Surveys; Global AIDS Response Progress Reporting; and www.aidsinfoonline.org

Data availability of PWID in behavioral surveys conducted between 2009 and 2013 Afghanistan, China, Indonesia, Malaysia, Nepal, Pakistan, Philippines, Thailand, Viet Nam Afghanistan, China, Malaysia, Nepal, Pakistan, Philippines, Thailand, Viet Nam Afghanistan, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, Viet Nam Afghanistan, Cambodia, China, India, Indonesia, Malaysia, Nepal, Pakistan, Philippines, Thailand, Viet Nam Nepal, Philippines Philippines Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance Surveys; Integrated Biological and Behavioral Surveys; Global AIDS Response Progress Reporting; and www.aidsinfoonline.org

HIV prevalence and epidemiology

HIV prevalence among people who inject drugs, 2010-2014 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) www.aidsinfoonline.org

HIV prevalence among people who inject drugs by gender, 2010-2014 #11 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; and 3) www.aidsinfoonline.org

HIV prevalence among people who inject drugs by age group, 2010-2014 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) www.aidsinfoonline.org

HIV prevalence among PWID in geographical locations that are higher than national prevalence, 2010-2014 #13 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) HIV Sentinel Surveillance Surveys; 3). Li L, Assanangkornchai S, Duo L, McNeil E, Li J (2014) Risk Behaviors, Prevalence of HIV and Hepatitis C Virus Infection and Population Size of Current Injection Drug Users in a China-Myanmar Border City: Results from a Respondent-Driven Sampling Survey in 2012. PLoS ONE 9(9): e106899. doi:10.1371/journal. pone.0106899

HIV prevalence among PWID in geographical locations where rising HIV prevalence trends are observed, 2005-2013 * male PWID ** 2013 data for Cebu and Mandaue reported as national Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) www.aidsinfoonline.org

Trends in HIV prevalence among PWID in ASEAN states/cities, where data is available, 2003-2013 * male PWID Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys

Trends in HIV prevalence among PWID in SAARC states/cities, where data is available, 2002-2012 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys

Hepatitis C and syphilis prevalence among PWID, countries where data is available, 2009-2014 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys and 2) HIV Sentinel Surveillance Surveys

Proportion of HIV transmission through injecting drug use among reported HIV cases, 2011-2015 Source: Prepared by www.aidsdatahub.org based on 1. Country Global AIDS Response Progress Reports 2015; 2. Directorate General of Disease Control and Environmental Health, Ministry of Health, Indonesia (Feb 2014). Situation Progress Report of HIV and AIDS in Indonesia in 2013 (Laporan Situasi Perkembangan HIV & AIDS di Indonesia tahun 2013, Kementerian Kesehatan RI 2013) ; 3. National Epidemiology Center Philippines. (2015). Philippines HIV/AIDS Registry: July 2015; 4. National AIDS Control Organisation India, Department of AIDS Control, & Ministry of Health and Family Welfare. (2012). Annual Report 2011-12.; 5. Ministry of Health Malaysia (2014). HIV and AIDS Reporting (1986-2013); 6. Ministry of Health, Singapore (2015). Update on the HIV/AIDS Situation in Singapore 2014.; 7. National AIDS Control Programme Sri Lanka. (2013). Retrieved 10 October 2014, from http://www.aidscontrol.gov.lk/web/index.php/en/statistics/hiv ; and 8. National Centre for AIDS and STD Control, Teku, Kathmandu (2014). Factsheet 2: Reported HIV Cases, as of Asar 2071 (15 July 2014).; 9. Centre for Health Protection, Department of Health Hong Kong. (2014). Hong Kong STD/AIDS Update, Vol. 19, No.1, Quarter 1 2013

Risk behaviours

Average number of injections among people who inject drugs, 2006-2013 * Cebu and Mandaue Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys;

Average duration of injecting drugs among PWID, 2006-2012 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys

Proportion of safe injection practices among PWID (regional median trend*) #22 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of PWID who reported safe injection practice at last injection, 2006-2014 #23 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of PWID who reported safe injection practice at last injection by gender, 2006-2014 *Manipur Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of PWID who reported safe injection practice at last injection by age group, 2006-2014 *Manipur Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Correlation between safe injection practice and HIV prevalence among PWID * Duration of consistent use of sterile injecting equipment varies from last week to last 6 months; ** Behavioral data for 2006-07, Never used used-needles and syringes; *** Behavioral data for 2008 Source: Prepared by www.aidsdatahub.org based on National HIV Sentinel Surveillance Reports; Integrated Biological and Behavioral Surveillance Reports

Proportion of PWID engaged in commercial sex in the past 12 months, 2006-2013 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys

Proportion of PWID who reported condom use at last sex, 2006-2014 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of PWID reported condom use at last sex by gender, 2006-2014 * Manipur Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org and India UNGASS Country Progress Report 2010

Proportion of PWID reported condom use at last sex by age group, 2006-2014 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org and India UNGASS Country Progress Report 2010

Proportion of PWID reported consistent condom use, 2006-2011 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys

Vulnerability and HIV knowledge

Proportion of PWID with comprehensive HIV knowledge, 2006-2012 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys; 3) UNAIDS. (2010). Global Report: UNAIDS Report on the Global AIDS Epidemic.

HIV expenditure

HIV prevention spending in Asia and the Pacific – low on HIV prevention among people who inject drugs, latest available year reported by countries, 2009-2013 #35 Note: China and India did not report prevention spending breakdown Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Trends in spending on PWID harm reduction programmes out of total prevention spending, countries where HIV prevalence among PWID is more than 10%, 2006-2013 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Regionally, less than one-fifth of PWID prevention spending comes from domestic public sources Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of AIDS spending by major spending category, Asia and the Pacific, 2009-2013 #38 AIDS spending breakdown is not available for China and India Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of prevention spending by category, 2009-2013 Youth Prevention mother-to-child General prevention and others Sex workers and their clients People who inject drugs Men who have sex with men Note: Data from latest available year. China and India did not report prevention spending breakdown. Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Spending on HIV prevention programmes focused on PWID, 2009-2013 Note: Data from latest available year. China and India do not report prevention spending breakdown. Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

National response

Number of syringes distributed per PWID per year by Needle and Syringe Programmes (NSP), 2014 Medium coverage: >100–<200 syringes per PWID per year Low coverage: <100 syringes per PWID per year High coverage: >200 syringes per PWID per year Source: Prepared by www.aidsdatahub.org based on 1) www.aidsinfoonline.org; and 2) Global AIDS Response Progress Reporting 2015

Number of syringes distributed per PWID per year, 2012-2014 Medium coverage: >100–<200 syringes per PWID per year Low coverage: <100 syringes per PWID per year High coverage: >200 syringes per PWID per year Source: Prepared by www.aidsdatahub.org based on 1) www.aidsinfoonline.org; and 2) Global AIDS Response Progress Reporting 2015

Number of needle and syringe programme (NSP) sites, 2011-2014 * reported 230 districts have NSP sites in 2014 but data not available for the number of NSP sites Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting 2015

Reported number of people who use drugs received opioid substitution therapy, 2012-2014 * only number people on methadone is reported in 2014. 2012 and 2013 reported numbers includes number of people on methadone and estimate people on buprenorphine. Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting 2015

Number of opioid substitution therapy (OST) sites, 2011-2014 Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting 2015

Number of NSP and OST sites by country where data is available, 2014   Number of needles/syringes programme sites Number of opioid substitution therapy sites Afghanistan 27 1 Bangladesh 88 4 Cambodia 5 China 814 767 India 401 178 Indonesia 232 90 Lao PDR  5*  8* Malaysia 629 838 Maldives Mongolia  1** Myanmar 51 35 Nepal 60 15 Pakistan 14  1* Thailand 42 140 Viet Nam  230*** 134 *2012 data; **2013 data; ***reported number of districts that have NSP sites in 2014 but data not available for the number of NSP sites Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting 2015

HIV testing coverage among PWID, countries where data is available, 2006-2014 * Programme data Note: Data is not strictly comparable across countries since methods and sampling varied. In addition, many surveys were conducted in a few urban areas and it might not necessarily reflect prevailing conditions at the national level. Source: Prepared by www.aidsdatahub.org based on Ministry of Health Indonesia.(2014). Recalculated HIV Testing Coverage presented at the Regional Management Meeting (RMM) 2014 using IBBS 2011 Data; Global AIDS Response Progress Reporting 2015; and www.aidsinfoonline.org

Stalled progress in HIV testing coverage among key populations HIV testing coverage among PWID (regional median) Note: regional median testing coverage is calculated using latest available data from UNGASS and GARPR 2010 to 2015 reporting rounds Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting 2015; and www.aidsinfoonline.org

Punitive laws hindering the HIV response among PWID in South Asia   Compulsory detention centres for people who use drugs Death penalty for drug-related offences Afghanistan NO NO INFO Bangladesh YES Bhutan India Maldives 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 PWID in South-East Asia   Compulsory detention centres for people who use drugs Death penalty for drug-related offences Brunei YES Cambodia NO Indonesia Lao PDR Malaysia Myanmar Philippines Singapore Thailand 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 PWID in East Asia   Compulsory detention centres for people who use drugs Death penalty for drug-related offences China YES Japan NO Mongolia 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 PWID in the Pacific   Compulsory detention centres for people who use drugs Death penalty for drug-related offences Fiji NO NO INFO Kiribati Marshall Islands FSM* Nauru 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

slides compiled by www.aidsdatahub.org THANK YOU slides compiled by www.aidsdatahub.org Data shown in this slide set are comprehensive to the extent they are available from country reports. Please inform us if you know of sources where more recent data can be used. Please acknowledge www.aidsdatahub.org if slides are lifted directly from this site