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Asia and the Pacific
There were an estimated 7.2 million people living with HIV/AIDS in Asia and the Pacificaccording to UNAIDS in December 2002. An estimated 490 000 people are estimated to have died of AIDS in the past year. About 2.1 million young people (aged 15-24) are living with HIV.
In comparison to the continent of Africa rates of HIV infection in the general population in Asia remain low. Prevalence rates exceed 1% in only three countries, Thailand, Cambodia and Myanmar. Such figures may be misleading - rates of HIV infection among specific populations, such as sex workers or intravenous drug users (IDUs) within each of these countries may be much higher.
Within the largest Asian nations, some regions may have a greater number of inhabitants than most African countries as well as having HIV prevalence rates much higher than the national average.
With such huge populations, many of the Asian countries have extremely large numbers of people living with HIV, even when prevalence rates among the general population are low, there can still be more people living with HIV than in many countries in Africa. For example, only 7 in 1,000 people are HIV-positive in India, but because of the sheer size of the population, this equals an estimated 3.86 million people - the second largest national HIV-positive population in the world.
In Asia, there is immense social pressure on men to marry and have children. A well established gay identity is non-existant, and men who have sex with men tend to be married too. Men who engage in male-male sex as well as heterosexual sex with their wives, or female partners, are more likely to be HIV-positive than their exclusively heterosexual counterparts.
Throughout the region, injecting drug use offers the epidemic huge scope for growth. Upwards of 50% of injecting drug users already have acquired the virus in parts of Malaysia, Myanmar, Nepal, Thailand and in Manipur in India.
Among the Pacific Island countries and territories, Papua New Guinea has reported the highest HIV infection rates. New surveillance data reveal an HIV prevalence of 1% among women attending antenatal clinics in the capital Port Moresby. Additionally, 85% of surveyed sex workers in Port Moresby did not use condoms consistently in 2001, and rates of other sexually transmitted infections ranged as high as 36%.
In Japan, a record 621 people (most of them males) acquired HIV in 2001, Here, the virus is spreading increasingly among young people. A reportedly growing trend of casual sex with multiple partners (known as sukusutomo or ‘sex friends’), along with falling condom sales, suggests that new patterns of HIV spread could widen significantly.
Nearly 40% of new HIV infections in 2001 were among people in their teens and twenties—a development that seems to match reports of increased rates of sexually transmitted infection among Japanese men (up 21% between 1998 and 2000) and women (up 14%) under 24.
The worst affected countries are;
India
According to UNAIDS, 3.97 million people were living with HIV/AIDS in December 2001.
In parts of north-east India, widespread injecting drug use helped establish an early entry-point for HIV. In Manipur in 1988 the prevalence of HIV was hardly detectable. Just four years later, HIV prevalence had risen to over 70% among injecting drug users and has stayed at this level ever since. Typically, the majority of injecting drug users are men who will eventually pass HIV to their wives, girlfriends or other sexual partners through unprotected sex.
A different pattern has been seen in southern and western states. By the mid- 1990s, a quarter or more of sex workers in cities such as New Delhi, Hyderabad, Madurai, Pune, Tirupati, and Vellore tested positive for HIV. By 1997 the prevalence of HIV among sex workers in Mumbai had reached 71%.
Countrywide, awareness of HIV/AIDS is high, with roughly three-quarters of adult Indians (aged 15–49) aware that correct and consistent condom use can prevent sexual transmission of HIV. But, in general, awareness and knowledge of HIV/AIDS remain low in rural areas and particularly among women.
Behavioural studies in India suggest that prevention efforts directed at specific populations (such as female sex workers and injecting drug users) are paying dividends in some states, in the form of higher HIV/AIDS knowledge levels and condom use. However, HIV prevalence among these key groups continues to increase in some states, underlining the need for well-planned and sustained interventions on a large scale.
Thailand
700,000 people were believed to be living with HIV/AIDS at the end of 2001, or 2.15% of the adult population.
The main route of transmission is heterosexual sex. It is currently thought that more than half of all new cases are occurring through transmission within marriage.
There is evidence of continuing transmission associated with injecting drug use, which was very important in the early establishment of HIV in Thailand. In contrast to the pattern seen with blood-borne infections in North America and Western Europe, where sexual transmission and injecting drug use transmission seem to be remarkably separate, there has been a shift in Thailand from a dominance of subtype B virus among IDUs to a dominance of 'subtype E', matching the strain that is most commonly transmitted through sex.
Recent reports suggest that the main modes of transmission may be changing. Whereas most HIV transmission in the 1990s occurred through commercial sex, half the new HIV infections now appear to be occurring among the wives and sexual partners of men who were infected several years ago. There are also indications that unsafe sexual behaviour is on the increase among young people in Thailand.
Myanmar (previously Burma)
530,000 people living with HIV/AIDS, or 1.99% of the adult population. The epidemic has centred around three main groups; injecting drug users, men who have sex with men, and heterosexuals with a high turnover of partners.
Cambodia
220,000 people living with HIV/AIDS, or 4.04% of the adult population. Cambodia has the most severe HIV epidemic in Asia and has also followed Thailand in a very active programme of HIV prevention which has had some success despite the lack of resources available within the country.
It has been the norm in Cambodia for men to engage in premarital and extramarital sex, particularly with women who are paid.There is some evidence that condom use among men using sex workers has increased dramatically in recent years and there are encouraging signs of a decline in HIV rates among pregnant women - from 3.2% in 1997 to 2.3% at the end of 2000.
It has been reported that consistent condom use among direct female sex workers has increased by 86% from 42% in 1997 to 78% in 1999. Among indirect sex workers (known as beer girls) consistent condom use increased by 300% from 9.6% to 46% over the same period.
HIV prevalence among men who have sex with men in Cambodia is estimated at 14%.
Cambodia has reported stabilising levels of infection, along with decreasing levels of high-risk behaviour. HIV prevalence among pregnant women in major urban areas declined slightly from 3.2% in 1996 to 2.8% in 2002. Prevalence among sex workers declined from 42% in 1998 to 29% in 2002, according to the latest surveillance data, with the decline most pronounced among sex workers under 20.
China
Official estimates put the number of people living with HIV in China at 1 million in mid-2002. Unless effective responses rapidly take hold, a total 10 million Chinese will have acquired HIV by the end of this decade.
There are also signs of heterosexually transmitted HIV epidemics spreading in at least three provinces (Yunnan, Guangxi and Guangdong) where HIV prevalence in 2000 was as high as 11% among sentinel sex worker populations.
The onward sexual transmission of HIV by people who became infected when they sold their blood to collecting centres that ignored basic blood-donation safety procedures poses a massive challenge, as does the need to provide them with treatment and care.
Japan
There are an estimated 10,000 people living with HIV/ AIDS, or 0.02% of the adult population. There has been a marked shift in the proportion of transmission due to homosexual sex, which has risen to more than double the proportion due to heterosexual sex; until 1999 the proportions were equal.
Papua New Guinea
There are an estimated 5,400 people living with HIV/AIDS, or 0.22% of the adult population.