The HIV/AIDS Epidemic in Asia

Jintanat Ananworanich, MD, PhD

US Armed Forces Research Institute of Medical Sciences The Thai Red Cross AIDS Research Centre Bangkok, Thailand
Jintanat.A@SearchThailand.org

Outline
Transmission of HIV: Routes and risk factors HIV situation in Asia
Prevalence Injecting drug users and Men who have Sex with Men

HIV situation in Thailand

Prevalence Future trend

Transmission of HIV
Sexual transmission Unprotected sex Heterosexual Men who have sex with men (MSM) Injecting drug use Sharing needles (Contaminated blood product) Mother to child transmission During pregnancy, during delivery, breastfeeding

Occupational exposure: Needle stick in health care personnel

Factors Associated with Higher Risk for HIV Transmission

Sexual transmission Anal intercourse > vaginal intercourse Multiple sexual partners Presence of other sexually transmitted infections Injecting drug use Sharing needles with multiple people Mother to child transmission Highest risk during delivery

The person who is the source for infection has high amount of HIV virus in the body

HIV Infection
HIV uses the human immune cells to make more HIV and kills the cell in the process After many years of infection Weakened immune system - Body is susceptible to infection - AIDS develops

HIV enters the body

HIV infects immune cells (CD4) of the body

HIV is spread through out the body in a few days

Asia is Large and Diverse

The continent with the largest population Diverse geography, culture, religion, law and wealth

Diverse HIV prevalence, HIV risk groups, and policy on treatment and prevention

HIV Epidemics in Asia

Statistics (2009)
5 million living with HIV (160,000 children) New infections 360,000 (22,000 children) AIDS deaths 300,000 (15,000 children)

HIV epidemics in Asia are concentrated among certain groups

Injecting drug users Sex workers and their clients Men who have sex with men
2010 UNAIDS report

HIV Prevalence in Asia

Country HIV prevalence Number with HIV infection 530,000 57,900 238,000 254,000 2,270,000 740,000

Thailand Cambodia Myanmar Vietnam India China

1.3% 0.70% 0.61% 0.44% 0.29% 0.06%

UNGASS 2008-2009 Report (From the slide collection of Prof. Praphan Phanuphak)

HIV Prevalence in Injecting Drug Users (IDUs)

Country China Indonesia Malaysia Thailand Vietnam Pakistan Myanmar Estimated number of IDUs 2,350,000 219,130 205,000 160,528 135,305 130,460 75,000 HIV prevalence in IDUs 12.3% 42.5% 10.3% 42.5% 33.9% 10.8% 42.6%

Bergenstrom and Abdul-Quader, AIDS 2010

HIV Prevalence in Men who have Sex with Men (MSM)

Country Myanmar Thailand India China Vietnam Cambodia Indonesia HIV prevalence in MSM (%) 23.5 35 5.5 30.8 4.8 24.7 0.05 12.5 5.3 9.4 0.8 8.7 2.1 8.1
van Griensven and van Wijngaarden, AIDS 2010

Thailand: From a Concentrated to a Generalized HIV Epidemic

19841987

1990 1988 IDUs 1989

1991

Homo/
bisexual men

FSWs

Male clients of FSWs

Pregnant women, children, general population

IDUs: Injecting drug users; FSWs: Female sex workers

Thailand: HIV Statistics

Statistics in 2009 Thailand population Number of adults living with HIV Adult HIV prevalence Children living with HIV Deaths since beginning of epidemics Antiretroviral treatment coverage Prevention of mother to child HIV transmission coverage Values 67 million 530,000 1% 22,000 500,000 > 80% 95%

2010 UNAIDS report; Thai MOPH

Thailand: HIV in Different At-Risk Groups

Bertozzi SM, et al. Lancet 2008

One in Three MSM in Bangkok has HIV Infection

% with HIV infection

van Griensven, JAIDS 2009

Warning Signs of a Rising HIV Epidemic in Thailand

Increased unsafe sex among the general
population Sharp increase in sexually transmitted infections Higher illicit drug use among youth High HIV prevalence among hard-to-reach populations (street-based FSWs, MSWs, MSM, IDUs, migrant workers and fishermen) A second wave of HIV epidemic in Thailand is anticipated
Modified from the slide collection of Prof. Praphan Phanuphak (Thai Red Cross AIDS Res Center)