regional overview of progress on universal access in asia-pacific steve kraus, regional director...
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Regional Overview of Progress on
Universal Access in Asia-PacificSteve Kraus, Regional Director
UNAIDS Regional Support Team for Asia and the Pacific
Bangkok, Thailand30 March 2011
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Estimated number of adults and children living with HIV, new infections and AIDS deaths, 1990-2009
Source: UNAIDS RST Asia-Pacific, based on data compiled for the UNAIDS Report on the Global AIDS Epidemic, 2010
The Asia-Pacific epidemic is stabilizing: declining new infections and deaths leveling off
300,000
4.9 million
360,000
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But significant variations in the region: increasing, stabilizing and declining country epidemic patterns
Source: UNAIDS RST AP, Country epidemic patterns from HIV estimates and projections data for the UNAIDS Report on the Global Epidemic 2010
Epidemic Pattern
Adults and children newly
Infected
Adults and children living
with HIV
Adults and children AIDS
Deaths
Countries
I Thailand, Cambodia, India
II Myanmar, Nepal, PNG*, China**
III Indonesia, Vietnam, Malaysia, Pakistan
IV<200
Philippines, Laos, Bangladesh
* Number of people living with HIV appears to be leveling off.**Likely trend from the available data. UNAIDS EPP-Spectrum projections not available for China.
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Important geographic variations within countries should inform programming
Sichuan
Yunnan
Xinjiang
Tibet
Gansu
Qinghai
Neimenggu
Guangxi Guangdong
Chongqing
HunanGuizhou
Hubei
Henan
Jiangxii
Fujian
Anhui
Zhejiang
Jiangsu
Shandong
Shaanxi
Shanxi
Hebei
Liaoning
Jilin
Heilongjiang
Beijing
Tianjin
Shanghai
Taiwan
Hainan
Ningxia
IDU expanding to sexual
IDU concentrated
Blood transmission expand to sexual partners
MSM concentrated
Low epidemic
Source: China Global Fund consolidated RCC proposal, 2008 4
Getting to zero in Asia and the Pacific: Responses informed by evidence
5Source: Commission on AIDS in Asia. 2008. Redefining AIDS in Asia: Crafting an Effective Response.
75 million
Men in Asia visit sex workers
(2-20% of adult men)
4 million Men who
inject drugs
10 million Women sell sex
16 million
Men who have sex with men
50 million Women married to men who visit
sex workers 1 million
infants and children
Men Women
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HIV prevalence among female sex workers, countries where data is available, 2001-2009
Source: www.aidsdatahub.org based on Sentinel surveillance data reported by National AIDS programs; Magnani R, Riono P, Nurhayati, et al. Sexual Risk Behaviors, HIV and Other Sexually Transmitted Infections among Female Sex Workers in Indonesia. Sex Transm Infect. 2010 Oct;86(5):393-9. Epub 2010 Jun 3
Progress in reducing infections among female sex workers, but may be masking high prevalence in some locations
Source: www.aidsdatahub.org based on data reported by National AIDS Programs from HIV Sentinel Surveillance
Prevalence among people who inject drugs remains high in several countries
HIV prevalence among people who inject drugs, countries where data is available, 2001-2009
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MSM epidemics are on the increase around the region
Source: www.aidsdatahub.org, based on data reported by National AIDS programs from HIV Sentinel Surveillance; China Centre for Disease Control and Prevention; Viet Nam IBBS; and Thailand population-based surveys
HIV prevalence among MSM, from selected cities, 2002-2009
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Proportion of all infections in women has stabilized at around 35% in last ten years
Estimated number of women and adults (15+) living with HIV, 1990-2009
Source: UNAIDS RST Asia-Pacific, based on data compiled for the UNAIDS Report on the Global AIDS Epidemic, 2010
35%
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HIV prevalence data indicate high quality interventions addressing young people at risk are required
Source: www.aidsdatahub.org based on DHS and youth surveys reported in UNGASS Country Progress Reports 2006, 2008, 2010
Young people who inject drugs and their older counterparts
Young sex workers and their older counterparts
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Source: www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008, 2010
* Manipur** 2009 Kathmandu
Insufficient reach of key affected populations
People who inject drugs
Female sex workers
Men who have sex with men
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Number of syringes/needles distributed per IDU per year (2009)
Source: www.aidsdatahub.org based on Towards Universal Access:
Scaling up Priority HIV/AIDS interventions in the health sector, 2010
Access to sterile needles and syringes remains low throughout the region
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Source: www.aidsdatahub.org based on UNGASS country Progress reports 2008 & 2010
Varying levels of condom use: highest among female sex workers
58
67
99
85 83
66
94
61
9096
75
43
53
65
99
92
65
78
31
86
73
58 57
21
7882
75
51
32
17
38
67
3543
36
16
3628
78
51
3122
4252
0
20
40
60
80
100%
FSW (with most recent client) MSM(with a male partner) PWID
% of condom use at last sex among key populations, most recent data, 2007-2009
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% of key affected populations receiving an HIV test in the last 12 months and who know the results, 2007-2009
Source: www.aidsdatahub.org based on UNGASS Country Progress Reports 2008 & 201014
Missed opportunities for HIV testing and counseling…
The number of people on treatment has increased steadily in the region, but slower than in the rest of the world
Source: www.aidsdatahub.org based on Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector, 2006-2010 15
Number of people receiving antiretroviral therapy in Asia- Pacific vs total low- and middle-income countries, 2003-2009
Estimated ART coverage among adults and children in Asia- Pacific vs. total low- and middle-income countries, 2008-2009
16Source: www.aidsdatahub.org based on Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector, 2010
Coverage of ART is increasing,but remains well below universal access
PPTCT coverage in East, South and South-East Asia vs.all low-and middle-income countries, 2005-2009
Source: www.aidsdatahub.org based on Towards Universal Access: Scaling up priority HIV/AIDS interventions in
the health sector, 2010
PPTCT coverage in Asia lags the global average even more than for ART…
Quality antenatal care coverage(4 visits) remains low in many countries
Source: www.aidsdatahub.org based on national surveys cited in WHO and UNICEF Countdown to 2015.Decade report (2000-2010) : Taking stock of maternal , newborn and child survival 2009
Antenatal care coverage at 4 or more visits, in countries where data are available
% of estimated HIV-positive incident TB cases that received treatment for TB and HIV, countries where data is available, 2007-2009
Source: www.aidsdatahub.org based on UNGASS Country Progress Reports 2010; Countries collected the data using ART patient registers and estimates from WHO STOP TB Data Base except Afghanistan ART Data Base, Indonesia ART Monitor and Reports, Japan Nagoya Medical Center & International Medical Center of Japan (ACC) Database, PNG National Department of Health Program Monitoring
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Tuberculosis is the first cause of death among PLHIV and coverage is low
Middle Income Countries contribute too little to the AIDS response
52%48%
Middle income countriesShare of domestic funding
Share of international funding
5%
95%
Low income countriesShare of domestic fundingShare of international funding
Source: UNGASS 2010 Indicator 1 data setMarshall Islands
Micronesia
Palau
Viet Nam
Vanuatu
India*
Fiji
Philippines
Mongolia
Tonga
Sri Lanka
Indonesia
China
Samoa
Pakistan
Thailand
Malaysia
0,0%
0,0%
0,0%
2,1%
6,5%
9,0%
11,8%
16,2%
24,8%
26,5%
33,2%
40,0%
76,0%
78,1%
78,4%
93,3%
98,4%
Share of domestic funding, middle income countries, 2009
Proportion of domestic funding, MICS, 2009
And still too little funding goes to high impact prevention
Source: UNGASS country progress reports 2010
Spending by impact category (%)
19
8
44
50
1 2
3741
SAARC SEA SAARC SEA SAARC SEA SAARC SEA
High impact - lowcost
High impact - highcost
Low impact - lowcost
Low impact - highcost
Most MIC need to spend less than 0.2% of their GNI to fund their response…
0,00% 0,10% 0,20% 0,30% 0,40%
Malaysia
China
Sri Lanka
Philippines
Indonesia
Fiji
Thailand
India
Pakistan
Mongolia
Vietnam
Papua New Guinea
Share of Gross National Income
current spending as a share of GNI
estimated resource needs as a share of GNI
Source: UNGASS 2010; World Data Bank
Regional evidence-base summary:
• Asia-Pacific HIV epidemic stabilizing, but considerable variation in the country and sub-national epidemics
• HIV still concentrated among key populations at risk and their partners, and at high levels in many locations.
• PWID and MSM interventions generally well below UA target of 80% coverage; FSW coverage better and programmes largely miss out on clients.
• Below global average on treatment for those in need and worse for PPTCT.
• Coverage of HIV-TB low and for HIV–HCV co-infection non-existent.
• Systematic combined reviews of epidemic, programme and expenditure data to adjust programming and funding, and programme evaluations to inform scale-up, remain the exception.
• International funding represents the majority of funding.
• In 2010, all Asian MIC would need to spend less than 0.5% of their GNI to fully fund a targeted response.
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ZERO NEW HIV INFECTIONS.
ZERO DISCRIMINATION.
ZERO AIDS-RELATED DEATHS.
Thank you