It may be hard to believe, but there are more HIV+ people in the Asia-Pacific region than in any other region outside of sub Saharan Africa.
In 2019, there were 5.8 million people in the region living with HIV, with about 300,000 new infections occurring in that year alone. Comparatively, the number of new infections was 170,000 in Eastern Europe and Central Asia; and 120,000 in Latin America.
China, India, and Indonesia alone accounted for almost 75% of the total number of people living with HIV within the Asia-Pacific.
Although there is huge variation in the spread of the virus across the region, experts generally agree that overall, the Asia-Pacific region is falling behind Africa in terms of its HIV response.
In places like Bangladesh, Pakistan, and the Philippines, the number of new infections is rising, along with the number of Aids-related deaths every year.
The steepest rise can be found in the Philippines, with new infections up by 200% between 2010 and 2018. Over the same period, new infections also rose in Pakistan (57%), Bangladesh (56%), Afghanistan (49%), and Papua New Guinea (26%).
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Key affected populations
Among at-risk populations, men who have sex with other men remain the most vulnerable to exposure, accounting for about 30% of new infections in 2018.
HIV prevalence is especially high in urban areas: in Bangkok, Yangon, and Yogyakarta, the estimated percentage of men who have sex with other men with HIV ranges from 20% to 29%. Other at-risk populations include people who inject drugs, transgender people, sex workers and migrant workers.
HIV testing and other preventive programmes
Late diagnoses remain a huge challenge to tackling HIV. In the Asia-Pacific region, only around 69% of people living with HIV were aware of their status in 2018; this is up from 58% in 2015. However, the numbers suggest nearly 2 million people who did not know they were HIV-positive.
Within the region, the numbers vary greatly. In Thailand, for example, nearly 95% of people living with HIV knew their status. Compare this to 37% in Bangladesh and 14% in Pakistan.
A few common themes emerge when discussing access to testing services.
Many people in this region continue to face stigma, discrimination and punitive legal environments that prevent them from openly seeking medical help. In many countries, homosexuality is still criminalised.
For most people, condom use remains the cornerstone of HIV prevention, and this has generally been successful. However, a 2018 study involving people living with HIV in Bangladesh, Indonesia, Laos, Nepal, Pakistan, the Philippines, and Vietnam found that 43% of 3,400 participants did not regularly use condoms with their partners.
Participants from the Philippines had the highest risk behaviour. This may be attributed to the country’s president Duterte, who has openly discouraged citizens to use condoms, describing it as eating a sweet with the wrapper on.
What happens next?
For a region as immense as the Asia Pacific, the HIV epidemic can seem complex and confounding. Yet there are similar key areas of concern – namely, the rising spread among men who have sex with men, and transgender people. In certain parts of Asia, low testing and treatment coverage continue to remain a challenge.
Another area is a lack of supportive national policy environments.
Without these, at-risk population will continue to experience stigma and discrimination, which prevents people from seeking prevention and treatment. Challenging laws and addressing harmful social, sexual, and gender norms will be vital for an effective HIV response in the region.