HIV prevention in Asia
HIV prevention in Asia
Prasada Rao and Bindu N. Lohani, Jakarta
In a region that is home to two-thirds of the world's
population, the HIV prevalence rate of 0.4 percent --
significantly lower than Sub-Sahara Africa -- translates into
more than 8 million adults and children living with HIV. More
than one million people were newly infected with HIV in South and
Southeast Asia in 2005.
The good news is that infection rates need not continue to
rise.
The Asia-Pacific's low prevalence means that governments in
the region still have a unique opportunity to stop the epidemic
before it is too late.
HIV infections in the region are concentrated mainly among
vulnerable groups, including sex workers, people who inject drugs
and men who have sex with men. Prevention programs targeting
these groups are urgently needed, now more than ever, if we are
to have a realistic chance at preventing the epidemic from
escalating further. And this means breaking down the stigma that
is often attached with those most marginalized.
In South and Southeast Asia, HIV prevention programs reach
less than one-fifth of sex workers, less than two percent of men
who have sex with men and less than one-tenth of pregnant women.
Injecting drug use and its direct connection to unprotected
sex, much of it commercial, lies at the heart of many Asian
countries' epidemics.
Yet prevention strategies rarely reflect the fact that such
lethal combinations of risk-taking exist in virtually every
country in the region. As a result, a handful of Asian countries
are on the brink of explosive epidemics, particularly Pakistan,
Vietnam and Indonesia.
We must not forget that prevention works. The recently
published joint UNAIDS-WHO report on the global AIDS epidemic
clearly states that prevention programs must be comprehensive and
sustained over the long-term if HIV infections are to decrease.
And the programs need to reach those most vulnerable to HIV, who
are often society's most marginalized.
Ultimately it is sexual behavior change that will bring about
a drop in HIV infections, as we have seen among sex workers and
their clients in Thailand and Cambodia. Behavior change includes
the use of condoms, a reduction in sexual partners and delayed
first sexual experiences.
But there are signs that high-risk behavior is on the rise
again in Thailand and Cambodia as prevention programs in those
countries weaken.
Twenty years into the epidemic, the evidence clearly shows
that unless prevention programs are sustained, HIV will continue
to spread, moving from vulnerable groups into the general
population.
We know that in order to reverse the AIDS epidemic, HIV
prevention and treatment programs including those for pregnant
women and children must be expanded simultaneously. This is the
most effective way to prevent new HIV infections and avert
deaths. Without a pro-poor antiretroviral program, countries may
slow down the pace of poverty reduction gains. Stigma against HIV
positive people needs to be addressed and affected children must
be protected.
UNAIDS and the Asian Development Bank estimate that the region
could cut the annual number of AIDS-related deaths by 40 percent
by 2010 and save billions of dollars in costs of treatment if HIV
prevention and treatment programs are urgently scaled up. In
Asia, only an estimated 14 percent of the 1.1 million people who
need antiretroviral therapy have access to it in a region that
has the second-highest need for HIV treatment in the world.
Until AIDS becomes a top political priority for governments in
Asia and the Pacific and HIV prevention and treatment efforts
reach those in greatest need, we will continue to lose ground in
our battle against this growing threat.
Prasada Rao is Director of the UNAIDS Regional Support Team
for Asia and Pacific in Bangkok. Bindu N. Lohani is Director
General of the Regional and Sustainable Development Department at
the Asian Development Bank in Manila, Philippines.