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.