HIV IN ASIA: HISTORY, CHALLENGES & SOLUTIONS
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HIV IN ASIA:HISTORY, CHALLENGES &
SOLUTIONS
Dr. Chwee-Lye ChngRegents Professor
Dept. of Kinesiology, Health Promotion
& Recreation
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RICHLY DIVERSE
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Why should you care about HIV in
Asia?
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• Compared to Sub-Saharan Africa, HIV prevalence rate in Asia low (20% of PLWHA live here), but with over 50% of world population here …(China, India, USA, Indonesia top 4 most populous nations on earth…)
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• SOUTH AFRICA & INDIA each with 5 million PLWHA.
• This # represents 20% for S. AFRICA, but only 1% for INDIA. ASIA -flashpoint for global HIV-AIDS epidemic in next decade.
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• In INDIA, # of new infections double every 14 months, soon overtake S. Africa
• In CHINA, # of AIDS cases grow by 30% each year, more than 10+ million PLWHA in 2010.
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• Although overall prevalence remains low, even relatively small increases in HIV infection rates in INDIA with population of one billion people could translate into large numbers of people becoming infected.
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• In many Asian countries HIV prevalence low in general population
• Significantly higher among those engaging in high-risk behaviors (IDU, MSM, CSW and clients, blood donors)
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What drives the HIV epidemic in
Asia ?
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• Vulnerable communities dominate HIV in Asia–IDU–CSW (male and female), clients, families, kids
–MSM
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INTRAVENOUS DRUGS
Opium-producing Golden Triangle bordering Myanmar, Thailand, Laos, Vietnam. Male IDUs infect Females
Easier talk about IDU than about sex (CSW, MSM)
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IDUs share gear with others 90% Indonesian IDUs share,
50% IDUs in treatment HIV+ 68% Nepalese IDUs in
treatment HIV+, public toilets store shooting gears for use by IDU friends
45% wives of Manipur IDUs HIV+
Needle exchange program
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• INDONESIA, with serious IDU problem, vibrant sex industry, high STD rates, migrant labor, cultural resistance to using condoms (<10%), low HIV knowledge (84%, 14-17 yrs)
• Underreporting, passive reporting system, Islamic resistance to explicit HIV risk reduction messages
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COMMERCIAL SEX CSW (F/M, ST/gay) survival &
drugs, truckers, military Size adult male using CSW, 5%
Hong Kong, 22% Thailand (lowered to 10%)
# clients per night (1 client Philippines vs 4 clients Thailand)
Condom use, 2% Bangladesh, 10% E. Timor, 33% Philippines, 90% Cambodia, 90% Thailand
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Availability of STD screening, treatment
Conflation of CSW, MSM, IDU epidemics
Increasingly HIV affects Asian females, 1990, Chinese males:9: 1 female
2002, Chinese males: 4:1 female 2007, Chinese males: 3:1 female Vietnam 300,000 CSW, where
1:80 females in HCMC is CSW
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CAMBODIA Fastest growing HIV
epidemic in Asia, with 49% CSW HIV+, 6% blood donors
Success 100% condom use program: 40% CSW HIV+ 1998 dropped to 23% 2000, condom sale 100,000 1994 rose to 11.5 million 1998, 29% military unsafe sex CSW in 1997 dropped to 3% in 2001
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THAILAND
–After India, China, Thailand ranks third country with largest PLWHA
–Famous 100% condom use program (military HIV infections of143,000 in1991 dropped to 20,000 in 2000)
–Poor women, sex tourism, bar owners
–Youth, females 15-24
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MSM
Hidden from view, difficult to reach for education, testing, treatment
High rates unsafe sex in urban areas
Sexual mixing of MSM, CSW, IDU
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MSM 2005 study of MSM prevention in11 Asian countries concluded that reached only 8% MSMCondom use low (12%)Believed low riskSocial pressure to marry/sex with women
Stigmatized, persecution, neglect
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MALAYSIAN MSM (n=517)
Islamic, homosexuality criminalized
3.9% MSM HIV+ VS 0.5% general pop
59% never HIV tested before
High knowledge but 50% UAI
Malay Islamic MSM more UAI
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MALAYSIAPRISONERS
4% Malaysians admit drug use
Mandatory imprisonment, HIV tested, 6.25% HIV+, 15 times greater than general population (0.4%)
There are jails, some prisons with 10% HIV+ prisoners, oversampling?
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SECRETARY-GENERAL OF THE UNITED
NATIONS, BAN KI-MOON,
“ F rom its birth, the campaign against AIDS was much more than a battle against disease. It was a cry for human rights. It was a call for gender equality. It was a fight to end discrimination based on sexual orientation. And it was a demand for the equal treatment of all people.”
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Thank you