National TB Program Indonesia 1 TB Epidemic DOTS HIV Epidemic.
Situation of HIV Epidemic & Response in China
description
Transcript of Situation of HIV Epidemic & Response in China
HIV Situation in China 2009 Data sources: 2009 HIV Estimation
Number of people living with HIV
Number of new infections in 2009
AIDS deaths in 2009
740,000 (560,000-920,000)
48,000 (41,000-55,000)
26,000 (22,000-30,000)
PLHIV in need of ARV treatment in 2009 190,000 (260,000-200,000)
Sexual transmission is now the main mode
Note: 2009: heterosexual 42.2%, homosexual 32.5%;
2007: heterosexual 44.7%; homosexual 12.2%;
2005: data on hetero-and homo- sexual is not available
Distribution of new infections by mode of transmission, by year. 2005-2009
Data sources: 2005, 2007 Joint Assessment; National 2009 AIDS/STD Annual Meeting
Highly-varied geographic distribution
Cumulative
reported cases:
326,000 up to end
of 2009
Cumulative AIDS
patients: 107,000
Cumulative deaths:
54,000
Cumulative reported HIV positives by province as of End of 2009
Data sources: National 2009 AIDS/STD Annual Meeting
Highly-varied geographic distribution
• As of end 2009, 55 counties have reported having over 1000 cases, which increased from 43 in 2008. – Shangcai County in Henan Province, Yining County of Xinjiang Province,
Butuo County and Zhaojue County of Sichuan Province has more than 5,000 reported HIV/AIDS positives
• Liangshan Prefecture of Sichuan Province is becoming the areas with most severe HIV epidemic. – Prevalence among the whole population in Butuo County and Zhaojue C
ounty is over 5%. – Average prevalence in other 14 counties was 0.83%,
• Meigu County: 3.44%, Jinyang County: 3.38%, Yuexi County: 1.72% and Ganluo County: 1.19%.
• Yi minority was most heavily affected with prevalence at 1.7%, and the prevalence was 0.69% among Miao People, 0.08% among Han People.
Different HIV Epidemic Dynamics
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
Estimated Size of Most-at-risk Population, China
DescriptionPopulation size estimate
(range)
Injecting drug users (IDUs) 1.5~3.0 million
Female sex workers (FSW) 1.8~4.5 million
Clients of FSW 17.7~37.4 million
Men who have sex with men (MSM)
2.0~7.1 million
Total 23.0~52 million
Data source: China 2007 HIV estimation; F Lu, N Wang, Z Wu, et al. Estimating the number of people at risk for and living with HIV in China in 2005: methods and results. Sex Transm infect 2006 ; 82 ( supply3 ): 87-91
Up to 50 million people in China are at high risk of exposure to HIV
IDU: keep spreading and seeding sexual transmission
Source: Ning W. HIV/AIDS Surveillance System in China. National Center for AIDS/STDs Control and Prevention, China CDC. Presentation at XVI International AIDS Conference, Toronto, Canada, August 12-18, 2006
Percentage of injecting drug users having sex with female sex workers, China Sentinel Surveillance
SWs: rising epidemic, especially among lower-level location based SWs
94.991.4
41.4
6.6
26.6
12.6
5.4 7.4
23.0
3.06.4
14.917.621.5 24.1
5.1
15.719.5
0
10
20
30
40
50
60
70
80
90
100
Hotel/night club based Karaokay bar/barbershop
based
Rented room/street based
perc
ent
Last week condom use Urine opiate positive Syphilis Gonorrhea Chlamydia HIV
Source: LiQinghua, Xu Junjie, Wang Weijia, et al. Survey of high risk behaviors and HIV/STI infection among FSWs from different venues of Kaiyuan City. China J AIDS STD, 2009, Vol.15 No. 2:164-166
Median number of male clients served last week
2
4
8
0
2
4
6
8
10
Hotel/night clubbased
Karaokaybar/barbershop
based
Rented room/streetbased
Num
ber
Higher risk and HIV infection among street-based sex workers, Kaiyuan, Yunnan, China, 2006
Homosexual transmission has accounted for one-third of all new infections in 2009
MSM: an alarmingly fast-growing epidemic
HIV Epidemic among MSMby Geographic Areas, 2008-2009
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
Around Shenyang
4.3-10.0%
Beijing and Tianjin
4.6-8.3%
Around Shanghai
5.0-10.9%
Southwest
8.5-20%
Sichuan
Chongqing
Jiangsu
Beijing
Evolution of HIV epidemic among MSM, 2003-2009
0.44.6 5 5.5
6.35.8
0
5
10
15
20
25
Beijing
0.6 1 1.34.6
10.6
12.9
0
5
10
15
20
25
Chengdu
10.4 10.8
16.3
19.2
0
5
10
15
20
25
Chongqing
4.7
0
5
10
15
20
25
Nanjing
0
5
10
15
20
25
Nanjing
2003
2004
2005
2006
2007
2008
2009
Chengdu
Chongqing
Nanjing
Beijing
2010 Universal Access Targets and MDG 6 Goals: A Difficult Target to Meet
25
45
46
25
38
25.4
30.9
20.9
8.6
80
90
90
90
0 20 40 60 80 100
ART
Intervention (Sexworkers)
Intervention (IDUs)
Intervention (MSM )
2005 achievement 2007 achievement 2008 achievement 2010 targets
Note: (1) 2005 and 2007 achievement based on 2006 and 2008 UNGASS report ; (2) 2008 achievements data from National Comprehensive Response Management Information System (CRMIS); (3) estimated number in need of ART is 190,000 as of 2009
UNGASS indicators achievement, China, 2005-2008
Coverage of PMTCT is limited
• The number of HIV infected PW who were found is relative
low all over the country – reported: 2695( Jan-Sep. 2009)– estimated: 7500( HIV prevalence among PW: 0.05%)( Esti
mated HIV-infected PW during Jan-Sep 2009: 5600)– only 48% HIV+ PW were found
• Coverage of PMTCT services was very limited– ARVs % of HIV+ PW
• among reported cases: 79.4%
• Among estimated: 38.1%
7.7%
30.3%
11.2%6.2%
19.2%26.6%
12.8%
3%
11.7%
HIV Drug-Resistance Rate at Provincial Level
2006-2007, China
HIVDR
(%)
Median months of ART
Henan 30.3 33.7
Anhui 26.6 31.7
Hubei 19.2 27.7
Zhejiang 12.8 10,5
Hebei 11.7 20.3
Yunnan 11.2 16.2
Xinjiang 7.7 5.5
Guangxi 6.2 13.5
Shanxi 3.0 25.7
NA
Main Challenges in Achieving Targets • National & provincial action plans are yet to be costed and strategically enhanced.
• Decentralization needs to be prioritized and infrastructure strengthened to ensure accountability.
• Resource allocation must be prioritized & balanced, with effective utilization of funds, human resources, equipments, information.
• Stigma and discrimination towards people living with HIV and MARPs must be eliminated.
• Legal and political barriers faced by non-government agencies to be removed; their capacity developed to increase effective functioning of civil society organizations.
• Coverage and quality of prevention & treatment interventions must be enhanced.
Severe Stigma and Discrimination Experienced by PLHIV
• 2 out of 5 reported having faced severe HIV-related discrimination.
• More than three quarter of all survey respondents reported that their family members had experienced discrimination as a result of their HIV status.
• More than 10 percent of women living with HIV who were diagnosed with HIV had been pressurized into terminating a pregnancy by health staff.
• About 15% reported having been refused employment or a work opportunity because of their HIV status.
• 9.1% Of those respondents with children said their children had been forced to leave school because of the HIV status of their parents.
• A substantial proportion of medical staff (26%), government officials (35%) & teachers (36%) changed their stance after learning of a person’s HIV positive status into a ‘discriminatory’ or ‘very discriminatory’ attitude.
Priorities for 2010---National 2009 AIDS/STD Annual Meeting (21 Jan. 2010)
• Carrying out final review of 2006-2010 Action Plan
• Developing Five Year Action Plan for Reducing and Preventing the Spread of HIV/AIDS (2011-2015)
• Improving surveillance system
• Scaling up prevention interventions among IDU, MSM, low-level sex workers, rural migrants, discordant couples and etc.
• Accelerating scale up of ART program
• Scaling up PMTCT and exploring ways to enhance prevention of HIV, STI and HBV by routine testing of pregnant women
Priorities for 2010(continued…)
• Strengthening support to most heavily affected areas especially Liangshan prefecture of Sichuan Province, Yili Prefecture of Xinjiang and Guangxi Province
• Case finding and management: rapid, easy and user-friendly testing method to be applicable in community and township health care settings, strengthen health facility-based testing, and management of reported cases
• Public education – with special emphasis to remote, poor and ethnic minority sites; education for students and community organizations
• Social mobilization and adoption of specific measures to encourage volunteers and civil society participation in AIDS response.