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Asia and Pacific Overview of the HIV Epidemic and Response

Asia and Pacific Overview of the HIV Epidemic and Response. JVR Prasada Rao Regional Support Team Asia & Pacific Bangkok. ICAAP, Kobe, July 2005. What data do we know? What does the data mean? What should be done?.

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Asia and Pacific Overview of the HIV Epidemic and Response

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  1. Asia and Pacific Overview of the HIV Epidemic and Response JVR Prasada Rao Regional Support Team Asia & Pacific Bangkok ICAAP, Kobe, July 2005

  2. What data do we know? What does the data mean? What should be done?

  3. No let up in the relentless progress of the epidemic and time is running out to deal with this epidemic at a relatively low cost…..

  4. 1985 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women

  5. 1993 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women

  6. 1998 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women

  7. 2004 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women 8 M HIV+ I M new Infections 0.5 M deaths

  8. Hot spots 2004 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women

  9. What does the data mean?

  10. National prevalence compared to prevalence among ANC in selected sites, 2002-2004 Cambodia Myanmar

  11. Poverty reduction: projected MDG 1 erosion Cambodia India UNAIDS-ADB. 2004. Impact of HIV/AIDS on Poverty in Cambodia, India, Thailand and Viet Nam.

  12. Drivers of the epidemic: familiar pattern in countries 90% SW Spouse 5% IDU 5% 50% Spouse SW 15% IDU 20% MTCT 15% 70% IDU SW 26 % Source: Thai Working Group on HIV/AIDS Projections, 2001

  13. Pacific: a different epidemicLessons from Papua New Guinea • Epidemic closer to African pattern and potential • Driven by multi-partner male-female sex • Sex with more than one partner in past year >50% • Male : female prevalence about equal (versus 3 : 1 in Asia)

  14. What should be done?

  15. Annual new HIV infection in Asia and the Pacific with and without intervention, 2005-2010 Source: UNAIDS estimates (derived from Lancet article, July 6, 2002 with data for 2004)

  16. Core Minimum Package • Promotion of condoms, lubricants and treatment of STIs for male and female sex workers and their clients • Clean needles, substitution treatment for IDUs • Delay of sexual intercourse, monogamy and condom use for young people • Voluntary counselling and testing • Prevention of mother-to-child transmission • Access to ART and other treatment

  17. Coverage No impact can be achieved without reaching the critical threshold • 60% Behaviour change of vulnerable communities • 80% of ART for eligible HIV positive ( 50% by 2005)

  18. Policy options: financial losses with different levels of care and prevention, 2001-2015

  19. Expanded response impact on new infections, prevalence, death, and financial loss by 2010 Baseline: Low prevention and care Expanded response: Limited prevention with expanded ARV Cumulative New Infections (Millions) HIV+ Adults and Children (Millions) Cumulative Financial Loss (Billions) Cumulative AIDS Deaths (Millions)

  20. Are we doing enough?

  21. Poor coverage 5.4% 19% 1% 8% Source: WHO (2004). Coverage of Selected Services for HIV/AIDS Prevention, Care and Support in Low and Middle Income Countries in 2003

  22. Poor coverage: proportion of people with advanced HIV infection receiving ART, 2004

  23. Why the response is not enough

  24. Why the response is not enough:Leadership and Commitment • Countries with head of state leadership of national AIDS committee: 2 • Countries with multisectoral policy: 9 • Countries with multi ministerial programs: 3 • Countries with regular surveillance: 3 • Countries with national M+E: 1

  25. 4.0 5.1 3.5 2.8 3.0 2.5 2.2 2.0 1.6 US$ (Billions) 1.4 1.3 1.5 1.0 0.5 0.0 2005 2006 2007 Estimated Resource Available Estimated Resource Needs Why the response is not enough:Rising resource gaps

  26. We can afford it! “… Moreover, the region as a whole can well afford these investments. Even the peak resource need of US$5.1 billion annually for the years 2007-2010 is just 4 per cent of current regional health expenditure (2001).” ADB/UNAIDS (2004) Asia-Pacific’s Opportunity: Investing To Avert An HIV/AIDS Crisis

  27. Why the response is not enough:Decreasing budgets Peso (millions) Baht (millions) Philippines Thailand

  28. Funding National Response Prevention Care, Support and Treatment Monitoring and Evaluation Others Why do we need the Three Ones? Government GFATM UN Agencies Bi-laterals Civil society

  29. Why the response is not enough:Partners • United Nations agencies • improving coordination • defining responsibilities • Multilateral institutions • eliminating overlaps • concentrating on comparative advantages • Civil society • speaking with one voice

  30. We can do it!

  31. If only… • If actions are prioritised based on solid quantitative and qualitative data • If top leadership of national governments move from commitment to action • If support from the international community is unified under ‘Three Ones’ principle • If civil society is vibrant, acting both as partner and watchdog • If resources are substantially stepped up immediately

  32. The Silent Tsunami... …requires an “emergency-like” response in Asia and Pacific

  33. Staying focused “Sometimes the snake charmer gets so engrossed in playing the flute he forgets what is important : catching the snake or playing the flute ….”

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