1. Regional Overview of Progress on Universal Access in Asia-Pacific Steve Kraus, Regional Director UNAIDS Regional Support Team for Asia and the Pacific Bangkok, Thailand 30 March 2011 1

2. Estimated number of adults and children living with HIV, new infections and AIDS deaths, 1990-2009 Source: UNAIDS RST Asia-Pacific, based on data compiled for the UNAIDS Report on the Global AIDS Epidemic, 2010 The Asia-Pacific epidemic is stabilizing: declining new infections and deaths leveling off 300,000 4.9 million 360,000 2

3. But significant variations in the region: increasing, stabilizing and declining country epidemic patterns Source: UNAIDS RST AP, Country epidemic patterns from HIV estimates and projections data for the UNAIDS Report on the Global Epidemic 2010 Epidemic Pattern Adults and children newly Infected Adults and children living with HIV Adults and children AIDS Deaths Countries IThailand, Cambodia, India IIMyanmar, Nepal, PNG*, China** IIIIndonesia, Vietnam, Malaysia, Pakistan IV <200 Philippines, Laos, Bangladesh * Number of people living with HIV appears to be leveling off. **Likely trend from the available data. UNAIDS EPP-Spectrum projections not available for China. 3

4. Important geographic variations within countries should inform programming Source: China Global Fund consolidated RCC proposal, 2008 4

5. Getting to zero in Asia and the Pacific: Responses informed by evidence 5 Source: Commission on AIDS in Asia. 2008. Redefining AIDS in Asia: Crafting an Effective Response. 75 million Men in Asia visit sex workers (2-20% of adult men) 4 million Men who inject drugs 10 million Women sell sex 16 million Men who have sex with men 50 million Women married to men who visit sex workers 1 million infants and children Men Women

6. 6 HIV prevalence among female sex workers, countries where data is available, 2001-2009 Source: www.aidsdatahub.org based on Sentinel surveillance data reported by National AIDS programs; Magnani R, Riono P, Nurhayati, et al. Sexual Risk Behaviors, HIV and Other Sexually Transmitted Infections among Female Sex Workers in Indonesia. Sex Transm Infect. 2010 Oct;86(5):393-9. Epub 2010 Jun 3www.aidsdatahub.org Progress in reducing infections among female sex workers, but may be masking high prevalence in some locations

7. Source: www.aidsdatahub.org based on data reported by National AIDS Programs from HIV Sentinel Surveillancewww.aidsdatahub.org Prevalence among people who inject drugs remains high in several countries HIV prevalence among people who inject drugs, countries where data is available, 2001-2009 7

8. MSM epidemics are on the increase around the region Source: www.aidsdatahub.org, based on data reported by National AIDS programs from HIV Sentinel Surveillance; China Centre for Disease Control and Prevention; Viet Nam IBBS; and Thailand population-based surveyswww.aidsdatahub.org HIV prevalence among MSM, from selected cities, 2002-2009 8

9. Proportion of all infections in women has stabilized at around 35% in last ten years Estimated number of women and adults (15+) living with HIV, 1990-2009 Source: UNAIDS RST Asia-Pacific, based on data compiled for the UNAIDS Report on the Global AIDS Epidemic, 2010 35% 9

10. HIV prevalence data indicate high quality interventions addressing young people at risk are required Source: www.aidsdatahub.org based on DHS and youth surveys reported in UNGASS Country Progress Reportswww.aidsdatahub.org 2006, 2008, 2010 Young people who inject drugs and their older counterparts Young sex workers and their older counterparts 10

11. Source: www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008, 2010www.aidsdatahub.org * Manipur ** 2009 Kathmandu Insufficient reach of key affected populations People who inject drugs Female sex workers Men who have sex with men 11

12. Number of syringes/needles distributed per IDU per year (2009) Source: www.aidsdatahub.org based on Towards Universal Access:www.aidsdatahub.org Scaling up Priority HIV/AIDS interventions in the health sector, 2010 Access to sterile needles and syringes remains low throughout the region 12

13. Source: www.aidsdatahub.org based on UNGASS country Progress reports 2008 & 2010www.aidsdatahub.org Varying levels of condom use: highest among female sex workers % of condom use at last sex among key populations, most recent data, 2007-2009 13

14. % of key affected populations receiving an HIV test in the last 12 months and who know the results, 2007-2009 Source: www.aidsdatahub.org based on UNGASS Country Progress Reports 2008 & 2010www.aidsdatahub.org 14 Missed opportunities for HIV testing and counseling…

15. The number of people on treatment has increased steadily in the region, but slower than in the rest of the world Source: www.aidsdatahub.org based on Towards Universal Access: Scaling up Priority HIV/AIDS Interventions inwww.aidsdatahub.org the Health Sector, 2006-2010 15 Number of people receiving antiretroviral therapy in Asia- Pacific vs total low- and middle-income countries, 2003-2009

16. Estimated ART coverage among adults and children in Asia- Pacific vs. total low- and middle-income countries, 2008-2009 16 Source: www.aidsdatahub.org based on Towards Universal Access: Scaling up Priority HIV/AIDS Interventions inwww.aidsdatahub.org the Health Sector, 2010 Coverage of ART is increasing, but remains well below universal access

17. PPTCT coverage in East, South and South-East Asia vs. all low-and middle-income countries, 2005-2009 Source: www.aidsdatahub.org based on Towards Universal Access: Scaling up priority HIV/AIDS interventions inwww.aidsdatahub.org the health sector, 2010 PPTCT coverage in Asia lags the global average even more than for ART…

18. Quality antenatal care coverage (4 visits) remains low in many countries Source: www.aidsdatahub.org based on national surveys cited in WHO and UNICEF Countdown to 2015.www.aidsdatahub.org Decade report (2000-2010) : Taking stock of maternal, newborn and child survival 2009 Antenatal care coverage at 4 or more visits, in countries where data are available

19. % of estimated HIV-positive incident TB cases that received treatment for TB and HIV, countries where data is available, 2007-2009 Source: www.aidsdatahub.org based on UNGASS Country Progress Reports 2010; Countries collected the data usingwww.aidsdatahub.org ART patient registers and estimates from WHO STOP TB Data Base except Afghanistan ART Data Base, Indonesia ART Monitor and Reports, Japan Nagoya Medical Center & International Medical Center of Japan (ACC) Database, PNG National Department of Health Program Monitoring 19 Tuberculosis is the first cause of death among PLHIV and coverage is low

20. Middle Income Countries contribute too little to the AIDS response Source: UNGASS 2010 Indicator 1 data set Proportion of domestic funding, MICS, 2009

21. And still too little funding goes to high impact prevention Source: UNGASS country progress reports 2010

22. Most MIC need to spend less than 0.2% of their GNI to fund their response… Source: UNGASS 2010; World Data Bank

23. Regional evidence-base summary: Asia-Pacific HIV epidemic stabilizing, but considerable variation in the country and sub-national epidemics HIV still concentrated among key populations at risk and their partners, and at high levels in many locations. PWID and MSM interventions generally well below UA target of 80% coverage; FSW coverage better and programmes largely miss out on clients. Below global average on treatment for those in need and worse for PPTCT. Coverage of HIV-TB low and for HIV–HCV co-infection non-existent. Systematic combined reviews of epidemic, programme and expenditure data to adjust programming and funding, and programme evaluations to inform scale-up, remain the exception. International funding represents the majority of funding. In 2010, all Asian MIC would need to spend less than 0.5% of their GNI to fully fund a targeted response.

24. 24 ZERO NEW HIV INFECTIONS. ZERO DISCRIMINATION. ZERO AIDS-RELATED DEATHS. Thank you