(July 2004) The rapid spread of HIV/AIDS epidemics in Asia, illustrated by dramatic increases in new infections in China, Thailand, and Vietnam over the past year, poses particularly worrisome challenges for the international health community.

Of the 4.8 million new HIV infections worldwide in 2003, Asia accounted for one in every four. Both the global and Asian numbers represent the greatest increases since the epidemic came to light more than 20 years ago, according to the latest estimates by UNAIDS and the World Health Organization (WHO).

Countries in Southeast Asia, including Cambodia and Vietnam, are experiencing particularly serious epidemics. National prevalence in Cambodia is the highest in Asia at around 3 percent. In neighboring Vietnam, adult HIV prevalence increased from 0.3 percent in 2001 to 0.4 percent in 2003. One in 75 households there has at least one member who has been affected by the virus.

Table 1
2003 Global Estimates of HIV and AIDS

Number of people living with HIV 37.8 million
Sub-Saharan Africa 25 million
South & Southeast Asia 6.5 million
Latin America 1.6 million
Eastern Europe & Central Asia 1.3 million
North America 1 million
East Asia 900,000
Western Europe 580,000
Caribbean 430,000
Oceania 32,000

Face of AIDS Shifts in Asia

High-risk behaviors threaten to fuel Asian epidemics, which remain largely concentrated among injecting drug users, men who have sex with men, and sex workers and their partners and clients. While Thailand has reduced new infections, from 140,000 in 1991 to 21,000 in 2003, UNAIDS cites increasing evidence that the virus there is spreading among sex workers’ spouses and clients and among such key groups as migrants and injecting drug users. In a 2003 Bangkok study, more than 15 percent of men who had sex with men had HIV, and 21 percent had not used a condom with their last casual partner. In Bangladesh, while national adult prevalence may be low (0.1 percent), UNAIDS says that men there continue to buy sex in greater proportions than anywhere else in the region, and Bangladeshi sex workers report the region’s lowest condom use.

Since Asia is a region of population giants, even small HIV prevalence can represent large numbers of affected people, and these epidemics can test already strained global resources. With more than 2 billion people between them, China and India alone account for a third of world population. Though prevalence is only 0.1 percent in China and between 0.4 percent and 1.3 percent in India, trends indicate a serious potential for expanding epidemics. India already has close to 5 million people living with the virus, the largest number infected with HIV outside of South Africa. UNAIDS reports that without effective action, 10 million people may be infected with HIV in China by 2010, according to UNAIDS.

Africa’s Epidemics Continue Unabated

Even though the new HIV/AIDS figures have thrown the global spotlight on Asia, AIDS deaths continue unabated in sub-Saharan Africa, where factors such as sex between people of different age groups and high levels of sexually transmitted infections have helped take the virus deep into the region’s general population. In 2003, sub-Saharan Africa buried some 75 percent of the 3 million people who died of AIDS around the world. With only 10 percent of the world’s population, the region holds some 66 percent of all people living with HIV. Seven southern African countries have prevalence rates above 17 percent. They include Botswana and Swaziland, whose rates exceed 35 percent.

Nowhere is the female face of AIDS more pronounced than in sub-Saharan Africa. Today, there are 13 infected women for every 10 infected men, up from a ratio of 12 to 10 in 2002. The difference is even greater among young people ages 15 to 24. The ratio of young women living with HIV to young men with the virus ranges from 20 to 10 in South Africa to 45 women for every 10 men in Kenya and Mali. AIDS has also killed one or both parents of an estimated 12 million children in sub-Saharan Africa.

Countries Must Expand Programs

The challenges to reducing the global AIDS burden are many, according to UNAIDS:

  • Programs must include a specific focus on the many factors that contribute to the special vulnerability and risk of women and young girls—factors such as gender and cultural inequalities, violence, and a lack of access to information.
  • Countries also face the need to expand prevention programs that reach a mere 1 in 5 people at risk of infection. Only one in 10 pregnant women in low- and middle-income countries was offered services for preventing HIV transmission from mother to child in 2003.
  • Treatment programs in poor countries are also inadequate and must be scaled up. Only 7 percent of those who need life-prolonging anti-AIDS treatment in developing countries have access to the antiretroviral therapy. The treatment comes with a warning, however: Countries must heed the need to make programs sustainable to prevent the development of drug-resistant HIV strains.

In the meantime, global spending on HIV/AIDS is far from what will be needed in the near future. An estimated US$12 billion will be needed by 2005 for prevention and care in low- and middle-income countries, according to UNAIDS. Yet, global spending was just under US$5 billion in 2003. In addition, roughly US$20 billion will be needed by 2007 to meet a range of needs: to provide antiretroviral therapy to just over 6 million people; support 22 million orphans; provide HIV counseling and testing to 100 million adults; provide school-based HIV/AIDS education to 900 million students; and offer peer counseling services to 60 million out-of-school young people.

Yvette Collymore is a senior editor at PRB.