(October 2002) The HIV/AIDS pandemic took hold later in Asia than in most other regions, but the large sex industry and injecting drug trade favored its rapid spread. UNAIDS estimates there were fewer than 600,000 people living with HIV/AIDS in South and Southeast Asia in 1990; by 2001, the estimate topped 6 million. More than half of these people live in India. During 2001, there were an estimated 800,000 new HIV infections in the region.

Thailand and Cambodia initially were at the center of Southeast Asia’s HIV epidemic, but both countries have been successful in slowing infection rates. The thriving sex industry in Thailand facilitated HIV infections, but new infections have slowed dramatically, largely because of the Thai government’s mandatory condom-use program for brothels. In central and northern Thailand, up to 30 percent of commercial sex workers had HIV in the early 1990s; by 1999, the rate had fallen to 13 percent. Infection rates among the Thai military have declined as well, reversing an upward trend. In Thailand and Cambodia, programs promoting condom use in brothels have reduced HIV transmission in both sex workers and their clients, as well as in the general population. Thailand’s success in controlling the spread of HIV is attributed to the government’s willingness to commit substantial resources to public health, the mobilization of multiple sectors, an aggressive prevention program, and an excellent health infrastructure. Cambodia’s government also acted early to slow the HIV epidemic by promoting condom use, reducing the fear and stigma associated with AIDS, and introducing programs to lessen vulnerability to infection.

In Cambodia, Myanmar, and Thailand, life expectancy in 2010 will be nearly two years to four years lower than it would be without AIDS. The U.S. Census Bureau also projected that Cambodia, Myanmar, Thailand, and several other non-African countries will experience lower population growth rates because of AIDS.

Since the late 1990s, however, HIV/AIDS experts have detected alarming increases in HIV prevalence in other South and Southeast Asian countries. India is home to more people with HIV/AIDS than any other country except South Africa. Prevalence is high among urban residents, injecting drug users, truck drivers, and commercial sex workers. In some Indian cities, there has been a worrying increase in HIV/AIDS among pregnant women, suggesting that HIV is moving into the general population. A recent UNAIDS study, Report on the Global HIV/AIDS Epidemic, says that HIV is infecting “strikingly diverse” populations in India, which may mean the disease is poised for rapid spread.

HIV prevalence has also increased among sex workers in Indonesia, Vietnam, and several other countries. While HIV prevalence in Indonesia is relatively low, recent increases in HIV prevalence among sex workers and injecting drug users, along with increasing sexual activity among adolescents and young adults, point to a potential surge in HIV infections. In one drug treatment center in Jakarta, 40 percent of patients in 2001 had HIV, up from just 15 percent the previous year.

Peter Lamptey is president of the Family Health International (FHI) Institute for HIV/AIDS. Merywen Wigley is an associate technical officer at the FHI Institute for HIV/AIDS. Dara Carr is a technical director for health communication at PRB. Yvette Collymore is senior editor at PRB. Excerpted from PRB’s Population Bulletin “Facing the HIV/AIDS Pandemic” (PDF: 786KB).