Some Background Facts on HIV/AIDS in Asia 

From Joint United Nations Program on HIV/AIDS
New Delhi, 6 March 2000

Overview

The spread of HIV, the virus that causes AIDS, began in the region in the early to mid-1980s. By the late
1980s, it was increasing rapidly among several populations, in particular sex workers and injecting drug users.

Across the continent as a whole, an estimated 6.5 million people were living with HIV at the end of 1999, over
five times as many as have already died of AIDS in the region. By 1999, the region contained nearly 60% of the
world's adult population and about 20% of the world's estimated HIV infections. The major force driving the
epidemic in Asia is heterosexual transmission. With a population of nearly 3.5 billion, the Asia-Pacific region
has the potential to greatly influence the course of the global epidemic.

China

Because of it size and rapid changes in social and sexual behaviours during the past decade, China potentially
represents a major focus of the HIV epidemic in the Asia-Pacific region. Almost half a million people in a
population of over 1 billion are estimated to be HIV-positive. The bulk of new infections appear to be
concentrated among injecting drug users. Transmission is primarily through use of shared infected needles.
The potential to spread beyond the drug-injecting population is high due to massive population movements and
increasing disparity in income, which fuels the sex industry (there are an estimated 4 million commercial sex
workers in China).

India

With a population of one billion, greater than the entire population of Africa, the HIV epidemics in India will have
a major impact on the overall spread of HIV both in the region and worldwide. India has the highest number of
HIV infections in the world. At present, it is estimated that some 3.7 million Indians have HIV or AIDS, but the
patterns of transmission in the country vary widely. In some states, especially in the south and west of the
country, HIV has a significant grip on the urban population, with over 1 in 50 pregnant women testing
HIV-positive. In the northeast, HIV infection has sped through networks of drug injectors, and from them to their
wives. In other states, the first HIV infections were only detected in the past year or two.

Thailand

Thailand's well-established HIV prevention efforts continue to bear fruit, with a fall in prevalence (proportion of
adults living with HIV/AIDS), particularly among young women and young male military conscripts. The
epidemic was virtually non-existent until the mid-1980s but by end 1999, there were an estimated 800,000
cases of HIV infection in the country. As a result of a committed and effective prevention strategy, infection
levels peaked and are now tending to stabilize. 

Malaysia

The HIV epidemic is spreading slowly, mainly among injecting drug users but also among individuals whose
sexual behaviour may be high-risk. The epidemic may have reached its peak during the 1990s, as it now
appears that HIV transmission has stabilized, and incidence (the proportion of adults newly infected each year)
may be stable. However, prevalence will continue to increase for a few more years.

Viet Nam

Infection rates remain low but are rising. The highest risk group is injecting drug users, but there are warning
signs that HIV transmission could increase dramatically through sexual risk behaviour. In female sex workers,
HIV prevalence increased five-fold in the four years to 1998, reaching 2.6%.

Bangladesh

A similar pattern of low HIV prevalence accompanied by warning signals that rates could rise quickly exist.
About half of all sex workers are infected with syphilis, which indicates that many clients do not use condoms;
syphilis and other sexually transmitted infections also greatly increase the chance of HIV transmission.
Bangladesh also estimates it has 25,000 drug injectors who share needles and syringes daily and the virus
among them is bound to spread.

Myanmar

It is believed that infection rates are high and rising, recent and accurate data is difficult to find.

Cambodia

Asia's highest levels of infection are recorded in Cambodia, where HIV appears well established in the general
population in all provinces. HIV prevalence among pregnant women in 1998 exceeded 2% in 12 out of the
country's 19 provinces. Nationwide, on average, some 3.7% of married women of reproductive age were living
with HIV in 1998.

Vulnerable Populations

As Asian countries grow economically, population mobility increases, especially because of environmental
degradation and a search for better economic opportunities that often encourage people to move to cities from
the countryside. The virus is thus spread through truckers, traders, contract labourers, sailors and their sexual
partners, many of whom are sex workers. 

Areas near national borders also present higher risk. Border crossings are frequented by refugees and
migrants who may cross over regularly. Border-crossing groups often include sex workers. Some studies
suggest that busy land border crossings and international fishing ports have higher rates of HIV and sexually
transmitted infections than other locations.

Sex workers are particularly vulnerable to HIV and represent the most significant core group for transmission
to the rest of the population through their clients. The main factors influencing the spread of HIV include the
number of clients a day and the proportion of men who visit sex workers regularly. The absence of condom
use increases transmission even more. Sex work continues to be illegal in many countries so prevention
remains difficult.

Men who have sex with men represent one of the highest risk groups because of the transmission probabilities
associated with unprotected anal sex. Many of these men may also have sex with women and so help spread
HIV to their female partners.

The region has been significantly affected by injecting drug users, the first community to be affected in most
countries in South and Southeast Asia. Drug users are rapidly switching from non-injecting drugs to injecting
drugs, forcing previously undetectable levels of HIV to increase significantly. Some provinces in China, New
Delhi in India, and Kathmandu in Nepal report HIV prevalence rates of 80% or more, 45%, and 45%
respectively among injecting drug users.

Facts and Figures (end 1999)

Adults and children newly infected with HIV during 1999: 1.5 million (worldwide: 5.6 million) 
Adults and children estimated to be living with HIV/AIDS: 6.5 million (worldwide: 33.6 million) 
Adult and child deaths due to HIV/AIDS from beginning of epidemic to end 1999: 1.2 million (worldwide:
16.3 million)

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