CSIRO PUBLISHING

Sexual Health, 2014, 11, 119–125 http://dx.doi.org/10.1071/SH13045

Review

Current status of HIV treatment in Asia and the Pacific region Angsana Phuphuakrat A, Sasisopin Kiertiburanakul A and Somnuek Sungkanuparph A,B A

Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. B Corresponding author. Email: [email protected]

Abstract. Asia and the Pacific represent a diverse group of nations facing HIV epidemic profiles of differing severity. Compared to other parts of the world, the burden of HIV disease is high in this region because of its large populations. At the end of 2011, 5 million people were living with HIV in Asia and the Pacific. This accounted for 15% of people living with HIV worldwide. The prevalence of people living with HIV, as well as access to HIV treatment and care, varies widely between countries. Differences between high-income economies and the rest of the continent are remarkable. Many high-income countries provide antiretroviral therapy (ART) to their citizens. Middle- and low-income countries have rapid ART scale-up and are dependent on international funding. This may compromise the sustainability of ART availability. In addition, lack of access to second- and third-line therapy remains a problem in many countries. The global goal of achieving universal access to ART by 2015 requires mainly low- and middle-income countries to be targeted. Regional policy should be developed in order to identify new infections in key populations, to start earlier treatment, to retain patients in care and to maintain funding. Additional keywords: access to health care, AIDS, antiretroviral therapy. Received 1 April 2013, accepted 28 October 2013, published online 17 January 2014

Introduction At the end of 2011, 5 million people were living with HIV in Asia and the Pacific.1 These accounted for 15% of people living with HIV worldwide. The burden of HIV disease is comparatively high because of the large populations in this region. Asia and the Pacific represent a diverse group of nations facing HIV epidemics of different severity.2 The global goal of achieving universal access to antiretroviral therapy (ART) by 2015 requires mainly low- and middleincome countries to be targeted. Most of the countries in Asia and the Pacific are in these economies. This review focuses on the current status of delivering ART to those in need in the region, access to services and treatment coverage of HIV-infected people. Epidemiology of HIV in Asia and the Pacific The prevalence of patients with HIV infection varies widely between countries. Commercial sex workers (CSWs), men who have sex with men (MSM) and injecting drug users (IDUs) are the groups seriously affected by HIV/AIDS in most of Asia and the Pacific. Seven countries in the region have more than 100 000 people living with HIV: China, India, Indonesia, Myanmar, Pakistan, Thailand and Vietnam (Table 1). India alone accounts for about half of the HIV burden in this region. Across the region, rates of HIV infections have dropped by 20% over 10 years.3 However, the progress in Journal compilation  CSIRO 2014

reducing new HIV infections varies throughout Asia and the Pacific. Although Oceania, South Asia and South-East Asia have made progress in reducing new HIV infection, new cases are increasing in East Asia.1 A significant proportion of new HIV infections is in young people under the age of 25.3 Five epidemic profiles can be distinguished in this region as consequences of HIV transmission dynamics and varying coverage levels of HIV services:2–4 (1) declining epidemic: new HIV infections and numbers of people living with HIV, and AIDS-related deaths are declining (Cambodia and Thailand); (2) maturing epidemic: declining new infections, but the number of people living with HIV and the number of AIDS-related deaths are stable or increasing (Malaysia, Nepal, Papua New Guinea and Vietnam); (3) latent epidemic: new infections and the number of people living with HIV are increasing, but AIDSrelated deaths remain low (Bangladesh and Laos); (4) expanding epidemic: new infections and the number of people living with HIV are increasing, and AIDS-related deaths are increasing (Indonesia and the Philippines); (5) low-prevalence: countries with

Current status of HIV treatment in Asia and the Pacific region.

Asia and the Pacific represent a diverse group of nations facing HIV epidemic profiles of differing severity. Compared to other parts of the world, th...
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