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The epidemics in the region are concentrated epidemics which are characterized by transmission mostly through specific sexual or drug using behavior, and concentrated among specific behavioral populations. This translates into HIV seroprevalence that is usually below 1% at the national level but much higher in specific communities. In countries such as India, Cambodia, Vietnam, Thailand and China, HIV prevalence has declined or remained steady over the last five years, while countries such as Bangladesh, Pakistan and the Philippines have seen growing prevalence. In most countries across the region, the HIV prevalence among key populations at higher risk, such as people who inject drugs (PWID), female sex workers (FSWs), men who have sex with men (MSM), and transgender persons, and the sexual partners of these people, is significantly higher than for others. Additionally, there are often large regional differences in HIV prevalence within countries; for example, in China, over half the country's PLHIV reside within just five of the 22 provinces[2], and in India, 60% of PLHIV live in six of its 28 states[3]. Across the region, even as gains have often been made in lowering prevalence among female sex workers, the prevalence among men who have sex with men and transgender persons has been rising rapidly; while the prevalence among people who inject drugs has remained extremely high for a number of years. The increasing prevalence among MSM is especially marked in urban centres. An additional complexity is the fact that there are sometimes critical overlapping behavioral risks among sex workers, men who have sex with men, and injecting drug users.
While about 70% of the people living with HIV in the region are men, there is a steady increase in the number of new infections among young women and wives/spouses of men who concurrently engage in unprotected sex with multiple partners, and/or inject drugs. About 50 million women in the region are at risk of infection from their partners and spouses who are clients of sex workers. Severe stigma and discrimination, violation of human rights, gender inequality and extremely poor access to information and services including counselling, testing and life-saving treatment are major socio-structural contributors to epidemics in the region. Punitive laws and violation of human rights of HIV key affected populations such as MSM are not only threats to human security and dignity, but also hurdles to appropriate public health responses. The severe socio-economic impact of the epidemic on people living with HIV and their households, particularly in the context of the economic crisis and food price inflation, is a major cause for concern. In the absence of appropriate social protection, many such households resort to irreversible coping mechanisms, such as selling of assets, and are pushed into poverty. Chronic inequality, criminalization of groups such as MSM, transgender persons, sex workers and PWID, marginalization of communities, inadequate resources, and poor access to services make the HIV epidemic a human rights and development challenge. It also impacts other development challenges such as democratic governance, maternal and child health, education improvements, and poverty reduction. UNDP’s response to HIV, Health and DevelopmentHIV and other pandemic and neglected diseases disproportionately affect the poor and marginalized around the world. Poverty, gender inequality and other social factors can exacerbate the spread of disease. At the same time, the spread of disease itself undermines the prosperity and wellbeing of individuals, families and communities. The achievement of the Millennium Development Goals and sustainable human development more broadly thus requires strengthened action on the linkages between HIV, health and development. UNDP’s work on HIV, health and development is always carried out in partnership with other agencies and programmes, particularly those with more specific health sector expertise. As a cosponsor of the Joint United Nations Programme on HIV/AIDS (UNAIDS), UNDP’s HIV work focuses in particular on addressing human rights and the legal environment, women and girls, and most at risk populations. UNDP also contributes to other key areas of the UNAIDS response, including promoting multi-sectoral AIDS planning, advancing social protection, and addressing HIV in humanitarian settings. Since 2003, UNDP has partnered with the Global Fund to Fight AIDS, Tuberculosis and Malaria to support countries in implementing large scale multi-sectoral programmes to address those three diseases. UNDP also participates in a number of other important global health partnerships, including Roll Back Malaria and Special Programmes on Neglected Tropical Diseases (TDR) and Human Reproduction (HRP). UNDP’s work on HIV, health and development is organized into three main streams of work, as follows:
Response by HIV, Health and Development Practice TeamWithin the context mentioned above, UNDP’s HIV, Health and Development Practice Team in Asia and the Pacific seeks to address the human development, governance, human rights, gender and trans-border challenges of HIV and AIDS in the region. We assist countries to implement HIV responses that are integrated, involve key sectors of government and civil society and promote human rights and gender equality. In doing so, we ensure that HIV and AIDS are addressed within the broader poverty reduction strategies, and support countries to respond to the key social drivers of their HIV epidemics such as status of women, their economic empowerment, the protection of human rights, and the legal environment. Central to our work is strengthening partnerships between affected communities and governments to ensure more effective and inclusive governance of HIV responses. We support the development of policies and programmes that reduce the vulnerability of key populations and help people who are impacted by the epidemic. These efforts include removal of punitive laws and practices that undermine effective responses to HIV among MSM, migrants, sex workers and people living with HIV; facilitation of HIV-sensitive social protection; and adoption of TRIPS (the Agreement on Trade Related Aspects of Intellectual Property Rights) flexibilities into national laws for expanding access to treatment. The Practice Team works closely with the UNDP country offices in the region, as well as the national governments, regional intergovernmental institutions such as SAARC, SPC and ASEAN, and regional civil society organizations; specifically in the areas of policy and programme development, policy advocacy, leadership, capacity development, South-South cooperation, and management of GFATM grants. We also work closely with other UNDP Practice Teams, such as Democratic Governance, Poverty Reduction, and Gender. Key priority areasHuman Rights and Sexual DiversityMen who have sex with men and transgender personsAmong men who have sex with men, highly concentrated and severe HIV epidemics have emerged in urban areas across the region with prevalence rates ranging between 30.7% in Bangkok and 5.8% in Beijing. Yet, investments in HIV programming for MSM remain limited, ranging from 0% to 4% of the total spending for HIV programming in countries region-wide. Across the region, some 19 countries criminalize male to male sex, and in the majority of the countries, there is a lack of comprehensive HIV interventions for men who have sex with men. A 2006 survey of the coverage of HIV interventions in 15 Asia-Pacific countries estimated that targeted prevention programmes reached less than 8% of MSM, far short of the 80% coverage that epidemiological models indicate is needed to turn the HIV epidemic around[4]. The Report of the Commission on AIDS in Asia[2] notes the spread of HIV among MSM as a “fast growing epidemic”. According to the Report, high partner turnover with low condom use has led to a rapid rise of HIV prevalence. Social taboos and discrimination against same-sex relationships push the majority of MSM in the region underground and outside the reach of prevention and treatment services. The Report further notes that in the worst case scenario, 50% of all new infections will be caused by male to male sex by 2020. Another worrying aspect of the epidemic is the restrictive legal and social environment in the region; highly discriminatory stereotypes and myths; and violation of the rights of MSM, transgender persons and sexual minorities. These structural barriers significantly increase the vulnerability of MSM and transgender persons to HIV and have an immense adverse effect on their health and human rights. What We Do
Sex workThe future of the HIV epidemic in the Asia Pacific region depends to a large extent on the conditions of the sex industry, and the ability of sex workers and their clients to protect themselves from HIV infection. The reports of the Commission on AIDS in Asia and Commission on AIDS in the Pacific have been key in recognizing unprotected paid sex as one of the central drivers of the HIV epidemic in the region. The Report by the Commission on AIDS in Asia[2] estimated that up to 10 million women in Asia are selling sex to an estimated 75 million men, who in turn have intimate relations with 50 million women. Even though it is well known that early interventions with sex workers can reverse the epidemic, as has been shown in Thailand, Cambodia and Tamil Nadu (India) in the late 90s and early 2000s, sex work interventions remain a relatively low priority in most countries, with only 10% of the Global Fund to fight AIDS, TB and Malaria (GFATM) resources received by the countries in this region spent on sex work programming. Rights based responses are essential to allow for an open discourse among sex workers and service providers on their HIV-related needs so that health-seeking behaviors can be sustained over a period of time. However, throughout Asia and the Pacific, legal structures often fail to adequately protect the rights of women when they are involved in sex work. In most countries, there is active criminalization of sex workers and the sex industry, and even in those countries of the region where there is no stated criminalization of sex work, there are discriminatory and abusive practices towards sex workers. Moreover, literature indicates that violence is prevalent in the sex industry, and that sex workers face a unique set of factors that make them vulnerable to all forms of violence; while there are also specific factors that can help protect those engaged in sex work from experiencing violence, and diminish the extreme vulnerability that they often face. What We Do
Women and Girls, Gender-Based Violence and Spousal TransmissionWhile about 70% of the people living with HIV in the region are men, there is a steady rise in the number of new infections among young women and monogamous wives/spouses whose male partners are engaging in HIV higher risk behavior. The proportion of women newly infected with HIV has risen from 21% of all new infections in Asia and the Pacific in 1990, to 35% of all new infections in 2009[1]; but reaching as high as 57% of all new infections in Papua New Guinea. About 39% of new infections in Thailand and 46% in Cambodia are among women. Furthermore, women and girls often bear the brunt of the epidemic at the household level where the impact of the epidemic is most acutely felt. Although the majority of women in the region have been infected through their husbands or long term partners, many women are forced to leave their homes when found to be HIV-positive or else when their husbands die from AIDS. Women in the region have limited access to ARV and HIV services, and stigma and discrimination associated with the disease makes them particularly vulnerable to abuse and violence. What We Do
HIV- sensitive Social Protection and the Socio-economic Impact of the EpidemicThe Report by the Commission on AIDS in Asia[2] estimates the annual economic cost of AIDS on Asian households at about US $ 2 billion. Each AIDS death results in a loss of at least US $ 5,000 or 14 years of productive life calculated at a modest US $ 1 a day. External shocks such as the recent price hikes in food and fuel as well as the financial crises lead to extremely vulnerable socio-economic conditions for people living with HIV and their households, calling for further analysis and action. The most significant factor concerning the impact of the financial crisis on people living with HIV is that even during normal times, they are under extreme socio-economic stress[5]. Volatile food prices, which have been rising steadily in the Asia Pacific region, make the situation worse[6]. Social protection reduces people’s vulnerability to socio-economic risks and impoverishment. It protects them from shocks and helps them conserve and accumulate assets so that they can improve their livelihoods and productivity. It also contributes to transforming economic and social relations in ways that strengthen the longer term livelihood prospects of the poor and vulnerable people. People living with HIV are one such vulnerable group that needs social protection support. Studies by UNDP from six countries in Asia clearly show that people living with HIV and their households are chronically burdened by illnesses, loss of jobs and income, rising medical expenses, food insecurity and depletion of savings and other resources. The impact is more severe on women. This calls for strategic HIV-sensitive social protection initiatives that can protect affected people from irreversible coping mechanisms and poverty. The key to sustainable HIV-sensitive social protection, as examples in the region and elsewhere show, is not to create parallel systems, but to appropriately integrate HIV into existing social protection initiatives, based upon a rights-based approach with active involvement of people representing HIV-affected households and other key populations. In Asia and the Pacific, since 2006, UNDP has been engaged in the assessment of socio-economic impact of HIV at the household level, with a view to helping countries and communities develop impact mitigation strategies. UNDP’s focus on HIV-sensitive social protection is in its usefulness in mitigating the socio-economic impact of HIV on people living with HIV and their households, and to integrate it into UNDP’s overall social protection and human development agenda. What We Do
Migrants’ rights to health and removal of HIV travel restrictions for migrant workersAccording to the 2009 UNDP Global Human Development Report on Migration[7], there are approximately 55.6 million migrants from Asia, representing 29.6% of the total migrants in the world. The vulnerabilities of migrants to poor health in general and to HIV in particular across national borders, have been part of the agenda of the UNDP Regional HIV Programme for about a decade. What We Do
[1] UNAIDS, 2010. UNAIDS Report on the Global AIDS Epidemic. [2] Commission on AIDS in Asia, 2008. Redefining AIDS in Asia: Crafting an effective response. [3] NACO, 2010. [4] WHO, et al., 2010. Priority HIV and sexual health interventions in the health sector for MSM & TG people in the Asia Pacific-Region. [5] UNDP. Preliminary data from ongoing studies on the socio-economic impact of HIV at the household level in China, Cambodia and Indonesia. [6] UNDP, 2009. A preliminary study of the impact of HIV on poverty and food security among HIV-affected households in Asia: Hunger briefing paper series. [7] UNDP, 2009. UNDP Human Development Report 2009 Overcoming Barriers: Human mobility and development, Page 30 Table 2.1. |
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The countries in the Asia Pacific region are home to serious HIV epidemics that pose special challenges to societal and human development. In global terms, the region accounts for the second highest number of world-wide AIDS-related deaths (300,000), the second highest number of new infections (360,000), and the second highest number of people living with HIV (PLHIV) (about 5 million)[1]. In Asia, HIV will cause an estimated total loss of 180 million years of healthy and productive life between 2002 and 2020, more than any other disease[2].