HIV, Health and Development

Home | Publications | Media Reports | Innovative Approaches | MSM Country Snapshots | News and Events | Programmes/Initiatives | Contact Us

What's New

AIDS laws in Asia and the Pacific are failing to protect those most vulnerable

29/5/13: Bangkok - Legal protections are unevenly enforced and human rights violations persist for people living with HIV in Asia and the Pacific. According to a new report released today by the United Nations Development Programme (UNDP), weak anti-discrimination laws affect the daily lives of those living with HIV by creating barriers to access to health care, prevention and treatment, and employment and education opportunities.  Most people who experience rights abuses do not attempt to seek redress through legal means, according to the report. More...

Art Exhibit by Sex Workers from ASEAN countries "Yet, still we dance!"

4/4/13: Bangkok - ‘Yet, still we dance’ was a unique art exhibit with works created by sex workers from eight ASEAN countries and Timor-Leste. More than 50 sex worker artists were involved in creating this exhibit using a range of mediums including sculpture, painting, fabric, and photography. It ran for 10 days at the Bangkok Art and Culture Centre... More...

The countries of 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 (309,000), the second highest number of new infections (369,000), and the second highest number of people living with HIV (PLHIV) (almost 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 disease2.

The epidemics in the region are concentrated epidemics which are characterized by transmission mostly through specific sexual or drug using behaviour, and concentrated among populations engaging in unsafe behaviours. This translates into HIV seroprevalence that is usually below 1 percent at the national level but much higher in specific communities. In countries such as Malaysia, Myanmar, Papua New Guinea, India, Cambodia, and Thailand, HIV prevalence has declined or remained steady over the last ten years, while countries such as Bangladesh, Indonesia, Sri Lanka and the Philippines have seen growing prevalence1. 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 India, 57 percent of PLHIV reside in just four of its 28 states3.

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 behavioural risks among sex workers, men who have sex with men, and injecting drug users.

Asia and the Pacific at a glance

  • Second largest number of people living with HIV (almost 5 million)1
  • Prevalence varies greatly between and within countries
  • Largest epidemics concentrated among key populations at higher risk, such as people who inject drugs, men who have sex with men, transgender people, and sex workers
  • In urban areas across the region the majority of new infections are among sexual minorities (MSM and transgender people); and by 2020 transmission among MSM could constitute approximately 50 percent of total infections8
  • Women constitute 35 percent of all HIV positive people, the majority of whom contracted the disease from their male partners10
  • Punitive laws, rights violations - 19 countries in the region actively criminalize male to male sexual behaviour; less than 20 percent of MSM and transgender people have access to prevention services8
  • All countries of the region criminalize some aspect of sex work (sex work in private, soliciting, and/or brothels), with the only exceptions being New Zealand and the Australian state of New South Wales9
  • Severe socio-economic impact on households of PLHIV - 6 million households in Asia will fall below the poverty line by 2015 if the response is not accelerated; most are vulnerable to irreversible coping mechanisms, such as selling of assets to pay for medical expenses; women are disproportionately affected2
  • Inadequate social protection for households affected by HIV
  • Poor access to treatment - only 31 percent of PLHIV in need in the region are on treatment10
  • There are travel restrictions on entry, stay or residence for people living with HIV in 11 countries in Asia and the Pacific

While the percentage of women who are living with HIV has stabilized over the years at about 35 percent, women are disproportionately impacted by the disease.10 They shoulder additional economic and care-giving burdens, in spite of the added constraints on their education and income opportunities.

Stigma and discrimination, violation of human rights, gender inequality and poor access to information and services, including counselling, testing and life-saving treatment are major socio-structural contributors to epidemics in the region. Laws that criminalize and violate human rights of HIV key affected populations such as men who have sex with men, transgender people, people who inject drugs and sex workers 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 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. 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 Development

HIV and other pandemic and neglected diseases disproportionately affect the poor and marginalized around the world. The achievement of the Millennium Development Goals and sustainable human development more broadly 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 under the Framework Convention on Tobacco Control (FCTC), 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:

  • Mainstreaming, Gender and MDGs
  • Governance, Human Rights and Vulnerable Groups
  • Global Fund Partnership: Implementation Support and Capacity Development

Watch the below video to learn more about UNDP's response to HIV


Response by HIV, Health and Development Practice Team

Within 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, transgender people and people living with HIV; facilitation of HIV-sensitive social protection; and adoption of the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) 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, as UNDP's HIV work is almost always designed as contribution to broader development goals in those areas.

Key priority areas

Human Rights and Sexual Diversity

Men who have sex with men and transgender people

Among 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 percent in Bangkok and 5.8 percent in Beijing. Yet, investments in HIV programming for MSM remain limited, ranging from 0 to 4 percent 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. The latest estimates show that less than one quarter of men who have sex with men are covered by HIV prevention programmes in many countries, including Bangladesh, India, Indonesia, Malaysia, the Philippines, and Vietnam14. This is far short of the 80 percent coverage that epidemiological models indicate is needed to turn the HIV epidemic around4.

The Report of the Commission on AIDS in Asia notes the spread of HIV among MSM as a “fast growing epidemic”2. 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 percent of all new infections will be caused by male to male sex by 2020.

A key aspect of the worsening epidemic are restrictive legal and social environments; highly stigmatizing stereotypes and myths; persistent discrimination in healthcare, employment and other areas; 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.

UNDP APRC is also the Technical Assistance provider under two multi-country Global Fund to Fight AIDS, Tuberculosis and Malaria grants in the Asia-Pacific Region: Project DIVA, the Multi-country Global Fund Programme covering South Asia; and the ISEAN-Hivos Multi-country Global Fund Programme covering the islands of South East Asia. These two grants focus on strengthening community responses to HIV among MSM as well as transgender people.

What We Do
  • Assist country programmes and partners to develop HIV-related legal and policy environments that are consistent with international human rights standards and good practice
  • Work with governments, national human rights institutions, the judiciary and community organizations to promote access to justice, support legislative review and reform, and enforcement of protective laws and anti-stigma initiatives
  • Support initiatives to advance the human rights of sexual minorities, including lesbian, gay, bisexual and transgender people (LGBT)
  • Leadership development and anti-stigma initiatives with religious leaders and other key influential leaders
  • Capacity development of civil society organizations to ensure they are able to fully participate in development and implementation of policies and programmes
  • Research, policy and capacity development to address the needs of men who have sex with men and transgender people in national strategies, plans, programmes and funding mechanisms

Sex work

The 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 the 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 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 other women.2

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 1990s and early 2000s, sex work interventions remain a relatively low priority in most countries, with only 10 percent 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 time.

However, throughout Asia and the Pacific, legal structures often fail to adequately protect the rights of women, men and transgender people when they are involved in sex work. In most countries, there is active criminalization of sex workers and the sex industry, and regardless of the status of the law there are extensive discriminatory and abusive practices towards sex workers. Moreover, sex workers face a unique set of factors that make them vulnerable to many forms of violence.

What We Do
  • Support initiatives that promote access to justice, legislative review and reform, and enforcement of protective laws and anti-stigma initiatives
  • Help strengthen the legal and human rights environment at the national and state/provincial levels to protect the rights of people in sex worker
  • Capacity development of civil society organizations and communities to ensure legal literacy about their rights and that they fully participate in development and implementation of policies and programmes
  • Research, policy and capacity development to address the needs of sex workers in national strategies, plans, programmes and funding mechanisms
  • In partnership with other UNAIDS Co-sponsors and civil society organization partners, address gender-based violence against sex workers through primary research and developing evidence-based policies, programmes and advocacy strategies

Key affected women and girls

The proportion of women among all HIV-positive people in the region has stabilized at about 35 percent.2 The majority of women living with HIV contracted the virus through their male spouses.10

Women and girls often bear the brunt of the epidemic at the household level, where its impact is most acutely felt. Gender inequality, stigma, discrimination, laws that discriminate women and gender-based-violence continue to making women vulnerable to HIV and negatively impact women living with HIV and their children.

What We Do
  • Identifying and defining the needs and challenges of key HIV affected women and girls
  • Access to Justice for key HIV affected women and girls and policy advocacy on how the law impacts key HIV affected women and girls
  • Support countries, which are due to report to the Committee on the Elimination of Discrimination against Women (CEDAW), to include age and sex disaggregated data regarding HIV and women and girls
  • Research and evidence-informed policy advocacy on spousal transmission
  • Research and evidence-informed policy advocacy on HIV and violence against women
  • Research and evidence-informed policy advocacy on the socio-economic impact of HIV on women and girls

HIV- sensitive social protection and the socio-economic impact of HIV

The Report by the Commission on AIDS in Asia estimates the annual economic cost of AIDS on Asian households at about US$ 2 billion2. 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 stress5. Volatile food prices, which have been rising steadily in the Asia Pacific region, make the situation worse6. 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 five 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.12 The impact is more severe on women living with HIV or living in households affected by HIV.13

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-sensitive considerations into existing social protection initiatives including universal health coverage. It is also critical that a rights-based approach be taken with active involvement of people representing HIV-affected households and other HIV key populations.

Since 2006, UNDP has been engaged in the assessment of socio-economic impact of HIV at the household level in Asia and the Pacific, with a view to helping countries and communities develop an evidence-base for impact mitigation strategies. UNDP’s focus on HIV-sensitive social protection contributes to mitigating the socio-economic impact of HIV on people living with HIV and their households, as part of UNDP’s overall social protection and human development agenda.

What We Do
  • Development planning/mainstreaming
    • Research and evidence-informed policy advocacy for the integration of HIV-sensitive considerations into existing social protection schemes and policies, including universal health coverage
    • Facilitate South-South learning on HIV-sensitive social protection
  • Governance
    • Address impacts on key populations at higher risk (MSM, TG, SW), and those affected, particularly women living with HIV; and facilitate community participation through access to justice initiatives
    • Provide technical assistance in review/reform of laws and policies for empowerment of communities, social justice
    • Socio-economic impact assessments

Intellectual property rights, TRIPS, and access to affordable medicines

The right of every human being to access the highest attainable standards of health is now fully recognized by numerous national constitutions and legally binding international human rights treaties.1 In the field of HIV and AIDS, the 2000 Millennium Declaration and the 2001 UN General Assembly Special Session on HIV/AIDS set the goal to achieve universal access to treatment for HIV and AIDS for all those who need it (MDG Goal 6, Target 2). This was reaffirmed in the 2006 Political Declaration on Universal Access to HIV/AIDS Prevention, Care and Treatment and updated in the 2011 Political Declaration on HIV/AIDS.

Access to essential medicines is now established as the right to health and the right to life. In the context of HIV, this includes access to antiretroviral drugs and other medicines essential for HIV care, including medicines for the treatment of co-infections such as tuberculosis and Hepatitis C.

Generic medicines competition in low- and middle-income countries has played a major role in the dramatic reduction of prices of antiretroviral (HIV) drugs in the past decade. From 2000 to present, for example, the price of first generation antiretroviral treatment combinations decreased from more than US$ 10,000 to as little as US$ 67 per patient per year, largely because of generic competition.

This has enabled governments and international funding agencies, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the United States President's Emergency Plan for AIDS Relief (PEPFAR), to greatly increase antiretroviral treatment coverage in low and middle income countries. In Asia, the number of people living with HIV on treatment has almost tripled since 2006.

The legal framework that has allowed governments and international partners to promote the use of generic medicines is defined by the public health-related flexibilities of the World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), as captured in the 2001 Doha Declaration on the TRIPS Agreement and Public Health.2

Access to affordable generic medicine is increasingly becoming important globally. Chronic non-communicable diseases such as heart disease, diabetes and cancer, which often require long-term and sometimes lifetime treatment and medication, are becoming a major threat to many developing countries across Asia and the Pacific. Its importance is further highlighted as many countries begin to pursue universal health coverage as a proven strategy to reduce poverty, improve health disparities and accelerate human development.

WHAT WE DO
  • Research, policy and capacity development to address legal and policy environment for the use of TRIPS flexibilities and engagement of the community
  • Facilitate national, regional and inter-regional dialogues to share experiences and good practices

Migrants’ rights to health and removal of HIV travel restrictions for migrant workers

According to the 2009 UNDP Global Human Development Report on Migration, there are approximately 55.6 million migrants from Asia, representing 29.6 percent of the total migrants in the world7. Addressing the vulnerabilities of migrants to poor health in general and to HIV in particular across national borders, has been part of the agenda of the UNDP Regional HIV Programme for the past decade.

What We Do
  • High level advocacy for policies and programmes for safe mobility that emphasize the right to health and access to HIV services of migrant workers throughout the migration cycle
  • Policy advocacy against discriminatory policies on entry, stay and residence for people living with HIV.
  • Research for evidence-informed advocacy on the HIV vulnerability of migrants in the region
  • Facilitate regional, sub-regional and inter-country dialogues among various stakeholders to promote safe mobility and removal of travel restrictions
  • Facilitate inter-country dialogues among various stakeholders to promote access to antiretroviral treatment for migrants

 

1 UNAIDS, 2012. 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. Data from national studies on the socio-economic impact of HIV at the household level in China, India, 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.
8 UNDP, 2010. Legal environments, human rights and HIV responses among men who have sex with men and transgender people in Asia and the Pacific: An agenda for action.
9 UNDP, 2012. Sex Work and the Law in Asia and the Pacific.
10 UNAIDS, 2011. HIV in Asia and the Pacific: Getting to Zero.
11 UNAIDS, 2010. UNAIDS Report on the Global AIDS Epidemic.
12 UNDP, 2011.The Socio-Economic Impact of HIV at the Household Level in Asia: A Regional Analysis.
13 UNDP, 2011. The Socio-Economic Impact of HIV at the Household Level in Asia: A Regional Analysis of the Impact on Women and Girls.
14 UNDP, UNAIDS, APCOM, HIV & AIDS Data Hub, 2012. MSM Country Snapshots.