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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.
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:
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
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
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
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
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
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
1 UNAIDS, 2012. UNAIDS Report on the Global AIDS Epidemic.
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