HIV/AIDS: Asia

Incidence, Prevalence, Trends, and Patterns

In the 1980s, the HIV/AIDS epidemic was already sweeping through much of the world, but Asia's first cases were identified only by the mid-decade. However, by the 1990s, HIV/AIDS became a “pandemic” or global epidemic as it spread rapidly through southeast and then south Asia. By 2008, Asia accounted for almost six million of the estimated 33 million people living worldwide with HIV/AIDS, second only to sub-Saharan Africa, with India the largest single contributor with 2.5 million persons living with HIV/AIDS (PLWHAs). Asia is defined here as spanning from the Indonesia in the east to Turkey in the west, and from Russia in the north to the Maldives in the south. Regional divisions are: south and southeast Asia, east Asia, central Asia, and west Asia (Middle East). Women aged 15 and above now comprise over a third of all PLWHAs in Asia, and their proportion is slowly rising.

Overall adult prevalence rates of HIV are low at less than 1 percent in all Asian countries except Thailand. This is one of the reasons the magnitude of the epidemic and its risk is frequently not fully grasped. Women in particular often lack awareness about HIV/AIDS and its dynamics, enhanced by low-risk perception due to their own relatively lower levels of voluntary participation in “risky behavior” (IDU, unprotected sex, and/or multiple sexual partners) as compared to men, contributing to their greater vulnerability. Lack of awareness and low-risk perception is partly responsible for the current feminization of the epidemic because women often do not, or traditionally cannot take protective measures, particularly within marriage.

The trajectory of the HIV/AIDS epidemic largely began in the “Golden Triangle” of the continent's drug industry, primarily affecting injection drug users in Thailand, Vietnam, and Myanmar, and continuing along a corridor through India to Afghanistan, Pakistan, and Nepal. Spreading primarily through heterosexual contact, the epidemic soon widened to include the overlapping and thriving sex industry, affecting not only female commercial sex workers (CSWs), but also extending from the clients to their non-CSW partners. Injection drug users and CSWs continue to be the most affected groups in Asia, still directly and indirectly impacting the feminization of the epidemic. A third group, men having sex with men (MSMs) are also significant in this process in that many are married or have regular heterosexual female partners. This triad of “high-risk” groups, along with mobile populations such as migrants and truck drivers play a crucial role in conveying the infection to the general and “low risk” female populations by acting as a “bridge population.”

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