Although the first cases of AIDS in Asia were reported mid‑1980s, the more extensive spread of HIV began late compared with the rest of the world, occurring in Cambodia, India, Myanmar and Thailand in the early 1990s (Ruxrungtham, Brown and Phanuphak, 2004[1]; UNAIDS, 2013[2]). Asia is second only to sub-Saharan Africa as the region with the greatest number of people with HIV. The UN set an SDG target to end the epidemic of AIDS as a public threat by 2030.
In Asia-Pacific, the prevalence of HIV infection varied importantly, ranging from less than 0.1% of adults aged 15 to 49 in Bangladesh, Mongolia, New Zealand and Sri Lanka to 1% of adults aged 15 to 49 in Thailand in 2020 (Figure 3.26, left panel). Although HIV prevalence is low, the absolute number of people living with HIV was high at more than 2.2 million in reporting countries and territories in 2021, because of Asia-Pacific’s large population (Figure 3.26, right panel).
Expanded access to antiretroviral therapy (ART) has increased the survival rates of people living with HIV, but about half of the people eligible for HIV treatment do not receive it worldwide (UNAIDS, 2018[3]). The estimated ART coverage amongst persons living with HIV in 2021 was less than half in Pakistan, Indonesia, Bangladesh, Mongolia, the Philippines and Fiji, whereas more than three‑quarters had access to ART in Thailand, Cambodia and New Zealand (Figure 3.27).
Over past years, many countries in Asia-Pacific responded to HIV/AIDS successfully and incidence rates have declined. Bangladesh, Singapore and Sri Lanka had less than 0.01 new case of HIV infection per 1 000 uninfected population in 2021. However, almost 0.4 new cases of HIV infections per 1 000 uninfected population were reported in Papua New Guinea in 2021 (Figure 3.28). Moreover, the Philippines more than tripled the new cases of HIV infection between 2000 and 2018 (UNAIDS, 2019[4]).
Advances in HIV prevention and treatment could end AIDS as a public health threat in the region. Recent evidence has emerged showing that antiretroviral drugs not only improve the health and prolong the lives of people living with HIV, but also prevents HIV transmission. The rapid scale up antiretroviral therapy in recent years in Asia and the Pacific provides unprecedented opportunity to successfully implement antiretroviral-based interventions for prevention. The benefits of ART can be fully realised only if people living with HIV are diagnosed and successfully linked to care. This will require targeted efforts and removing barriers especially amongst key affected populations, as most of Asia’s epidemics occur amongst sex workers and their clients, men who have sex with men, transgender persons, and injection drug users.
