From the Editorial team

In this second edition of the Data Hub Newsletter, we bring to you key highlights from country reviews on Indonesia, Malaysia and Nepal which draw attention to some of the crucial issues in addressing the HIV epidemic.

The figures from a 2007 study undertaken by the Ministry of Health, Lao PDR point out that although HIV prevalence in the general Lao population is a low 0.1 percent, the prevalence among 540 men having sex with men (MSM) was estimated at 5.6 percent in Vientiane. The study highlights specific challenges in reaching MSM population through HIV prevention programmes.

Also included in this issue is a study which presents the systematic review on HIV and Hepatitis C virus infections among drug users from 17 provinces and autonomous regions in China.

Based on UNGASS progress reports (2008), the HIV and AIDS Data Hub carried out an assessment of Monitoring and Evaluation (M&E) Systems in 19 countries in Asia-Pacific. The assessment shows that only 44% of countries have a functional M & E unit and half have a budget to implement the planned activities.

The Data Hub invites you to participate in the ICAAP satellite meeting on “Data sources, data uses – Identify gaps in HIV data for decision making in the Asia-Pacific region” on 10 August, 2009 in Bali, Indonesia. Further details are included.

We welcome your feedback, comments and suggestions. If you have articles/studies related to HIV and AIDS in the Asia-Pacific, we would appreciate your sharing with us. Thank you

Latest Country Highlights

High risk groups dominate HIV trends - Indonesia

Two provinces of Papua are experiencing a generalized HIV epidemic, with a HIV prevalence of 2.4% amongst the general population aged 15 – 49 years. Young adults in the ages of 20 – 29 account for 54% of cumulative AIDS cases. More than 40% of the reported AIDS cases amongst IDUs were in the 15 – 24 age groups. Stigma and discrimination are one of the major challenges in addressing the epidemic. Take a look at the Indonesian Country Review

Reaching out to Most At Risk Populations – Malaysia

Before 2005, the Government has allocated less than USD10 million per annum for the national response to HIV and AIDS. A three-fold increase in this allocation, now totalling more than USD30 million per annum, has been made available to both government agencies and civil society organizations for the next five years (2006-2010) in support of implementation of the current National Strategic Plan (4). Aligned with the National Policy, about USD$3.8 million has been allocated to NGO’s to support their efforts in HIV Prevention and control (16).

The Government’s commitment to the harm reduction approach for IDU is best illustrated through its allocation of USD 90 million for these programmes. Indeed, 60% of the AIDS budget were made available to the HIV and AIDS response for five years for harm reduction programmes. However, it has been recognised by both Government and civil society that other HIV prevention programmes would also be needed. Take a look at the Malaysia Country Review

Labor migrants at risk – Nepal

Along with IDUs, MSM and female sex workers (FSW), an additional group with an elevated risk of HIV are the labour migrants. Data from the 2006 Integrated Bio-Behavioural Survey (IBBS)allowed epidemiologists to estimate that 41% to 46% of all HIV infections in Nepal occur in migrants. Spouses or female partners of migrant workers and clients of sex workers account for 26% of all adult infections. Prevention efforts have yet to reach the migrants who are potential victims and HIV positive. Take a look at the Nepal Country Review

Recent Trends - MSM in Lao PDR

The figures from a 2007 study reveal that although HIV prevalence in the general Lao population is a low 0.1 percent, the prevalence among 540 men having sex with men (MSM) was estimated at 5.6 percent in Vientiane in 2007. The study undertaken by the Ministry of Health, the Burnett Institute and other partners* is “worrying” especially in a country whose neighbors – Cambodia, Thailand and Vietnam – already have documented HIV epidemics in their MSM communities. The study also surveyed risk behaviours among MSM and found that, while the vast majority of respondents knew unprotected anal sex was high-risk, less than a quarter used condoms with non-regular partners in the previous 3 months. Only 6% had previously been tested for HIV. Less than one percent reported injecting drug use. In addition, more than half reported having sex with women in the previous 3 months.

Similarly, a previous qualitative study conducted among 88 young men in the capital city of Vientiane showed that men having sex with men also have sex with women and do not identify themselves as homosexuals. This makes them more difficult to reach by HIV prevention programs.

*Sheridan S, Phimpachanh C, Chanlivong N, et al. HIV prevalence risk behaviour among men who have sex with men in Vietiane Capital, Lao people’s democratic republic. AIDS, 2007 23: 409 – 414

**Toole MJ, Coghlan B, Holmes WR, et al. Understanding male sexual behaviour in planning HIV programmes: lessons from Laos, a low prevalence country. STI, 2006. 82,2: 135 - 138

Assessment of Monitoring and Evaluation Systems

An assessment by the Data Hub of the Monitoring and Evaluation systems in 19 countries in Asia-Pacific, based on their UNGASS progress reports (2008), show that most countries have key components of an effective system in place. A lot of progress has been made in recent years. However, when it comes to implementation, only 44% of countries have a functional M&E unit and half have a budget to implement the planned activities. In 40% of countries, development partners have not aligned their reporting systems with the national framework.

Systematic review of HIV and HCV infection among drug users in China

This systematic review presents data of HIV and HCV infection among 15,565 Chinese drug users from 17 provinces and autonomous regions. The HIV prevalence was 12.6% in IDUs and 1.1% in non-IDUs and the HCV prevalence rates were 67% in IDUs and 18.3% in non-IDUs. The overall HIV and HCV co-infection prevalence was 6.5% in IDUs. The map shows that Yunnan and Xijian provinces disclosed the highest HIV prevalence among IDUs and that HIV infections follow common drug trafficking routes.

This is important information to improve understanding of the high prevalence of HIV and HCV infection in China, and of the need to widen the harm-reduction responseso as to effectively tackle the epidemic. You may access this article which is published in the International Journal of STD & AIDS 2009: 399-405

ICAAP Events

Data sources, data uses – Identify gaps in HIV data for decision making in the Asia-Pacific region, Bali, Indonesia, 10 August, 2009

Critical data on the HIV epidemic is still limited or unavailable. HIV and behavioral surveillance, size estimations of populations at risk and monitoring of the national response are often crippled by inadequate funding and limited resources. Recent 2008 UNGASS national progress reports show that more countries in Asia – Pacific are reporting on more indicators than in past years. However, there are still gaps that need to be addressed.

The ICAAP satellite meeting titled “Data sources, data uses” organized by the HIV and AIDS Data Hub for Asia-Pacific on 10 August, 2009 will discuss some of the key issues in addressing these gaps and in producing comprehensive reports for the next round in 2010. More information is available in the Congress Booklet on ICAAP website

Falling through the cracks: addressing the reproductive health needs of female sex workers, Bali Indonesia, 10 August 2009

In recent years, there has been renewed momentum examining issues of integration of HIV and reproductive health programs as well as a deeper analysis of “linkages” being led by UNFPA, WHO, UNICEF, IPPF and other partners. More information is available in the Congress Booklet on ICAAP website

Caring for children and families affected by HIV in concentrated and low level epidemics: Government and community responses that are making a difference! Bali Indonesia, 10 August 2009

Despite impressive efforts in Asia and the Pacific to extend access to HIV care and support, children living with and affected by HIV and their caregivers have been largely overlooked. There are approximately 150,000 children living with HIV in Asia-Pacific, and 80 million orphans due to all causes including AIDS – more than in any region in the world. More information is available in the Congress Booklet on ICAAP website

Making Empowerment Real: Using community-led approaches to strengthen evidence base on interventions for female, male and transgender sex workers, 11 August 2009

It is now generally accepted that community engagement is an essential part of HIV programme implementation and service delivery. Inspite of this vital role, community-led initiatives are held back by limited roles, capacities and resources. This session will feature an interactive component with the audience through small discussion groups where samples of tools that have been adapted for the use of sex workers will be shared. More information is available in the Congress Booklet on ICAAP website

Latest Resource Material

Global

• Prevention and treatment of HIV and other sexually transmitted infections among MSM and transgender populations: report of a technical consultation, 15 – 17 September 2008, Geneva, Switzerland, World Health Organization 2009
• UNGASS : Monitoring the Declaration of Commitment on HIV & AIDS, Guidelines on the construction of core indicators: 2010 reporting
• HATiP, HIV & AIDS Treatment in Practice, Issue 138, June 2009

Regional

• Discussion Paper, HIV and AIDS in Asia and the Pacific: A review of progress towards Universal Access, UNESCAP, Bangkok 2009
• Asia Pacific Civil Society and 2008 UNGASS on HIV and AIDS, 2008 Asia Pacific Council of AIDS Service Organisations
• Meeting Report : Health Sector response to HIV & AIDS among men who have sex with men, report of the consultation, 18 – 20 February, 2009, World Health Organisation, Regional Office for the Western Office, Manila, The Philippines

China

• “I will fight to my last breath”: Barriers to AIDS Treatment for Children in China, Asia Catalyst, April 2009

Links on all this from the reference materials site. Click here to view the documents mentioned above.

HIV related events in July and August 2009

• Monitoring and Evaluation of HIV and AIDS Programs organized by Institute for Population and Social Research, Mahidol University, 13 – 24 July 2009 in Bangkok, Thailand
• First Asia Pacific Conference on health promotion and education organized by the International Union for Health Promotion and Education (IUHPE), Department of Public Health, Dokkyo Medical University, School of Medicine, 18 – 20 July 2009 in Chiba City, Japan
• Sub-regional meeting on HIV among Men who have Sex with Men/Transgenders in Insular Southeast Asia, 4 – 8 August 2009 in Bali, Indonesia.
• Second Regional Consultation on Prevention of HIV Related to Drug Use, The Asian Consortium on Drug Use, HIV/AIDS and Poverty (ACDHAP), organized by the UNODC Regional Centre for the East Asia and the Pacific, 7 – 18 August 2009 in Bali, Indonesia.The 9th International Congress on AIDS in Asia and the Pacific (ICAAP 9), 9 – 12 August 2009 in Bali, Indonesia.

About Us

AIDS Data Hub is an initiative of a partnership between the Asian Development Bank (ADB), the United Nations Joint Programme on AIDS (UNAIDS), the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) – that provides user-friendly data on most-at-risk population groups, women, children, and young people, disaggregated by age and sex. It also probes provincial and district-level situation where data are available, and provides updates on the prevalence, behaviours and national responses.