Blog Poll: Target Population Groups at Risk to Better Fight HIV/AIDS in Asia

Condoms for sex workers in Cambodia.
Condoms for sex workers in Cambodia.

By Susann Roth

On World AIDS Day, it’s time to share where ADB blog readers think we should invest in to achieve future zero transmission of HIV/AIDS in the region.

If you were a young adult in the late 1980s and early 1990s, you grew up with the awareness that contracting HIV was a risk for everybody and that only your own personal behavior could protect you from it. In Asia and the Pacific, this notion of universal risk has changed thanks to investments in data generation and analytics; we now understand the HIV epidemic now much better and can focus on targeted interventions for key “at risk” population groups.

On World AIDS Day, it’s time to share the results of ADB’s November blog poll, which asked readers what we invest in to achieve future zero transmission of HIV/AIDS in the region. An overwhelming majority (70%) of participants in our survey chose treatment and prevention for key population groups at risk.

Much progress has been achieved in fighting HIV/AIDS in Asia and the Pacific over the past two decades. Progress, however, has been uneven, and is stagnating in some countries. The region still has the second highest number of people living with HIV (5.1 million in 2015), and just three countries—the People’s Republic of China, India, and Indonesia—account for about three-quarters of them. New infections are declining in South and Southeast Asia, but rising in East Asia.

Key population groups at risk in the region include men who have sex with men, sex workers, people who take injectable drugs, and transgender people. For them, the main issues are insufficient access to treatment, which affects about one-third of the total, and lack of awareness about their infection status.

For 20% of ADB blog readers, we should prioritize better use of data to understand who is left behind in prevention and treatment and target programs. For instance, Thailand is a world leader in the provision of HIV/AIDS prevention services, but data show that Thais under 25 are not being reached by prevention efforts. Across the region, data also show that men who have sex with men are becoming infected at a younger age, but again prevention and testing services are reaching fewer young men who have sex with men, who have reported lower condom use than their older counterparts. More efforts are needed to reach younger people at risk of HIV infection; this requires outreach in schools and leveraging the power of social media.

6% of those who took part in the poll focused on investing in legal reforms to inhibit stigmatization and exclusion, and forging partnerships outside the health sector. The legal aspect is quite important in Asia and the Pacific, where 37 countries still criminalize some aspects of sex work; 11 have compulsory detention centers for people who use drugs; 15 punish drug-related offenses with the death penalty; 17 criminalize same-sex relations; and 10 impose some form of restriction on the entry, stay, and residence of people living with HIV. In countries where people still get stigmatized, we need partnerships between legislators, civil society organizations and health experts to ensure that all people at risk have access to HIV prevention, testing and treatment without discrimination.

Finally, 4% of ADB blog readers picked investing in urban response as the best way to achieve zero transmission of HIV/AIDS in the region. HIV prevalence among men who have sex with men is particularly high in urban areas; cities such as Bangkok in Thailand, Yangon in Myanmar, and Yogyakarta in Indonesia have estimated HIV prevalence rates of 20-29%. Data on condom use shows that it is lower for men who have sex with men in urban areas, where under half of men who have sex with men reported using a condom. A combination of awareness raising, social marketing of condoms, and targeted health services is required to respond to the urban HIV epidemic.

We must recognize that the fight against HIV/AIDS in Asia and the Pacific is far from being over. The younger generation shows higher levels of risk behavior. The epidemic is spreading, and excluded population groups and weakly governed urban health systems challenge unified responses. To achieve the UNAIDS 90-90-90 target by 2020, we must radically extend the reach of HIV services and treatment, utilize data to target population groups at risk, and forge more partnerships outside the health sector.