Human immunodeficiency virus (HIV) is a retrovirus that destroys or impairs the cells of the immune system. As HIV infection progresses, a person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). It can take 10‑15 years for an HIV-infected person, without treatment, to develop AIDS. HIV and AIDS is an important public health problem that requires monitoring the trend of the epidemic and the impact of intervention, therefore a sustainable development goal is to reduce new infections of HIV and mortality due to HIV (WHO, 2024[1]). In 2023, 39.9 million people are living with HIV, of which almost 25% (9.3 million) are not receiving treatment (UNAIDS, 2024[2]). Although in 2023 there were about 39% fewer cases of acquired HIV compared to 2010, an estimated 1.3 million people acquired HIV in 2023; Central Asia being one of the regions with increased new HIV infections (UNAIDS, 2024[2]). 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[3]; UNAIDS, 2013[4]).
In Asia-Pacific, the prevalence of HIV infection varied importantly, ranging from one in 1 000 adults aged 15 to 49 in Nepal, Australia, Bangladesh, Sri Lanka, New Zealand and Mongolia to 10 out of 1 000 adults aged 15 to 49 in Papua New Guinea in 2023 (Figure 3.26, left panel). Although HIV prevalence was relatively low in India (0.2%) for 2021, the absolute number of people living with HIV was high at more than 2.5 million in 2023 (Figure 3.26, right panel).
Although access to antiretroviral therapy (ART) has increased the survival rates of people living with HIV, about a quarter of the people eligible for HIV treatment do not receive it worldwide (WHO, 2024[1]). The estimated ART coverage amongst persons living with HIV in 2023 was less than 40% in Pakistan, Fiji, Indonesia and Mongolia, whereas more than 80% had access to ART in Nepal, Thailand, Cambodia and New Zealand (Figure 3.27, left panel). Comparing lower-middle- and low-income countries with high-income countries, on average, there is a gap of 29% in favour of the higher-income countries, showing the greater need for funding ART in lower-income countries.
Over past years, many countries in Asia-Pacific responded to HIV/AIDS successfully and incidence rates have declined. New Zealand, Sri Lanka and Bangladesh had one new case of HIV infection per 100 000 population in 2023. However, Philippines, Fiji and Papua New Guinea increased in incidence in 2023 compared to 2021, with Papua New Guinea having almost seven new cases of HIV infections per 100 000 uninfected population in 2023 (Figure 3.27, right panel).
Advances in HIV prevention and treatment could end AIDS as a public health threat in the region. The ART does not only improve health and prolong the lives of people living with HIV, but also prevents HIV transmission. The rapid scale up of ART, along with efforts of making it more affordable for low- and middle-income countries, is an opportunity for Asia Pacific countries to successfully implement antiretroviral-based interventions for prevention (WHO, 2024[1]). 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.
