Protection of human rights is fundamental in AIDS battle, says WHO

News release

MANILA, 1 December 2009 — Violation of human rights or insufficient compliance with human rights principles, compounded by limited or no access to health services, including prevention and life saving therapies like ART, could significantly contribute to the spread of the epidemic in Asia, the World Health Organization has warned. WHO said that unless drastic measures are taken to address these issues, the Region's HIV/AIDS epidemic could significantly worsen despite progress in some countries. WHO, in collaboration with Member States, marks World AIDS Day on 1 December to raise awareness worldwide about HIV/AIDS and to promote solidarity in the face of the pandemic. This year's theme, "Universal Access and Human Rights", seeks to ensure that human rights are protected and that global targets for HIV/AIDS prevention, treatment and care are met. WHO said violations against human rights fuel the spread of HIV and put marginalized groups, such as injecting drug users, sex workers, and men who have sex with men and transgender people at a higher risk of infection. These population groups are more vulnerable to contracting HIV because they are often unable to realize their civil, political, economic, social and cultural rights, and they lack access to information, education and services necessary to ensure sexual and reproductive health and prevention and care and treatment of infection. While access to HIV services is expanding in some settings, most-at-risk population groups continue to face technical, legal and socio-cultural barriers to accessing those services, WHO said. Globally, an estimated 33.4 million people are living with HIV, with the Western Pacific Region accounting for 1.4 million infections at the end of 2008. The epidemic continues to grow in the Region, although showing signs of stabilization, with an estimated number of new infections of about 136 000 in 2008, a slight decline compared to earlier years. The burden of HIV continues to be predominant among men (69% of HIV-infected adults in 2008), due to the more predominant engagement of men in high-risk behaviours like unprotected commercial sex, unsafe use of injecting drugs, and unprotected sex amongst men.

Of concern is the number of new infections among children in the Region that has increased to 5700 in 2008; this is mainly a consequence of the low coverage of services on prevention of mother to child transmission (PMTCT) in most Western Pacific countries, while paediatric HIV has become very uncommon in other settings with higher PMTCT coverage. WHO stressed that the number of HIV infections must decrease dramatically before it can begin to effectively curb the epidemic, calling for renewed and more targeted prevention interventions, coupled with further expansion of treatment services. "Future HIV trends will be influenced directly by the level at which HIV prevention and treatment efforts are sustained and intensified," said Dr Shin Young-soo, WHO Regional Director for the Western Pacific. "For the majority of countries in the Region, comprehensive interventions will need to target populations with high risk behaviours, which are the main drivers of the epidemic in the Region".

HIV/AIDS Fact Sheet

Global HIV epidemic • 33.4 million people were living with HIV worldwide at the end of 2008. It is also estimated that the same year 2.7 million persons became newly infected with HIV, and that 2 million AIDS-related deaths occurred.• Globally, women account for almost half of all HIV infections.• The number of children living with HIV was estimated at 2.1 million in 2008.• New HIV infections have been reduced by 17%. The declines reflect the effectiveness of HIV prevention interventions.• However, in some countries there are signs that new infections are rising again. • In 2008, 42% of people in need of antiretroviral treatment were receiving it, compared to 33% in 2007.• In 2008, 45% of HIV-positive pregnant women in low-and middle-income countries received antiretrovirals for the prevention of mother to child transmission (PMTCT). • The reported number of HIV testing and counseling sites increased by approximately 35% between 2007 and 2008. However, the proportion of people living with HIV who were aware of their status remained low, with a median of less than 40%.

HIV in the Western Pacific Region • The estimated number of people living with HIV in the Western Pacific Region by the end of 2008 was 1.4 million, compared to 1.3 million at the end of 2007, and 870 000 at the end of 2001.• The majority of HIV infections in Western Pacific countries continue to be among men, with women accounting for about 31% of the total burden. This is because men engage more frequently in behaviour that exposes them to a higher risk of acquiring HIV (unprotected commercial sex, unprotected sex among men, and unsafe injecting drug use). • The number of AIDS-related deaths among adults and children in 2008 was up to 90 000, more than double the number estimated in 2001. This increase in mortality is occurring as the epidemic becomes mature and more people living with HIV enter into the symptomatic phase, while the coverage of antiretroviral therapy—the only way to stop the progress of HIV infection into HIV disease and AIDS—remains limited to just over 30% of those in need.• As a sign of the stabilization of the epidemic and the success of prevention interventions, the number of new HIV infections for all ages in the Western Pacific Region in 2008 was estimated at 136 000, marking a slight decline compared to earlier years.• However, the number of new infections among children in the Region increased up to 5700 last year alone. Since these infections are almost invariably acquired during pregnancy or breast-feeding, they represent a consequence of the very limited coverage of services for the prevention of mother-to-child transmission in the Region, reaching just one fourth of all estimated pregnancies in mothers living with HIV.• The future scenario of the HIV epidemic in the Region will be determined by the level at which HIV prevention efforts are sustained and intensified. For the majority of Western Pacific countries, prevention interventions will need to increasingly focus on high-risk behavior such as unprotected commercial sex, unsafe use of injecting drugs, and unprotected sex among men.

Progress in health sector response: • HIV testing and counselling services continue to successfully expand in several countries, both in terms of their availability and in the levels of uptake. However, testing and counselling still do not sufficiently reach those population groups where most HIV infections are concentrated, leaving large proportions of people living with HIV unaware of their status.• 122 290 people living with HIV were receiving life-saving antiretroviral therapy (ART) at the end of 2008, representing an eight-fold increase compared to 2004, and a 37% expansion from 2007. Only 31 % of those in need were actually receiving ART. A more consistent progress was reported in the provision of paediatric ART, with 6,600 children living with HIV receiving treatment, accounting for almost three quarters of children in need.• Coverage of interventions for most-at-risk populations, including services for people who inject drugs, condom promotion and prevention and management of sexually transmitted infections among sex workers and their clients, and services for men having sex with men, are all on the rise. However, they have not yet reached the critical level recommended by the Commission on AIDS in Asia in their 2008 milestone report, for interventions to have a major impact on the epidemic.• Scale-up of the prevention of mother-to-child transmission has increased coverage from 13 % in 2007 to 23 % in 2008, which represents significant progress, but is still a long way from reaching the goal of eliminating paediatric HIV infection.• HIV/TB collaborative activities are increasingly addressing the problem of co-infections, with more people living with HIV screened for active TB, and an increased proportion of newly diagnosed cases of TB being tested for HIV. However, other recommended evidence-based interventions, including TB prophylaxis measures, are still at very low levels of implementation.

Challenges and recommendations Further scale-up of the health sector response is urgently needed in most Western Pacific countries. The issues include:• Coverage of interventions for most-at-risk populations, particularly for men who have sex with men and injecting drug users • Further scale up of ART, including issues related to quality of services and treatment outcomes• Coverage of prevention of mother-to-child transmission of HIV, unacceptably low despite an increased availability of services and raising uptake of testing among women.• Testing and counselling services, especially among most-at-risk populations• Generating quality and reliable strategic information on HIV by tracking and monitoring the HIV epidemic as well as health sector interventions with a focus on the main drivers of the epidemic in the Region.

Data source: - WHO/UNICEF/UNAIDS. Toward Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector, Progress report 2009. - Country reports on the framework indicators monitoring Health Sector Responses, 2009- UNAIDS/WHO, AIDS Epidemic Update, November 2009.- 2001 and 2008 Estimates breakdown by WHO Regions (not published), UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance and Estimation, November 2009.- Country consensus reports/meetings on HIV estimates, 2007-2009.

For more information, please contact Dr Massimo Ghidinelli, WHO Regional Adviser in HIV/AIDS and Sexually Transmitted Infections, at tel: +63 2 528 9714;
mobile: +63 928 501 2066; e-mail: