Challenges in Asia-Pacific

 Spectators wait to receive free condoms given during the celebration of World Aids Day in Cebu City, central Philippines.

The countries of the Asia Pacific region are home to serious HIV epidemics that pose special challenges to societal and human development. In global terms, the region accounts for the second highest number of world-wide AIDS-related deaths, the second highest number of new infections, and the second highest number of people living with HIV (PLHIV) (almost 5 million).

The epidemics in the region are concentrated epidemics which are characterized by transmission mostly through specific sexual or drug using behaviour, and concentrated among populations engaging in unsafe behaviours. This translates into HIV prevalence that is usually below 1 percent at the national level but much higher in specific key populations at higher risk, such as people who inject drugs (PWID), female sex workers (FSWs), men who have sex with men (MSM), and transgender persons, and the sexual partners of these people. Prevalence varies greatly between and within countries; for example, in India, 57 percent of PLHIV reside in just four of its 28 states.

Across the region there have been gains made in lowering prevalence among female sex workers, however, the prevalence among MSM and transgender persons has seen steady increase, and HIV rates among people who inject drugs has remained extremely high for a number of years. The increasing prevalence among MSM is especially marked in urban centres. An additional complexity is the fact that there are sometimes critical overlapping behavioural risks among sex workers, MSM, and injecting drug users.

Stigma and discrimination, violation of human rights, gender inequality and poor access to information and services, including counselling, testing and life-saving treatment are major socio-structural contributors to epidemics in the region. Laws that criminalize and violate human rights of HIV key affected populations are not only threats to human security and dignity, but also hurdles to appropriate public health responses.

The severe socio-economic impact of the epidemic on people living with HIV and their households is a major cause for concern. In the absence of appropriate social protection, many such households resort to irreversible coping mechanisms, such as selling of assets, and are pushed into poverty. It also impacts other development challenges such as democratic governance, maternal and child health, education improvements, and poverty reduction.

UNDP also works on broader health-related issues beyond HIV and AIDS, such as chronic non-communicable diseases (NCDs) (e.g. cancer, cardiovascular disease, diabetes and hypertension). NCDs disproportionately affect the poor and the vulnerable with impoverishing consequences through catastrophic health expenditures, disability, and care burdens on women and girls. The World Health Organization projects the Asia-Pacific region to record the world’s greatest number of NCD-related deaths by 2020. In the Pacific Island region, the issue is of particular concern - about 40% of the combined population of 9.7 million have been diagnosed with a NCD, and NCDs account for three quarters of all deaths and 40-60% of total health-care expenditure. As a result, governments in the Pacific have declared a ‘NCDs crisis’ and have engaged UNDP, the World Health Organization and other UN agencies for support.

Facts and figures

  • Asia-Pacific is home to almost 5 million people living with HIV.
  • HIV prevalence in countries such as Malaysia, Myanmar, Papua New Guinea, India, Cambodia, and Thailand, has declined or remained steady over the last ten years, while Bangladesh, Indonesia, Sri Lanka and the Philippines have seen growing prevalence.
  • Epidemics are concentrated among key populations at higher risk, such as people who inject drugs, men who have sex with men, transgender people, and sex workers.
  • In urban areas the majority of new infections are among sexual minorities (MSM and transgender people); and by 2020 transmission among MSM could constitute approximately 50 percent of total infections.
  • Chronic non-communicable diseases (NCDs) pose growing threats to developing countries. Today, 80% of global deaths from NCDs occur in developing countries, which also account for 90% of premature deaths from NCDs.

How we address these challenges

UNDP’s work on HIV, health and development is always carried out in partnership with other agencies and programmes, particularly those with more specific health sector expertise. As a cosponsor of the Joint United Nations Programme on HIV/AIDS (UNAIDS), UNDP’s HIV work focuses in particular on addressing human rights and the legal environment, women and girls, and most at risk populations. UNDP also contributes to other key areas of the UNAIDS response, including promoting multi-sectoral AIDS planning, advancing social protection, and addressing HIV in humanitarian settings. Since 2003, UNDP has partnered with the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to support countries in implementing large scale multi-sectoral programmes to address those three diseases. UNDP also participates in a number of other important global health partnerships, including under the Framework Convention on Tobacco Control (FCTC), Roll Back Malaria and Special Programmes on Neglected Tropical Diseases (TDR) and Human Reproduction (HRP).

UNDP’s HIV, Health and Development Practice Team in Asia and the Pacific seeks to address the human development, governance, human rights, gender and trans-border challenges of HIV and AIDS in the region. We assist countries to implement HIV responses that are integrated, involve key sectors of government and civil society and promote human rights and gender equality. In doing so, we ensure that HIV and AIDS are addressed within broader democratic governance and poverty reduction strategies, and support countries to respond to the key social drivers of their HIV epidemics, such as status of women, their economic empowerment, the protection of human rights and the legal environment.

The Practice Team works closely with the UNDP country offices in the region, as well as the national governments, regional intergovernmental institutions such as SAARC, SPC and ASEAN, and regional civil society organizations; specifically in the areas of policy and programme development, policy advocacy, leadership, capacity development, South-South cooperation, and management of GFATM grants.

Central to our work is strengthening partnerships between affected communities and governments to ensure more effective and inclusive governance of HIV responses. We support the development of policies and programmes that reduce the vulnerability of key populations and help people who are impacted by the epidemic. These efforts include removal of punitive laws and practices that undermine effective responses to HIV among MSM, migrants, sex workers, transgender people and people living with HIV; facilitation of HIV-sensitive social protection; and adoption of the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) flexibilities into national laws for expanding access to treatment.

UNDP addresses socioeconomic determinants and governance of non-communicable diseases in close partnership with the World Health Organization. For example, as part of the UN Interagency Task Force on the Prevention and Control of Noncommunicable Diseases established by the UN Economic and Social Council in July 2013, UNDP is mandated to support governments in their implementation of Article 5 of the WHO Framework Convention on Tobacco Control, which addresses governance of tobacco control such as regulatory independence from industry interference.

The key priority areas of our work are as follows:

  • Human Rights and Sexual Diversity; Men who have sex with men and transgender people
  • Sex work
  • Key affected women and girls
  • HIV- sensitive social protection and the socio-economic impact of HIV
  • Intellectual property rights, TRIPS, and access to affordable medicines
  • Migrants’ rights to health and removal of HIV travel restrictions for migrant workers