Home to nearly 2 billion people, an estimated 2.3 million adults and children live with HIV/AIDS in East Asia and Pacific (EAP) countries. That number is increasing, deeply affecting countless individuals as well as the region's health systems, economies, and social fabric. HIV/AIDS is a major development challenge and a top priority for the World Bank.

The epidemiological profile of HIV/AIDS throughout this diverse region is complex. The pace and severity of the disease have been dramatically different from country to country.  In Cambodia, Myanmar, and Thailand, HIV/AIDS prevalence has spread quickly, and already exceeds 1 percent among the general population. While these countries were hit early, others such as Vietnam and several provinces in China are only now starting to experience growing epidemics—particularly in regional “hot spots”—and need to mount swift, effective responses.

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Although the epidemiological profile differs between countries, injecting drug use and sex work are major drivers of HIV/AIDS transmission.  In EAP countries, the epidemic generally begins at a low level among commercial sex workers regularly having unprotected sex with clients, injecting drug users sharing needles and syringes, or men having unprotected sex with men. As HIV/AIDS spreads among these groups, it becomes more heavily concentrated in these populations. In some cases the disease then spreads among these (often overlapping) populations and then into the general population. In China, HIV/AIDS has now spread to all of China’s 31 provinces, autonomous regions and municipalities.  Sexual transmission of HIV from injecting drug users to their partners features prominently in China's epidemic. When HIV/AIDS has come close to saturation in high-risk populations and infection rates grow to greater than 1 percent among the general population, the epidemic is considered to be "generalized." The trajectory of growth depends on the size of the at-risk populations and how much they overlap, but there is significant potential for growth. In this region, the data suggest that countries are categorized as: Low level: Mongolia, Lao PDR, Philippines, Timor-Leste, and the Pacific Island member states.   Concentrated: Papua New Guinea, China, Indonesia, Vietnam, and Malaysia.   Generalized: Thailand, Cambodia, and Myanmar. There are some indications however that Papua New Guinea is moving towards a generalized epidemic.		The Thailand report on the economics of effective AIDS treatment found that government antiretroviral treatment costs would increase dramatically in the coming years, yet meeting such costs would be affordable and yield substantial health benefits.   Read more       Regional HIV/AIDS Strategy      Executive Summary in Local Languages:      Chinese  Thai  Vietnamese  Bahasa Indonesian           Related Links   Fact Sheet:HIV/AIDS in East Asia and Pacific   World Bank HIV/AIDS Issue Brief      Frequently Asked Questions on HIV/AIDS

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The epidemic has ample room to grow in the region. As East Asia and Pacific is the most populous region in the world, even a small increase in HIV/AIDS prevalence will translate into a large number of people living with HIV/AIDS. UNAIDS predicts there will be more than 11 million new cases of HIV/AIDS in the region by 2010.

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The challenge of HIV/AIDS in East Asia and Pacific countries is two-fold: (1) preventing new cases of HIV and (2) caring for those who are infected.  In 2005, almost a million people in the region needed antiretroviral treatment, the second-highest number in the world.

In response to the pandemic, all EAP countries have established national HIV/AIDS programs. However, national responses are neither uniform in intensity nor in degrees of success. There is a wide variation between and within countries in the level of political commitment, adequacy of funding for HIV/AIDS, and availability of effective prevention programs and treatment.

While some countries are considered to be success stories, others are still lagging behind in the fight against HIV/AIDS. Thailandand Cambodiaare examples of countries that show how strong government commitment, early and adequate responses with increased funding, and targeted interventions can curtail the growth of the epidemic.

In Thailand, the number of annual new HIV infections has fallen from 140,000 a decade ago down to 15,000 in 2005. Both Thailand and Cambodia demonstrate the primacy (in an epidemic fueled by commercial sex) of involving a few key sectors—the ministry of health, brothel owners, the police (ministry of interior), and provincial administrations.

These countries are examples of success but in them, as in other countries, there is still a lot more that must be accomplished. Several countries such as Timor-Leste and the Philippines have very low rates of HIV infection despite high-risk behavior, and so still have a rare opportunity to prevent a future epidemic.

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Since the early 1990s, the World Bank has been actively involved in the fight against HIV/AIDS in East Asia and Pacific through lending, policy dialogue, and research and analysis.

The World Bank in East Asia and Pacific countries has:

• Completed a regional strategy. This plan recommends increasing and improving political commitments; developing more comprehensive approaches to addressing the epidemic; improving public health surveillance, monitoring, and evaluation; stepping up prevention efforts, advancing healthcare, support, treatment, and health services delivery. A summary version of this strategy has been translated into several languages, including Chinese, Thai, Vietnamese, and Bahasa Indonesian .
   
• Released a report on the Thailand Antiretroviral Treatment study: The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand. The purpose of the report is to advise the Thai government and population on the benefits, costs, and consequences of expanding antiretroviral treatment, as well as to assist in the design of implementation policies.
   
• Supported programs in China, Vietnam, Indonesia, Papua New Guinea, and Thailand. Between 1992 and 2005 the World Bank financed 13 health projects with HIV/AIDS-related components in seven East Asia and Pacific countries (China, Cambodia, Indonesia, Malaysia, Papua New Guinea, Philippines, Thailand, and Vietnam). Cumulative lending in the region for HIV/AIDS and related interventions stands at over US$130 million, making the World Bank one of the largest financiers of HIV/AIDS projects over the years.
   
• Shared knowledge and information. The EAP region published a Guidance Note on Health Care Worker Safety from HIV and Other Blood Borne Infections, which provides information about important precautions needed to help healthcare workers prevent transmission of HIV and other blood borne diseases. At the 2004 Shanghai Conference on Scaling Up Poverty Reduction, Senator Mechai Viravaidya of Thailand gave a presentation on lessons learned in Thailand and the region. Other publications include two issues of the Thailand Social Monitor: (1) "Thailand's Response to AIDS: Building on Success, Confronting the Future," and (2) "Coping with the Crisis in Education and Health." Other publications include project performance assessment reports that formed the basis for country case studies in the evaluation of Bank's assistance for fighting the HIV/AIDS epidemic:
   
  • Indonesia: Evaluation of the Bank's Assistance in Responding to the AIDS Epidemic (467kb pdf)
  • Cambodia Disease Control and Health Development Project
  • Indonesia HIV/AIDS and STDs Prevention and Management Project
      
• Promoted prevention and treatment of HIV/AIDS for World Bank staff. The region has been involved in a Bank-wide effort to provide services, education, and training to staff to promote a better understanding and awareness of these issues within the workplace.

Working together with governments, civil society, and other development partners, the World Bank can play a critical role in addressing HIV/AIDS in the East Asia and Pacific region to prevent the region from becoming the future epicenter of the HIV/AIDS epidemic.

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