Doing the Right Thing

1. Doing the Right Thing Karen A. Stanecki XV International AIDS Conference

2. Global Report 2002 Global Report 2004 Trends in global adult HIV prevalence 50 Millions 40 30 Estimated number of people living with HIV 20 10 0 1991 1993 1995 1997 1999 2001 2003

3. Deaths due to AIDS New infections Global Global Sub-Saharan Africa Sub-Saharan Africa Steadily rising annual HIV infections and AIDS deaths 5 Millions 4 3 2 1 0 1991 1993 1995 1997 1999 2001 2003

4. IDU (Guangxi, China) IDU (Jakarta, Indonesia) IDU (Hanoi, Vietnam) Sex workers (Guangxi, China) Sex workers (Hanoi, Vietnam) Sex workers (Jakarta, Indonesia) Rising HIV infection among injecting drug users, followed by rising infection among sex workers 100 90 80 70 60 % HIV positive 50 40 30 20 10 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

5. High proportions of men who inject drugs are also clients of sex workers Hanoi, Vietnam Bangkok, Thailand** Katmandhu Valley, Nepal Surabaya, Indonesia Delhi, India Sichuan, China* Central Bangladesh 0 10 20 30 40 50 60 70 80 90 100 % Unprotected commercial sex Commercial sex with a condom Source: Behavioural surveillance reports

6. 100 80 60 % 40 Condom use, Female sex workers 20 HIV prevalence, female sex workers 0 1995 1997 1999 2001 2003 Increasing condom use and decreasing HIV infections in Cambodia Source: Cambodia National Center for HIV/AIDS Dermatology and STDs, Ministry of Health

7. Needle-exchange programmes promote healthy sexual behaviour and safe injection Bangladesh 100 Participated in needle exchange 90 90 Did not participate 80 72 70 59 60 51 50 Percent 38 40 30 21 17 20 16 10 0 Sought medical treatment for STI** Used needle after other injector last time Used needle after other injector in the last week Reported STI symptom past year* * of sexually active respondents; ** of respondents reporting STIs Source: National behavioural surveillance data

8. Asia’s HIV prevention successes have three features in common • They recognize and target the behaviors that are causing most new infections • They use the most effective interventions that directly reduce the risk of HIV transmission • They provide the services to the population at greatest risk of HIV exposure

9. Treatment is critical, and HIV prevention services remain a major priority in Indonesia Sex workers needing condoms and STI services 200 000 Drug injectors needing needles and condoms 115 000 High-risk MSM needing condoms and lubricant 63 000 Prisoners needing prevention services 110 000 Men and women needing antiretrovirals 8 500 0 50 000 100 000 150 000 200 000 250 000 Source: Based on national estimates of people at risk for HIV, Ministry of Health , Indonesia

10. HIV prevalence in adults, end 2003 38 million people [range: 35-42 million] living with HIV as of end 2003 Adult prevalence % 15.0% − 39.0% 5.0% − 15.0% 1.0% − 5.0% 0.5% − 1.0% 0.1% − 0.5% 0.0% − 0.1% not available

11. HIV prevalence among 15−24-year-olds in selected sub-Saharan African countries, 2001−2003 20 Men Women 15 10 % HIV prevalence 5 0 Niger (2002) Mali (2001) Burundi (2002) Kenya (2003) Zambia (2001-2002) South Africa (2003) Zimbabwe (2001-2002) 2004 Report on the Global AIDS Epidemic (Fig 7)

12. It’s about human rights Every person in need must have access to HIV treatment. And the more people have access to effective prevention, the fewer people will be in need of treatment.