Situation of HIV Epidemic & Response in China

CMT Retreat

3 February 2010

HIV Situation in China 2009 Data sources: 2009 HIV Estimation

Number of people living with HIV

Number of new infections in 2009

AIDS deaths in 2009

740,000 (560,000-920,000)

48,000 (41,000-55,000)

26,000 (22,000-30,000)

PLHIV in need of ARV treatment in 2009 190,000 (260,000-200,000)

Sexual transmission is now the main mode

Note: 2009: heterosexual 42.2%, homosexual 32.5%;

2007: heterosexual 44.7%; homosexual 12.2%;

2005: data on hetero-and homo- sexual is not available

Distribution of new infections by mode of transmission, by year. 2005-2009

Data sources: 2005, 2007 Joint Assessment; National 2009 AIDS/STD Annual Meeting

Highly-varied geographic distribution

Cumulative

reported cases:

326,000 up to end

of 2009

Cumulative AIDS

patients: 107,000

Cumulative deaths:

54,000

Cumulative reported HIV positives by province as of End of 2009

Data sources: National 2009 AIDS/STD Annual Meeting

Highly-varied geographic distribution

• As of end 2009, 55 counties have reported having over 1000 cases, which increased from 43 in 2008. – Shangcai County in Henan Province, Yining County of Xinjiang Province,

Butuo County and Zhaojue County of Sichuan Province has more than 5,000 reported HIV/AIDS positives

• Liangshan Prefecture of Sichuan Province is becoming the areas with most severe HIV epidemic. – Prevalence among the whole population in Butuo County and Zhaojue C

ounty is over 5%. – Average prevalence in other 14 counties was 0.83%,

• Meigu County: 3.44%, Jinyang County: 3.38%, Yuexi County: 1.72% and Ganluo County: 1.19%.

• Yi minority was most heavily affected with prevalence at 1.7%, and the prevalence was 0.69% among Miao People, 0.08% among Han People.

Different HIV Epidemic Dynamics

Sichuan

Yunnan

Xinjiang

Tibet

Gansu

Qinghai

Neimenggu

Guangxi Guangdong

Chongqing

HunanGuizhou

Hubei

Henan

Jiangxii

Fujian

Anhui

Zhejiang

Jiangsu

Shandong

Shaanxi

Shanxi

Hebei

Liaoning

Jilin

Heilongjiang

Beijing

Tianjin

Shanghai

Taiwan

Hainan

Ningxia

IDU expanding to sexual

IDU concentrated

Blood transmission expand to sexual partners

MSM concentrated

Low epidemic

Key Factors Driving the Epidemics

Estimated Size of Most-at-risk Population, China

DescriptionPopulation size estimate

(range)

Injecting drug users (IDUs) 1.5~3.0 million

Female sex workers (FSW) 1.8~4.5 million

Clients of FSW 17.7~37.4 million

Men who have sex with men (MSM)

2.0~7.1 million

Total 23.0~52 million

Data source: China 2007 HIV estimation; F Lu, N Wang, Z Wu, et al. Estimating the number of people at risk for and living with HIV in China in 2005: methods and results. Sex Transm infect 2006 ； 82 （ supply3 ）： 87-91

Up to 50 million people in China are at high risk of exposure to HIV

IDU: keep spreading and seeding sexual transmission

Source: Ning W. HIV/AIDS Surveillance System in China. National Center for AIDS/STDs Control and Prevention, China CDC. Presentation at XVI International AIDS Conference, Toronto, Canada, August 12-18, 2006

Percentage of injecting drug users having sex with female sex workers, China Sentinel Surveillance

SWs: rising epidemic, especially among lower-level location based SWs

94.991.4

41.4

6.6

26.6

12.6

5.4 7.4

23.0

3.06.4

14.917.621.5 24.1

5.1

15.719.5

0

10

20

30

40

50

60

70

80

90

100

Hotel/night club based Karaokay bar/barbershop

based

Rented room/street based

perc

ent

Last week condom use Urine opiate positive Syphilis Gonorrhea Chlamydia HIV

Source: LiQinghua, Xu Junjie, Wang Weijia, et al. Survey of high risk behaviors and HIV/STI infection among FSWs from different venues of Kaiyuan City. China J AIDS STD, 2009, Vol.15 No. 2:164-166

Median number of male clients served last week

2

4

8

0

2

4

6

8

10

Hotel/night clubbased

Karaokaybar/barbershop

based

Rented room/streetbased

Num

ber

Higher risk and HIV infection among street-based sex workers, Kaiyuan, Yunnan, China, 2006

Homosexual transmission has accounted for one-third of all new infections in 2009

MSM: an alarmingly fast-growing epidemic

HIV Epidemic among MSMby Geographic Areas, 2008-2009

Sichuan

Yunnan

Xinjiang

Tibet

Gansu

Qinghai

Neimenggu

Guangxi Guangdong

Chongqing HunanGuizhou

Hubei

Henan

Jiangxii

Fujian

Anhui

Zhejiang

Jiangsu

Shandong

Shaanxi

Shanxi

Hebei

Liaoning

Jilin

Heilongjiang

Beijing

Tianjin

Shanghai

Taiwan

Hainan

Ningxia

Around Shenyang

4.3-10.0%

Beijing and Tianjin

4.6-8.3%

Around Shanghai

5.0-10.9%

Southwest

8.5-20%

Sichuan

Chongqing

Jiangsu

Beijing

Evolution of HIV epidemic among MSM, 2003-2009

0.44.6 5 5.5

6.35.8

0

5

10

15

20

25

Beijing

0.6 1 1.34.6

10.6

12.9

0

5

10

15

20

25

Chengdu

10.4 10.8

16.3

19.2

0

5

10

15

20

25

Chongqing

4.7

0

5

10

15

20

25

Nanjing

0

5

10

15

20

25

Nanjing

2003

2004

2005

2006

2007

2008

2009

Chengdu

Chongqing

Nanjing

Beijing

2010 Universal Access Targets and MDG 6 Goals: A Difficult Target to Meet

25

45

46

25

38

25.4

30.9

20.9

8.6

80

90

90

90

0 20 40 60 80 100

ART

Intervention (Sexworkers)

Intervention (IDUs)

Intervention (MSM ）

2005 achievement 2007 achievement 2008 achievement 2010 targets

Note: (1) 2005 and 2007 achievement based on 2006 and 2008 UNGASS report ; (2) 2008 achievements data from National Comprehensive Response Management Information System (CRMIS); (3) estimated number in need of ART is 190,000 as of 2009

UNGASS indicators achievement, China, 2005-2008

Coverage of PMTCT is limited

• The number of HIV infected PW who were found is relative

low all over the country – reported： 2695（ Jan-Sep. 2009）– estimated： 7500（ HIV prevalence among PW: 0.05%）（ Esti

mated HIV-infected PW during Jan-Sep 2009: 5600）– only 48% HIV+ PW were found

• Coverage of PMTCT services was very limited– ARVs % of HIV+ PW

• among reported cases： 79.4%

• Among estimated： 38.1%

7.7%

30.3%

11.2%6.2%

19.2%26.6%

12.8%

3%

11.7%

HIV Drug-Resistance Rate at Provincial Level

2006-2007, China

HIVDR

(%)

Median months of ART

Henan 30.3 33.7

Anhui 26.6 31.7

Hubei 19.2 27.7

Zhejiang 12.8 10,5

Hebei 11.7 20.3

Yunnan 11.2 16.2

Xinjiang 7.7 5.5

Guangxi 6.2 13.5

Shanxi 3.0 25.7

NA

Main Challenges in Achieving Targets • National & provincial action plans are yet to be costed and strategically enhanced.

• Decentralization needs to be prioritized and infrastructure strengthened to ensure accountability.

• Resource allocation must be prioritized & balanced, with effective utilization of funds, human resources, equipments, information.

• Stigma and discrimination towards people living with HIV and MARPs must be eliminated.

• Legal and political barriers faced by non-government agencies to be removed; their capacity developed to increase effective functioning of civil society organizations.

• Coverage and quality of prevention & treatment interventions must be enhanced.

Severe Stigma and Discrimination Experienced by PLHIV

• 2 out of 5 reported having faced severe HIV-related discrimination.

• More than three quarter of all survey respondents reported that their family members had experienced discrimination as a result of their HIV status.

• More than 10 percent of women living with HIV who were diagnosed with HIV had been pressurized into terminating a pregnancy by health staff.

• About 15% reported having been refused employment or a work opportunity because of their HIV status.

• 9.1% Of those respondents with children said their children had been forced to leave school because of the HIV status of their parents.

• A substantial proportion of medical staff (26%), government officials (35%) & teachers (36%) changed their stance after learning of a person’s HIV positive status into a ‘discriminatory’ or ‘very discriminatory’ attitude.

Priorities for 2010---National 2009 AIDS/STD Annual Meeting (21 Jan. 2010)

• Carrying out final review of 2006-2010 Action Plan

• Developing Five Year Action Plan for Reducing and Preventing the Spread of HIV/AIDS (2011-2015)

• Improving surveillance system

• Scaling up prevention interventions among IDU, MSM, low-level sex workers, rural migrants, discordant couples and etc.

• Accelerating scale up of ART program

• Scaling up PMTCT and exploring ways to enhance prevention of HIV, STI and HBV by routine testing of pregnant women

Priorities for 2010(continued…)

• Strengthening support to most heavily affected areas especially Liangshan prefecture of Sichuan Province, Yili Prefecture of Xinjiang and Guangxi Province

• Case finding and management: rapid, easy and user-friendly testing method to be applicable in community and township health care settings, strengthen health facility-based testing, and management of reported cases

• Public education – with special emphasis to remote, poor and ethnic minority sites; education for students and community organizations

• Social mobilization and adoption of specific measures to encourage volunteers and civil society participation in AIDS response.