Male clients of sex workers are the largest factor in the HIV epidemic in Asia Clients of female sex workers make up the largest HIV-affected population group in Asia. The Commission on AIDS in Asia estimates that on average, there are about 10 male clients for every sex worker. As many as 37 million men in China and 30 million men in India buy sex regularly. Many of these men are married (or will be married in the future) and if infected, may transmit HIV to their wives and children. The most effective way to prevent HIV infections in low risk women is to prevent their husbands from becoming infected. The proportion of men who visit sex workers and the levels of condom use during commercial sex are key factors in determining the rate of transmission of HIV. Data on men who buy sex are not routinely collected or uniformly reported. The data presented here are gleaned from DHS surveys, and from general population sexual behavior surveys in Bangladesh and Thailand. High-risk men are not an easily identifiable group within the general population and therefore prevention programmes often take advantage of the fact that paying for sex is more common among men in certain occupations. For example, 40% of urban moto-taxi drivers in Cambodia paid for sex in the past year, compared to 12.7% of urban men overall. [Technical note: moto-taxi drivers surveyed in BSS 2007 and urban men in DHS 2005. The slide value for Cambodia is for Phnom Penh only.]

Key Affected Populations

2 HIV Prevalence and Epidemiological Status (1990-2009) - IDU - MSM - Sex Worker Risk Behaviors (2004-2009) Vulnerability and HIV Knowledge (2005-2009) HIV Expenditure (2006-2009) - Sources of AIDS Spending - Spending by Categories - Prevention Spending - Spending on Care and Treatment National Response (2005-2009) - Coverage and Prevention - HIV Testing - Care and Treatment - Monitoring and Evaluation Archives CONTENT

Risk behaviours

4 Condom use at last sex among KAPs and use of sterile injecting equipment at last injection among IDUs, Asia Pacific * Manipur ** Kathmandu Valley *** Programme monitoring data KAPs= Key affected populations Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Report s 2005, 2008 & 2010

5 % of condom use at last sex among key affected populations, 2008-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2008 & 2010

6 % of condom use at last sex among key affected populations, 2006-2008 Source: Prepared by www.aidsdatahub.org based on WHO, UNAIDS, & UNICEF. (2009). Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector- Progress Report 2009

7 Trends in % of condom use at last sex among IDUs, countries where data is available, 2007-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010

8 % of condom use at last sex among IDUs, by age group, countries where data is available, 2007-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010 *Manipur ** Kathmandu

9 % of injecting drug users reporting the use of a condom the last time they had sexual intercourse, 2007 Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2008). 2008 Report on the Global AIDS Epidemic

10 % of IDU reported using sterile injecting equipment the last time they injected, by age group, 2007-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010 *Manipur ** Kathmandu

11 % of IDU reported using sterile injecting equipment the last time they injected, by gender, 2007-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010 * Manipur

12 % of injecting drug users sharing injecting equipment at last injection in selected cities, 2007-2008 Source: Reports of behavioral surveys by National AIDS programs cited in WHO. (2009). HIV/AIDS in the South-East Asia Region 2009.

13 % of injecting drug users reporting the use of sterile injecting equipment the last time they injected, 2007 Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2008). 2008 Report on the Global AIDS Epidemic

14 % of injecting drug users who have adopted safe behaviors to prevent HIV, by age, 2005* Safe behaviors include: Using sterile equipment for injection and using condoms consistently during sexual intercourse Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2006). 2006 Report on the Global AIDS Epidemic. * Data collection between 2003-2005 19 16 19 27 89 8 82 19 0 25 50 75 100 Bangladesh Indonesia Thailand Vietnam (%) Age <25 yrs Age 25+ yrs

15 % of condom use at last anal sex with a male partner among MSM, 2008-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2008 & 2010 * 2007 data ( Lao PDR- Vientiane city) ** Manipur *** Kathmandu

16 Trends in % of condom use at last anal sex with a male partner among MSM, countries where data is available, 2005-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010 *2005 = 2004 data (central A) and 2007 = Dhaka and Sylhet ** Hijra sex workers *** 2007 – end project evaluation data & 2009 – program monitoring data

17 % of condom use at last anal sex with a male partner among MSM, by age group, countries where data is available, 2007-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010 * Manipur ** Kathmandu

18 % of active MSMs who are married or reported recent sex with women among selected countries in Asia Source: Prepared by www.aidsdatahub.org based on Data from national behavioural surveillance and Naz Foundation International and Vision 2002; Choi, Liu et al 2003; Colby 2003; Girault, Saidel et al 2004; van Griensven, Thanprasertsuk et al 2004; Pisani and Dili STI survey team 2004a cited in Monitoring the AIDS Pandemic Network. (2004). AIDS in Asia: Face the Facts - A Comprehensive Analysis of the AIDS Epidemic in Asia 2004.

19 Trends in % of condom use with the most recent client among female sex workers, East, South East Asia, and Pacific, 2004-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010 * Only among brothel based ; ** Both male and female sex workers ; *** survey was conducted in 5 , 7 and 10 high HIV prevalence provinces/ cities in 2004, 2006, and 2009 respectively

20 Trends in % of condom use with the most recent client among female sex workers, South Asia, 2005-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010 * 2009 – Manipur only

21 % of condom use with the most recent client , female sex workers vs male sex workers, countries where data is available, 2005-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010 * For male sex workers – condom use at last anal sex with male partner

22 % of condom use at last sex among sex workers, by age group, countries where data is available, 2007-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2008 & 2010

23 Proportion of female sex workers who ever used drugs and who injected drugs, 2006-2009 Source: Prepared by www.aidsdatahub.org based on Behavior Surveillance Surveys and Integrated Biological and Behavioral Surveillance Surveys * Injected drugs in the last 12 months; ***In the last 3 months and calculated median value; DFSW= direct female sex workers, IDFSW = indirect female sex workers, KTM= Kathmandu; *** ever used drug in the last month and injected drugs in the last 12 months; ++ injected drugs in the last 6 months; + ever injected drugs

% of men reported paying for sex in the last 12 months, countries where data is available, 2003 - 2009 Sources: www.aidsdatahub.org based on 1. FHI, ICDDR, B., & USAID. (2006). Assessment of Sexual Behavior of Men in Bangladesh: A Methodological Experiment, 2. National Institute of Public Health, National Institute of Statistics Cambodia, & ORC Macro. (2006). Cambodia Demographic and Health Survey 2005 , 3. India, NBSS-General Population (2006) and BBS in 6 states (2009) cited in National AIDS Control Organization India. (2010). UNGASS Country Progress Report: India; 4. Ministry of Health and Population Nepal, New ERA, & Macro International Inc. (2007). Nepal Demographic and Health Survey 2006; 5. National Statistics Office Philippines, & ORC Macro. (2004). Philippines National Demographic and Health Survey 2003; 6. Brown, T., Rhujareonpornpanich, O., Peerapatanapokin, W., et al. (2009). Revising HIV Estimates and Projection: Implications of the National Sexual Behavior Survey; and 7. National Institute of Hygiene and Epidemiology Vietnam, ORC Macro, USAID, et al. (2006). Vietnam Population and AIDS Indicator Survey 2005 24 *Thailand, Age Adjusted Data from National Sexual Behaviour Survey (2006)

% of condom use with the most recent client , female sex workers, male sex workers and transgender, countries where data is available, 2003-2009 Sources: www.aidsdatahub.org based on 1. National Center for HIV/AIDS Dermatology and STDs Cambodia. (2008). Presentation: Behavioral Sentinel Surveillance 2007. 2. Indian Council of Medical Research, FHI, & India AIDS Initiative. (2007). Integrated Behavioural and Biological Assessment: Repeated Surveys to Assess Changes in Behaviours and Prevalence of HIV/STIs in Populations at Risk of HIV- Round 1 (2005-2007). 3. National AIDS Control Program Pakistan, Canada-Pakistan HIV/AIDS Surveillance Project, & Canadian International Development Agency. (2005). HIV Second Surveillance in Pakistan - National Report Round 1 & National AIDS Control Program Pakistan, Canada-Pakistan HIV/AIDS Surveillance Project, & Canadian International Development Agency. (2008). HIV Second Generation Surveillance in Pakistan: National Report Round III, and 4. UNGASS Country Progress Reports 2006,2008 & 2010 * Cambodia TG/ Hijra - with male client * * Nepal male sex workers – condom use at last anal sex with male partner, *** Pakistan TG/Hijra – surveyed years (2005 and 2008), **** India FSW (Manipur) and Hijra/TG (Tamil Nadu)

Archives

27 % of men who have sex with men reporting the use of a condom the last time they had sex in India (2002) , Indonesia (2002-2003) and Vietnam (2006) Sources: Prepared by www.aidsdatahub.org based on 1. India National AIDS Control Organization (NACO) .National Baseline High Risk and Bridge Population Behavioural Surveillance Survey, 2002, 2. Indonesia Ministry of Health and Central Bureau of Statistics. Behavioural Surveillance in 13 Provinces, 2002-2003. 2004, and 3. National Institute of Hygiene and Epidemiology Vietnam, FHI, Vietnam Administration of HIV/AIDS Control, et al. (2006). Results from the HIV/STI Integrated Biological and Behavioral Surveillance (IBBS) in Vietnam 2005 – 2006.

28 THANK YOU slides compiled by www.aidsdatahub.org Data shown in this slide set are comprehensive to the extent they are available from country reports. Please inform us if you know of sources where more recent data can be used. Please acknowledge www.aidsdatahub.org if slides are lifted directly from this site