Teens in Vietnam educate their peers about HIV/AIDS prevention and healthy behaviors.

A new report issued by UNAIDS this month reveals that nearly 5 million people are living with HIV in Asia. While this total is overshadowed by the numbers affected by HIV/AIDS in sub-Saharan Africa and represents only a tiny percentage of the population in the region, a slight turn upwards in infection rates could result in a huge increase in those infected and affected by HIV, including children.  Rapidly changing demographics in Asia such as an increasingly mobile population and economic migration to urban areas, as well as changing cultural norms among youth with greater globalization, all contribute to the spread of HIV throughout the region and put already vulnerable youth at even greater risk.

“Some argue Asia will never be another Africa in terms of the magnitude of the epidemic, while others say it has all the ingredients,” said Scott McGill, Save the Children’s Asia Advisor for HIV/AIDS.  “Either way – a swiftly escalating and evolving epidemic would swamp these countries’ abilities to cope or respond– especially when you consider the numbers of people.”

Some of the world's most populated countries are in Asia.  Yet the scale of the global epidemic in the region has not yet reached the levels of infection seen in Africa. And although the impact of the epidemic varies widely across the region, many experts believe there is still time to contain the spread of the virus through properly targeted interventions – and lessen its impact on countries, communities and children.  This takes the right political will and leadership to deal with often difficult or taboo topics, as well as  and adequate funding targeting resources to those most-at-risk.

Unlike large parts of sub-Saharan Africa, where the HIV epidemic is widespread and more evenly distributed, the percentage of the population living with HIV in Asia varies widely between and even within countries.  Southeast Asia has the greatest number of people living with HIV.  India has the highest burden of infection among all countries in Asia, although that figure reportedly has declined due largely to improved data collection methods.  The same data, released by UNAIDS, shows that the number of infections is decreasing in South and South East Asia but increasing in East Asia.  Countries like Cambodia, Myanmar and Thailand are making progress but still need to remain vigilant, while other countries like Indonesia and Vietnam are falling behind as infection rates climb upwards, especially within those populations most at risk.

Within countries in Asia, those affected by or living with HIV are often found in concentrated groups or pockets among marginalized populations (e.g., commercial sex workers, injecting drug users, etc.). This offers opportunities, but also poses challenges.  On the one hand, we might know by looking at the data who is in most need of access to prevention and treatment programs, and which children need care and support.  On the other hand, we risk further stigmatizing those who are living with HIV and AIDS or have been affected.   

"You can knock on any door in parts of sub-Saharan Africa, and pretty much everyone has been affected by HIV or AIDS.  This common experience enables communities more openly to identify and prioritize affected by HIVAIDS and who are in need. " says McGill.  "In Asia, it's not as straightforward.  Stigma is often very high and awareness of HIV/AIDS low.   Families do not want to risk disclosing their HIV status for fear of repercussions.  Often there are no services available, or families do not know how to access them."    

For this reason, adds McGill, we must look at what has worked in other higher burden settings and adapt this to communities in Asia.  McGill cautions that, in doing so, we need to be careful not to call harmful attention to children and families affected by the crisis.  You risk "outing" either their HIV status or situation, and then alienating them from their community, health services and schools. 

Rather, effective programs should identify communities with a large percentage of the population affected by HIV, and provide services to all children living there.  In doing so, we reach children made vulnerable by AIDS more discreetly.  By involving community leaders such as Buddhist monks from local pagodas you help to reduce discrimination and increase compassionate approaches that promote fair treatment of those affected by the disease such as by ensuring orphans and vulnerable children are not excluded from school.  These individuals can also be role models by advocating for those affected by HIV and AIDS and identifying and protecting those most in need.

Save the Children has applied this comprehensive approach to its HIV/AIDS programs in Asia, including Bangladesh, Cambodia, Bhutan, Myanmar, Nepal and Vietnam, with positive results for children and their families.  Read more below.

Targeting All to Reach Some

Bangladesh

Bus advertisements are part of a mass media campaign to limit the spread and impact of HIV in Bangladesh.

HIV infection rates in Bangladesh are still low in the general population but dramatically rising among more vulnerable groups.  Results from a baseline survey led by Save the Children several years ago highlighted serious misconceptions related to the transmission and prevention of HIV/AIDS among young people.  This is especially unsettling when one realizes that young people account for one third of the total population of Bangladesh – some 38 million people. 

The government of Bangladesh moved quickly to expand its response to HIV/AIDS by implementing a national program to limit the spread and impact of HIV in the country especially initially among youth.  Through funding to the government from the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, Save the Children in partnership with the Bangladesh Ministry of Health and Welfare, and through a variety of public and private partners, including national and local non-governmental organizations, launched a nationwide mass media campaign that has reached millions of young people through various communications approaches,.  One aspect of the campaign includes television commercials, featuring a branded jingle and logo.  The logo and song are now so well known among young people, there are plans to issue it as an SMS and cell phone jingle.  The media campaign also includes a television drama series featuring a young woman affected by HIV/AIDS.  Media critics have hailed the show as one of the most popular television dramas running in Bangladesh. 

The extensive media outreach campaign was complimented by work on the front lines through youth organizations and clubs to train teens as peer educators, as well as work with teachers, religious leaders and parents to include information on HIV/AIDS prevention into high school, religious school, vocational training, and college curriculums. This is an outstanding success – globally few countries are doing this.

Cambodia

Buddhist monks help orphans and vulnerable children in Cambodia get the help they need.

In Cambodia, a country still recovering from decades of civil war, good news has emerged in the country's fight against AIDS.  Newly released data from UNAIDS shows that the number of people living with HIV in both rural and urban populations in Cambodia has declined over the past eight years.  The rate of infection now stands at an estimated 0.9 percent among adults in 2006, compared to 2 percent in 1998.  UNAIDS credits the drop to well-focused and sustained prevention efforts by the government and its partners.

Save the Children works with marginalized communities in urban areas of Cambodia to reduce the impact of HIV infection and to ensure families affected by AIDS get the support and care they need. Save the Children has partnered with Buddhist monks, who are highly revered and respected in their culture, to help educate these at-risk communities on the consequences and prevention of HIV. The monks also help identify children affected by AIDS and then work with communities to meet their needs such as by ensuring these children are safe, attend school, receive healthcare and are not discriminated against.

Myanmar

Myanmar has had one of the most serious HIV epidemics in the region, with higher infection rates along the country's border with Thailand and China.  The government crafted a national strategic plan on HIV, including increased efforts to prevent mother-to-child transmission.  Today, the country is starting to show signs of a decline in the number of people living with the virus, according to new figures released by UNAIDS.  The incidence of HIV among pregnant women at antenatal clinics has dropped from 2.2 percent in 2000 to 1.5 percent in 2006. 

Save the Children, through funding from UNICEF, is working in partnership with the government and local non-governmental organizations to increase awareness of ways to prevent HIV transmission between a mother and her baby, and to increase access to prevention care and support activities for new mothers and women likely to become pregnant.  Rather than target specific couples, Save the Children employed a more general approach and engaged the whole village.  Members of the community were asked to identify pregnant women and their spouses, and to encourage the couple to see the midwife to get tested for HIV.  Communities also were asked to contribute a small amount of funds to a central village health account, matched by Save the Children, to loan to husbands and their wives to access the maternity-related health services they needed.  In addition, HIV positive couples from urban areas came to rural settings to speak with couples and midwives to increase awareness about transmission of the HIV virus and break down barriers to discussing HIV openly and without fear.  The program is now considered a model and is being considered for replication across the country.