Living with HIV/AIDS

Widespread fear and misapprehensions about HIV/AIDS mean that in most of the region, people with HIV/AIDS and their families risk being rejected by their communities and denied access to health care, education, social and other services. These attitudes only worsen the impacts of HIV/AIDS and weaken efforts at prevention.

People with HIV/AIDS can make a valuable contribution to the HIV/AIDS response. Around the world, they have become involved in prevention and awareness-raising, in generating acceptance and compassion and in designing more effective programs.

People with HIV/AIDS in Thailand have already made a real difference, forming self-help and peer-support groups and giving the epidemic a human face at national and local levels. In other countries, discrimination and lack of voluntary confidential counselling and testing services that allow people to know they are HIV-positive before they develop full-blown AIDS, limits the large-scale participation of people with HIV/AIDS.

How HIV/AIDS is Affecting ...Young People

HIV/AIDS is disproportionately affecting adolescents and young people. Adolescence and early adulthood is a time where many young people are moving from depending on adults for protection and nurture to working or studying independently, sometimes far from their homes and parents. They may try to prove their independence with "adult" behaviour, but without an adult's experience, information or skills to guide them.

Sexual experimentation among unmarried young people is growing in much of the region, yet sex and prevention education and sexual and reproductive health services accessible to young people are lacking in many countries.

Young women in the sex industry are particularly vulnerable. Data from Cambodia shows 30% of sex workers aged 13-19 years are HIV-positive. Younger, less experienced sex workers find it harder to negotiate with managers and clients for safe sex. As they are usually from the poorest and most marginalized groups, they may have very low awareness about HIV/AIDS and its prevention.

How HIV/AIDS is Affecting ... Women

Women are biologically more vulnerable to HIV infection than men. They also have much less control over their lives and bodies in many parts of the region, and so can do much less to protect themselves against infection. Women tend to acquire HIV at a younger age. An increasing number of women are becoming infected with HIV by their male partners who are IDUs or visit commercial sex workers.

How HIV/AIDS is Affecting ... Children

An estimated 100,000 children under the age of 15 are living with HIV/AIDS in East Asia and the Pacific. Around a quarter of children born to a woman with HIV/AIDS become infected themselves – though a number of interventions can reduce this.

WHO estimates that around 80% of children born with HIV will die before age five, around 25% before age one. These children are far more vulnerable than adults to opportunistic infections and often fall sick once the disease starts to progress. Most are cared for within the family, making it imperative that the families know how to provide adequate care and that arrangements are made for alternative care when the parents are sick.

But all children whose parents have HIV/AIDS will be profoundly affected by the disease. The impacts on children affected by HIV/AIDS cut to the heart of UNICEF's child rights mandate. Without adequate planning and support, their survival, health, development, education and safety are in jeopardy. Poverty, discrimination and changing family structures in much of the region mean that these children often fall through the safety nets, and end up depressed, shunned, abandoned or in dangerous, exploitative work.

The Global Orphan Project recently estimated that more than 500,000 children are affected by HIV/AIDS in Thailand, including those whose parents have not yet started manifesting symptoms and are unaware of their status. Accurate figures are lacking in many other countries. In Cambodia, Khana, the Khmer HIV/AIDS NGO Alliance, estimated 30,000 children under 15 had been orphaned by AIDS as of the end of 1999. In Myanmar WHO/UNAIDS estimated 43,000 children had been orphaned in the same period.

In East Asia and the Pacific, HIV/AIDS is already undoing many of the gains achieved in children's health and welfare over the last decade and is increasing at an alarming rate, particularly among young people.

Risk Factors: Unsafe Drug Use

Behavioural surveillance data shows an increase in the use of a range of drugs by young people in the region, particularly the Mekong subregion and PNG. Myanmar, Viet Nam and China already have major HIV epidemics among injecting drug users. In Myanmar, HIV prevalence rates of 60% have been estimated among young people who inject drugs.

Heroin production continues in the Golden Triangle, and there are many addicts. New injectable drugs are constantly appearing and new populations are becoming involved in their use. Many users share needles, which poses extremely high HIV infection risks.

The Mekong subregion has been hit by a recent surge in the use of methamphetamines. In Thailand in 1999, the National Primary Education Commission (NPEC) reported 660,000 cases of drug-related offences by students, with 80,000 cases involving children still in primary school. Methamphetamines, like excessive alcohol and other psychoactive substances, are associated with increased HIV risk mainly through unsafe sex.

Sexually Transmitted Infections

Combatting sexually transmitted infections (STIs) is an integral part of programming for HIV/AIDS. Similar sexual behaviours lead to the sexual transmission of HIV and many STIs. STI prevalence is a barometer of HIV vulnerability and a contributing factor. High incidence of STIs is a clear warning that HIV incidence is already – or could soon be – correspondingly high. At the same time, the presence of many STIs increases the chances of transmission through unprotected sex many times over.

Men who Have Sex with Men

Available evidence suggests that sexual experimentation between young men is common throughout the Asia-Pacific region. Yet in much of East Asia and the Pacific, homosexuality and male-male sex tends to be ignored or even stigmatized. Men who have sex with men are greatly disadvantaged in terms of HIV/AIDS prevention because education and information materials rarely, if ever, target them. More importantly, they lack access to sexual health and other services directed to their needs. Tragically, the focus on heterosexual transmission has resulted in some cases in misconceptions that sex between men – specifically unprotected anal sex (a highly risky activity for HIV transmission) – is "safe".

The individual country reports contain more detailed information on the HIV/AIDS epidemics in priority countries in East Asia and the Pacific.