ISLAMABAD: The prevalence of HIV is increasing in Pakistan at a time when the epidemic generally appears to be stabilising in Asia, according to the 2009 AIDS epidemic update published by UNAIDS.

Injecting drug users in Asia have reported high rates of risk behaviour and among those surveyed in Pakistan two-thirds reported sharing needles.

Nearly 45 per cent of transvestites surveyed in Pakistan said they had experienced discrimination on the basis of their sexual orientation, and 40 per cent had experienced physical abuse or forced sex.

Although a recent study found low HIV prevalence (1 per cent) among transvestites, 58 per cent had sexually-transmitted infections, with 38 per cent having multiple infections. Only a few used condoms.

According to the update, 4.7 million people in Asia were living with HIV in 2008, including 350,000 infected over the previous year. Asia’s epidemic peaked in the mid-1990s and annual HIV incidence has subsequently declined by more than half. Regionally, the epidemic has remained somewhat stable since 2000.

An estimated 330,000 AIDS-related deaths took place in Asia. While the annual number of AIDS-related deaths in South and South-East Asia in 2008 was approximately 12 per cent lower than the mortality peak in 2004, the rate of HIV-related mortality in East Asia continues to increase, with the number of deaths in 2008 more than three times higher than that in 2000.

Notwithstanding its comparatively low HIV prevalence, the economic consequences of AIDS will force an additional six million households in Asia into poverty by 2015 unless national responses are significantly strengthened, the Commission on AIDS in Asia reports.

With the growth in transmission among the low-risk heterosexual population, vigilance was needed to prevent the epidemic from entering a new period of growth, the report said.

As of December 2008, 37 per cent of those in Asia needing antiretroviral therapy were receiving it, somewhat below the global average of 42 per cent for all low- and middle-income countries. This represents a sevenfold increase in treatment access in five years.

While discrete populations — primarily injecting drug users and sex workers and their clients — have accounted for most HIV infections, onward sexual transmission to the female partners of drug users and the clients of sex workers is becoming increasingly apparent.

According to national surveys, the percentage of national populations selling sex ranges from 0.2 per cent to 2.6 per cent of the female population, depending on the country. Although the total population of female sex workers in the region is relatively small, the number of male clients is much greater.

More than 4.5 million people in Asia are estimated to inject drugs. With an estimated 2.4 million drug injectors, China is estimated to have the world’s largest population of injecting drug users.

Indications suggest that the epidemic among men who have sex with men is expanding in Asia. An estimated 21,000 children under the age of 15 were newly infected with HIV in Asia in 2008. Mother-to-child transmission has been responsible for a relatively modest share of new HIV infections in the region.

Incarcerated populations in Asia appear to have a substantially higher HIV prevalence than the general population. Access to antiretroviral therapy or harm reduction services is limited in most prison settings in the region.