Catalyzing HIV prevention in Asia: from individual to population level impact

Abstract

HIV prevention in Asia has two sides, modest overall coverage of individual services, yet some leading examples of population impact at national level. This review assesses the coverage of individual services and the additional components required to catalyze population level impact in Asia. The review first assesses the latest data on the coverage of services by most-at-risk populations and country. The Asian Epidemic Model is used to estimate the coverage levels of these services required to reduce HIV incidence. Information on the services, unit costs, and coverage is used to define a priority prevention package that is affordable and can lead to high population coverage. Analysis of national programs, epidemiology, and behavior data is undertaken to identify additional factors required and barriers to population-level prevention impact. HIV prevention has shown variable coverage across Asia, with less than one in two sex workers, one in five injecting drug users, and one in two men who have sex with men reached with services. In addition, coverage of prevention of mother-to-child transmission is still low at 32%. Yet modeling suggests 60-80% coverage of all most-at-risk populations is required to reduce HIV incidence. National situations show the importance of implementing a priority package of HIV prevention to high coverage rapidly, combined with intense engagement of most-at-risk populations. HIV prevention at population level requires universal access to priority services alongside mobilization of all most-at-risk populations. It is only where service delivery and social change models of prevention have been combined effectively that HIV has declined. This helps explain the paradox in Asian HIV prevention, modest overall service delivery with some key national HIV prevention successes.