How is HIV transmitted in Asia?

There are three main HIV transmission routes in Asia:

• Unprotected paid (and unpaid) sex. Unprotected sex, both paid and unpaid, accounts for a significant share of new HIV infections in many Asian countries. A large number of men buy sex regularly and the level of condom use during paid sex in many countries is still low. These factors have contributed to a high HIV prevalence among sex workers and their clients across Asia. In addition, an increasing number of women who are married and considered ‘low-risk’ of HIV infection are becoming infected with HIV.⁴ Estimates suggest that around 25-40 percent of new HIV infections in several Asian countries are among wives and girlfriends of men who became infected through paid sex, having sex with other men or injecting drugs.⁵

• Injecting drug use. Injecting drug use is a major driving factor in the spread of HIV throughout Asia, notably in China, Indonesia, Malaysia and Vietnam. In China, nearly half of all people infected with HIV are believed to have become infected through injecting drug use, and in North-East India injecting drug use is the most common HIV transmission route.⁶ There is often an overlap between communities of IDUs and communities of sex workers in Asia, as those who sell sex may do it to fund a drug habit, or they may have become involved in sex work first before turning to drug use.

• Sex between men. Sex between men accounted for some of the earliest recorded cases of HIV in Asia, and transmission through this route is still a prominent feature of many countries’ epidemics. Most men who have sex with men (MSM) in Asia do not identify themselves as gay because of cultural norms that discourage homosexuality; in some cases they may even be heads of families, with children.⁷ This means that MSM can serve as a ‘bridge’ for HIV to spread into the broader population. HIV outbreaks are becoming evident among MSM in Cambodia, China, Nepal, Pakistan, Thailand and Vietnam.⁸

Mother-to-child transmission is also a significant HIV transmission route in Asia. At the end of 2007, it was estimated that 140,000 children in South and South-East Asia, and 7,800 children in East Asia, were living with HIV, most of whom became infected through mother-to-child transmission.