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An estimated 8.6 (6.0-13.0) million people are living with HIV in Asia in 2006: 6.0 million men; 2.4 million women; ~200 000 children. In 1006 alone, there were 960 000 (640 000-900 000) new infections and 630 000 (430 000-900 000) AIDS death (29). The infection rates are still low in Asia, compared with some other continents, particularly Africa. However, since the populations of many Asian countries are so large, even low HIV prevalence rates means large numbers of people are living with HIV.
While HIV/AIDS epidemics come later in Asia, Asia is becoming an epicenter of 2nd largest epidemic after sub-Safaran Africa. In contrast to sub-Saharan Africa where the heterosexual transmission is a major driving force of the epidemic, the epidemic in Asia shows much complex structure. One third of HIV infections are acquired through injecting drug use in Asia. In addition to the epidemic through heterosexual route, the previously neglected epidemic among the men sex with men (MSM) has emerged in Asia (31). In the industrial countries in Asia, including Japan, Korea, Singapore, China Taiwan and Hongkong, MSM is the most important risk group and also significant numbers of HIV infection occurred among hemophiliacs by contaminated blood products in early 1980s. Molecular epidemiology has been a useful tool to analyze the origin of HIVs and to track a course of global HIV spread, providing the in-depth knowledge on AIDS epidemic: The study areas include the analyses of the distribution of HIV genotypes in different geographic areas, route of virus spread and specific association of genotypes with different epide-miologic features, such as risk behaviors. In this article, we overview the current status of HIV/AIDS epidemic and the recent advance in the study on the molecular epidemiology of HIV in Asia.
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The Asia-Pacific region is vast and diverse and HIV epidemics in the region share that diversity. Table 1 summarizes the UNAIDS/WHO HIV estimates in different regions in Asia (29). We describe the outline of the epidemics in selected countries in Asia.
Table 1. HIV projection in various countries in Asia (end 2005) (UNAIDS/WHO)
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In India, the world's second most populous country, an estimated 5.7 million (The world's largest) were living with HIV in 2006. While the heterosexual transmission is the predominant mode (more than 80%) of HIV infections in most of regions in India, the injecting drug use is the main driver of the HIV epidemics in the northeast, especially in the state of Manipur and Nagaland, near the border with Myanmar. There is a substantial overlap between injecting drug use and paid sex in some areas of the country. In Tamil Nadu, HIV prevalence among sex workers is 50%.
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In China, an estimated 650 000 were living with HIV/AIDS at the end of 2005. The highest numbers of HIV infection have been reported from Yunnan (southwest), Henan (East Central), Xinjiang (Northwest), Guangxi and Guangdong (Southeast) provinces. HIV epidemic began in rural areas before spreading to cities-unusual pattern of HIV spread. Injecting drug use accounts for nearly half (44%) of the people living with HIV. However, a half of the new HIV infection occurred during unprotected sex. As HIV is spreading gradually to the general population, the numbers of HIV infection among women are growing. The unique features of epidemic in China is that a substantial portion of infections were caused by unhygienic practice of commercial plasma collection in central China during the early 1990s. An estimated 250 000 people, mainly rural peasants, were infected in the provinces, including Henan, Anhui, Shanxi, Hubei and Shngdong. Recent study found the evidence of sexual transmission of HIV to non-donors. HIV epidemic starts to go beyond high risk groups into general population.
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In Thailand, an estimated 580 000 were living with HIV/AIDS with national adult HIV prevalence of 1.4% at the end of 2005. Because of intensive prevention measures, the new annual infection rate continues to drop: the estimated 18 000 new infections in 2005 from the peak incidence of 140 000 in early 1990s. A large proportion of new HIV infection is in general population. Recent studies show that more than one-third of HIV infections in 2005 were among women who had been infected by their long-term partners. Moreover, the previously neglected epidemic among MSMs has been recognized relatively recently. HIV prevalence among MSMs in Bangkok has increased steeply from 17% in 2003 to 28% in 2005.
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An estimated 360 000 were living with HIV/AIDS at the end of 2005 with national prevalence of 1.3%. HIV prevalence among young people (15-24 years of age) was at concerned level of 2.2%. The high HIV infection levels were found in the high risk groups: 43% in IDUs and 32% among sex workers. However, there are some indications that the epidemic might be slowing down: National prevalence among pregnant women has declined from 2.2% in 2000 to 1.3% in 2005.
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An estimated 260 000 are living with HIV at the end of 2005, more than doubled since 2000. Appro-ximately 40 000 people are newly infected with HIV each year. Injecting drug use and sex work are the main factors driving the epidemic. HIV prevalence among IDUs increased from 9% in 1996 to 32% in 2003. The levels of infection are reaching as high as 63% (in Hanoi) and 67% (in Hai Phong) in 2005. Up to 12% of sex workers and 18% of the sexual partners of IDUs were found to be infected with HIV, and the prevalence among pregnant women reached 1% mark in some regions.
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An estimated 20 000 were living with HIV/AIDS in Japan at the end of 2005. More than 60% of new infections are among MSMs and 25% are acquired through heterosexual contacts. One out three new HIV/AIDS case reports is from AIDS patients, suggesting that a significant proportion of HIV-infected persons do not know their infections and visit clinics in the very late stage of diseases.