The incidence of new HIV infections in Asia and the Pacific will soon pass that in Africa and is projected to increase into the next century. The AIDS epidemic arising from these infections will have enormous consequences for the health and socioeconomic development of a region encompassing more than half the world's population.
PIP: The Asia-Pacific region has about 55% of the world's population, yet it has reported less than 3% of the world's reported AIDS cases. A 1996 World Health Organization data review found that 22% of the estimated 21.8 million HIV-infected people were from the Asia-Pacific region, suggesting that this region is at an early stage of the HIV/AIDS epidemic. Substantial underreporting of AIDS cases in some countries is likely. Among countries with more than 500 reported AIDS cases, since 1990, the AIDS incidence rates are falling in New Zealand and stabilizing in Australia but increasing in Thailand, India, and Burma. India has the highest estimated number of HIV-infected people (1.75 million) in the Asia-Pacific region. This number far exceeds the total estimates for North America, Australia, and Europe combined. China has only an estimated 10,000 cases of HIV infection, most of whom live in Yunnan province. HIV-1 incidence studies indicate that HIV-1 spread rapidly among intravenous (IV) drug users and sex workers in Thailand during the late 1980s. The HIV-1 seroconversion rate in these groups peaked at 50/100 person-years but now lies between 5 and 20/100 py. A decline in HIV incidence has been noted in Thai military conscripts. Several waves of HIV-1 infection have struck Thailand: IV drug users, sex workers, male clients, female partners of infected men, and infants of infected women. HIV-1 appears to be spreading in India, Burma, and Cambodia the same way it did in Thailand. The leading mode of HIV transmission is homosexual intercourse in Australia, New Zealand, and the French Pacific Territories. In southern China, Malaysia, and Vietnam, it is IV drug use. Heterosexual intercourse unrelated to sex workers is the primary mode of HIV-1 transmission in Papua New Guinea. HIV incidence rates are low in the Philippines and Indonesia. There have been various HIV-1 subtypes identified in the region (e.g., India has 4 subtypes to date). The first reported HIV-2 case was in India in 1990. HIV-2 is spreading rapidly there. Most persons infected with HIV-2 in India are also infected with HIV-1. An HIV/AIDS epidemic of the same scale as that in sub-Saharan Africa is expected.