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USAID
Regional Development Mission Asia
Cathy Jane Bowes
Director, Office of Public Health
The views expressed in this presentation are the views of the author and do not necessarily reflect the views or
policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB
does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any
consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.
GEOGRAPHIC FOCUS
HIV/AIDS:
Non-presence
countries
including
Burma, China,
Laos, Papua
New Guinea
and Thailand
Regional
Activitives
HIV/AIDS in Asia
Estimated number of people living with HIV/AIDS (end of 2007, UNAIDS)
Country (prevalence rate) # 2007 # 2001
Burma 0.7% (CI: 0.4 – 1.1) 240,000 (300,000)
China 0.1% (CI: 0.0 – 0.2) 700,000 (470,000)
Lao PDR 0.2% (CI: 0.1 – 0.4) 5,500 (1,200)
Thailand 1.4% (CI: 0.9 – 2.1) 610,000 (660,000)
PNG 1.5% (CI 1.4 – 1.6) 5,400 (1,000)
General Population Prevalence is low (end of 2007): 0.1% - 1.5%
HIV is Concentrated often at very high levels in Most at Risk Populations
(MARPs) in Urban Hotspots:
Female Sex Workers (Burma 28%?, China 0.3%; Laos <1%; Thailand 5%; PNG ?
Injecting Drug Users: (Burma 38%?; China 8%; Laos ?; Thailand 29%; PNG ?
Men who have sex with men: (Burma 30s?; China 2.1%*; Laos 5.6%; Thailand 24.7; PNG ?)
Significant Emerging MSM Epidemics in SE Asia
**In the Asia region MSM have markedly greater risk of acquiring HIV (18.7 OR) as compared to the general population (Beyrer et al., 2008)
RDMA’S HIV/AIDS Strategic Approach
• Focus on developing, monitoring & evaluating, and
replicating technical models for HIV prevention for
MARPs linked to care and treatment services for
PLHA
• Comprehensive prevention package includes
supportive interventions necessary for success in
reaching marginalized populations
• Strong emphasis on data for evidenced-based
programming
• Leveraging Global Fund and other non-USG to
achieve national scale-up
Cycles of Replicable Model
Development
Phase I: Phase II: Phase III:
Development Integration and Quality
and Evaluation Expansion Assurance
Implement Monitor and Post-expansion
evaluate expansion monitoring
Identify, develop
or adapt Assess Respond to
sustainability changes in the
Monitor and
epidemic, new
evaluate for
policies, etc.
effectiveness and
potential for
scale-up
Replicable Models
• Replicable models for HIV prevention
– Prevention with MARPs (MSM, IDU, female sex workers)
• Comprehensive prevention package: behavior
change communication, condom (and lube)
distribution, HIV counseling testing, STI services, and
referrals to substitution therapy and care and support
for positives
• Methods: Targeting hotspots with outreach, drop-in
centers, clinics, targeted media
• Organizational development and capacity building
for indigenous NGOs
• Models for prevention with positives
– PLHA-led, community-based
– MARP-focused training and services (i.e., MSM-friendly)
– Linking community to facility based approaches (goal w/
CDC)
Replicable Models (2)
• Replicable models for HIV care
– Positive Partnership Project - Income generation for
people living with HIV/AIDS
• Pairing HIV+ and HIV- persons together to develop
microenterprise while reducing stigma and discrimination in
Thailand
• New models being developed for former injecting drug users
(IDU) and other MARPs in China and Burma
Strategic Information
Coverage +
– Surveys which monitor HIV service utilization and
associated risk behaviors in hot spots in Thailand,
Burma, China, and Laos
• This data informs us what programmatic
components are needed for our clients at what
intensity to reduce risk behaviors
– Repeated surveys inform us of service delivery trends,
such as greater proportions of outreach clients (FSW
and MSM) who access clinical STI and VCT services
Strategic Information (2)
• Supporting TA for enhanced surveillance, i.e., integrated
biologic and behavioral surveillance (IBBS) in Laos with
FSW which documented increased condom use and
declines in both HIV and Sexually Transmitted Infections
(STIs)
Comparison of condom use at last commercial sex, by gender
100
96
95
90 91
90
2004
% 85
2008
81
80
75
70
FSW reporting condom w/ client Client reporting condom w/ FSW
Strategic Information (3)
• A2 - Modeling epidemiologic data and resource
needs combined with advocacy for policy change
(Yunnan and Guangxi in China, Hai Phong and
HCMC in Vietnam, Bangladesh and Thailand)
• Strengthened government capacity to implement data
use models at sub-national level in Chonburi,
Thailand
– Adapted successful national model for provincial
action planning and resource mobilization
– Will be replicated in another 43 provinces in
Thailand with support from the Global Fund
Building Regional Networks
• Giving visibility and a voice to marginalized
populations through Regional Networks
– Support capacity building for Asian Pacific
Network for People living with HIV/AIDS
(APN+)
– Developed Purple Sky Network (PSN) for MSM
in Greater Mekong Sub-region
• MSM now included in all HIV/AIDS National
Strategic Plans
Future Role of RDMA
• PEPFAR 2 begins ($48b which includes TB
and Malaria and GFATM contributions)
• New administration
• Potential for:
– Stronger links with Global Fund and other donors
– Stronger links with other USAID Bilateral Missions
(i.e., Cambodia, India, Philippines, Indonesia,
Vietnam)
THANK YOU
