Changing Patterns of HIV Epidemic in 30 Years in East Asia
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The HIV epidemic in East Asia started relatively late compared to the rest of the world. All countries or areas, except for North Korea, had reported HIV and AIDS cases, with China being the major contributor to the epidemic. Though initially driven by injecting drug use in China, East Asia did not experience an explosive spread. Strong commitment in China and early harm reduction programs in Taiwan managed to reduce transmission substantially among injecting drug users. In contrast to China and Taiwan, injection drug use has accounted just a little, if not at all, for the spread of HIV in other East Asian counties. However, following a global trend, sexual contact has become a major route of infection across the region. While much progress has been achieved in this region, with the epidemic among other key populations relatively stable, the emerging epidemic through sex between men is a growing concern. Recent estimates suggest that HIV prevalence among men who have sex with men (MSM) has reached 6.3 % in China, 7.5 % in Mongolia, and ranges between 8.1 %-10.7 % in Taiwan and between 2.7 %- 6.5 % in South Korea. In Japan, 74 % of male HIV cases were among MSM in 2012, while Hong Kong has witnessed a sharp increase of HIV cases among MSM since 2004. There is urgent need to address issues of discrimination and stigma toward homosexuality, and to strengthen the strategies to reach and care for this population.
KeywordsEast Asia Japan China Taiwan Hong Kong South Korea Mongolia HIV AIDS HIV testing MSM Epidemiology Global epidemic
This study was supported by a grant from the Ministry of Health, Labour and Welfare in Japan. We greatly appreciate the help of Altanchimeg Delegchoimbol at UNAIDS Mongolia, Sergelen Munkhbaatar at Mongolia Ministry of Health, and Jin Young Ahn at Yonsei University College of Medicine in South Korea for facilitating us with national data and/or country reports. Finally, our appreciation goes to Bishal Gyawali at the University of Southern Denmark for his assistance in the early stages of this review.
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Conflict of Interest
S. Pilar Suguimoto, Teeranee Techasrivichien, Patou Masika Musumari, Christina El-saaidi, Bhekumusa Wellington Lukhele, Masako Ono-Kihara, and Masahiro Kihara declare that they have no conflict of interest
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 1.UNAIDS: Global report: UNAIDS report on the global AIDS Epidemic 2013. Switzerland; 2013.Google Scholar
- 4.Central Intelligence Agency: The World Factbook 2013-14 [https://www.cia.gov/library/publications/the-world-factbook/index.html] (Last accessed: January 19th, 2014).
- 5.Ministry of Health of the People's Republic of China, UNAIDS, WHO: 2011 Estimates for the HIV/AIDS epidemic in China; 2011.Google Scholar
- 6.••Zhang L, Chow EP, Jing J, Zhuang X, Li X, He M, et al. HIV prevalence in China: integration of surveillance data and a systematic review. Lancet Infect Dis. 2013;13(11):955–63. The authors analyzed the HIV prevalence trends between 1990 and 2012.They collected data from more than 1800 sentinel sites across all Chinese provinces and did a systematic review of 821 independent published studies. Their study showed that HIV prevalence among MSM is increasing at an alarming rate across all regions, suggesting that sex between men has become the main route of transmission.PubMedCrossRefGoogle Scholar
- 7.Wu Z, Sullivan S. China. In: Yamamoto T, Itoh S, editors. Fighting a Rising Tide: The Response to AIDS in East Asia, Wu Z, Sullivan S. Tokyo: Japan Center for International Exchange; 2006. p. 76–95.Google Scholar
- 12.Sheng L, Cao WK. HIV/AIDS epidemiology and prevention in China. Chin Med J (Engl). 2008;121(13):1230–6.Google Scholar
- 14.Ministry of Health of the People's Republic of China, UNAIDS, WHO: 2005 Update on the HIV/AIDS Epidemic and Response in China. Beijing; 2006.Google Scholar
- 17.Ministry of Health of the People's Republic of China: 2012 China AIDS Response Progress Report; 2012.Google Scholar
- 18.••Wu Z, Xu J, Liu E, Mao Y, Xiao Y, Sun X, et al. HIV and Syphilis Prevalence Among Men Who Have Sex With Men: A Cross-Sectional Survey of 61 Cities in China. Clin Infect Dis. 2013;57(2):298–309. This study is a rigorous epidemiologic work on more than 47,000 MSM; probably the largest study to date on HIV and syphilis prevalence among MSM. The authors found high prevalence of HIV and syphilis with similar risk factors but distinct geographical distribution, attributed by the authors to diverse transmission dynamics.PubMedCrossRefGoogle Scholar
- 19.UNAIDS: HIV in China: Facts and Figures [http://www.unaids.org.cn/en/index/page.asp?id = 197&class = 2&classname = China + Epidemic + %26 + Response] (Last accessed: January 10th, 2013).
- 24.•Chow EP, Wilson DP, Zhang L. What is the potential for bisexual men in China to act as a bridge of HIV transmission to the female population? Behavioural evidence from a systematic review and meta-analysis. BMC Infect Dis. 2011;11:242. This study provides a comprehensive analysis of the bisexual characteristics of Chinese MSM during 2001 to 2010. Bisexual behavior among MSM is common in China to conceal their homosexuality and conform to Chinese social norms.PubMedCentralPubMedCrossRefGoogle Scholar
- 31.Centers for Disease Control R.O.C. (Taiwan): HIV/AIDS [http://www.cdc.gov.tw/english/page.aspx?treeid = e79c7a9e1e9b1cdf&nowtreeid = 6bb9113c9e323e98] (Last accessed: December 25, 2013).
- 32.Study Group on HIV Infection of Haemophiliacs: Report of the study group on HIV infection of haemophiliacs through blood products in Hong Kong. Hong Kong; 1993.Google Scholar
- 33.Feldman EA. HIV and Blood in Japan: Transforming Private Conflict into Public Scandal. In: Feldman EA, editor. Blood Feuds: AIDS, Blood, and the Politics of Medical Disaster. New York: Oxford University Press; 1999.Google Scholar
- 34.Centers for Disease Control R.O.C. (Taiwan): HIV/AIDS (1984 - 2012/12/31) [http://www.cdc.gov.tw/english/info.aspx?treeid = 00ED75D6C887BB27&nowtreeid = 334C2073091C8677&tid = EA2CB016562D29C9] (Last accessed: January 17th, 2014).
- 35.Centers for Disease Control R.O.C. (Taiwan): Annual reported number of cases of HIV among Taiwanese by risk factor [http://www.cdc.gov.tw/professional/downloadfile.aspx?fid = 909C64F271CE1554] (Last accessed: January 19th, 2014).
- 36.Centers for Disease Control Ministry of Health and Welfare R.O.C. (Taiwan): Statistics of Communicable Diseases and Surveillance Report. Taipei; 2013.Google Scholar
- 37.Centers for Disease Control Ministry of Health and Welfare R.O.C. (Taiwan): Annual Report. Taipei; 2013.Google Scholar
- 38.UNAIDS: Welcome (not) [http://www.unaids.org/en/resources/infographics/20120514travel/] (Last accessed: January 18th, 2014).
- 40.•Ko N-Y, Lee H-C, Hung C-C, Tseng F-C, Chang J-L, Lee N-Y, et al. Trends of HIV and Sexually Transmitted Infections, Estimated HIV Incidence, and Risky Sexual Behaviors Among Gay Bathhouse Attendees in Taiwan: 2004–2008. AIDS Behav. 2011;15(2):292–7. The paper identifies increasing HIV prevalence in MSM attending bathhouses in Taiwan from 2004-2007. Revealing that behavior is extremely risky, approximately 20%-30% of UAS and MSP and 80% of unprotected oral sex in the last visit to bathhouse. Recreational drug use may lead them to the perpetuating risk behaviors. Interventions at bath house are urgently needed.PubMedCrossRefGoogle Scholar
- 44.Chen Y-MA, Lan Y-C, Lai S-F, Yang J-Y, Tsai S-F, SH-S K: HIV-1 CRF07_BC infections, injecting drug users, Taiwan [letter]. Emerg Infect Dis 2006.Google Scholar
- 47.Chen Y-MA, Chen Y-H, Lin Y-T, Lim P-L, Yunihastuti E, Kiertiburanakul S, Merati T, Chaiwarith R, Phanuphak P, Li P-C et al: Hepatitis B (HBV) and hepatitis C (HCV) co-infection: long term immunological, virological and survival outcomes following cART. In: 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur; 2013.Google Scholar
- 51.Study Group on HIV/AIDS Epidemiology and Intervention: Surveillance and preventive activities for HIV/AIDS infection among high risk populations and monitoring of local and global epidemiologic trends of HIV/AIDS. Japan; 2013.Google Scholar
- 52.Japan Foundation for AIDS Prevention: Japan: HIV/AIDS update. ICAAP11, Bangkok, Thailand, November 18-22 2013.Google Scholar
- 54.Kojima H: The Viewpoint of a Specialist from an Outsourced HIV Counseling and Testing Service. In: 22nd Japanese Society for AIDS Research. Osaka, Japan; 2008.Google Scholar
- 55.Ministry of Health Labour and Welfare (MHLW): Annual Report of the National AIDS Surveillance Committee for year 2012. Tokyo; 2013.Google Scholar
- 58.••Gilmour S, Li J, Shibuya K. Projecting HIV transmission in Japan. PLoS One. 2012;7(8):e43473. This study highlights the need for new strategies to reach the MSM population. It points out gaps in the current knowledge about the key risk behaviors among this population and provides some recommendations.PubMedCentralPubMedCrossRefGoogle Scholar
- 60.Itoh S. Japan. In: Yamamoto T, Itoh S, editors. Fighting a Rising Tide: The Response to AIDS in East Asia. Tokyo: Japan Center for International Exchange (JCIE); 2006. p. 119–55.Google Scholar
- 61.Korea Centers for Disease Control and Prevention: Annual Report on the Notified HIV/AIDS in Korea; 2013.Google Scholar
- 62.Korea Centers for Disease Control and Prevention: HIV/AIDS Control in the Republic of Korea. Seoul; 2011.Google Scholar
- 64.•Kee MK, Lee JH, Whang J, Kim SS. Ten-year trends in HIV prevalence among visitors to public health centers under the National HIV Surveillance System in Korea, 2000 to 2009. BMC Public Health. 2012;12:831. Large study (HIV/AIDS Cohort 2006) in Korea showing low HIV prevalence among high risk groups attending public health centers. Also, showed that HIV prevalence among “anonymous testers” was highest highlighting the importance to ascertain the characteristics of people choosing to take voluntary testing.PubMedCentralPubMedCrossRefGoogle Scholar
- 66.Korea Centers for Disease Control and Prevention: 2011 Annual Report on the Notified HIV/AIDS in Korea; 2012.Google Scholar
- 68.Surin S. Republic of Korea. In: Yamamoto T, Itoh S, editors. Fighting a Rising Tide: the Reponse to AIDS in East Asia. Tokyo: Japan Center for International Exchange; 2006. p. 156–71.Google Scholar
- 69.Lee J-H, Kim SH, Wang J-S, Sung KM, Kim SS, Kee M-K. Epidemiological and Immunological Characteristics at the Time of HIV Diagnosis for HIV/AIDS Cohort Registrants Representative of HIV-Infected Populations in Korea. Osong Public Health Res Perspect. 2012;3(2):100–6.PubMedCentralPubMedCrossRefGoogle Scholar
- 74.•Lee SH, Kim KH, Lee SG, Chen DH, Jung DS, Moon CS, et al. Trends of mortality and cause of death among HIV-infected patients in Korea, 1990-2011. J Korean Med Sci. 2013;28(1):67–73. This study revealed that a high proportion of patients are presenting late to care thus having early mortality. In a time when antiretroviral treatment is available, this study underlines the importance for early testing and diagnosing to get appropiate care.PubMedCentralPubMedCrossRefGoogle Scholar
- 80.Hong Kong Advisory Council on AIDS: Annual Report August 2009 - July 2010; 2011.Google Scholar
- 81.Special Preventive Programme Centre for Health Protection: HIV Surveillance Report: 2011 Update. Kowloon, Hong Kong; December 2012.Google Scholar
- 82.Special Preventive Programme Centre for Health Protection: Factsheet on HIV/AIDS Situation in Hong Kong. Kowloon, Hong Kong; 2012.Google Scholar
- 85.Ho R, Wong K: Programme manager’s viewpoint: Hong Kong (China) experience in combating the HIV epidemic among men who have sex with men. HIV/AIDS Prevention and Care Newsletter 2010:3-5.Google Scholar
- 87.Lee SS. The contribution of methadone maintenance treatment to HIV prevention - The case of Hong Kong. In: International Conference on Tackling Drug Abuse - Conference Proceedings. Hong Kong: Narcotics Division; 2005. p. 191–205.Google Scholar
- 88.Special Preventive Programme Centre for Health Protection: Factsheet HIV/AIDS Situation in Hong Kong. Kowloon, Hong Kong; 2010.Google Scholar
- 89.Li H, Goggins W, Lee SS: Multilevel analysis of HIV related risk behaviors among heroin users in a low prevalence community. BMC Public Health 2009, 9(137).Google Scholar
- 93.Government of Mongolia: AIDS reponse progress reporting. Mongolia; 2012.Google Scholar
- 97.National Center for Communicable Diseases (NCCD): HIV/AIDS cases ovierview [http://www.nccd.gov.mn/index.php?option=com_content&view=article&id=386:2013-11-29-05-29-40&catid=21:2011-09-01-03-24-23&Itemid=42] (Last accessed: January 19th, 2014).
- 98.Mongolia Ministry of Health: Second Generation HIV/STI Surveillance Report. Mongolia; 2005.Google Scholar
- 99.Mongolia Ministry of Health: Second Generation HIV/STI Surveillance Report. Mongolia; 2007.Google Scholar
- 100.Mongolia Ministry of Health: Second Generation HIV/STI Surveillance Report. Mongolia; 2009.Google Scholar
- 101.Mongolia National Committee on HIV and AIDS: UNGASS Country Progress Report: Mongolia; 2010.Google Scholar
- 102.••Mongolia Ministry of Health: Second Generation HIV/STI Surveillance Survey. Mongolia; 2011. This is a major source of informtion regarding the HIV epidemic in Mongolia since limited research has been published in English. Google Scholar
- 103.•Yasin F, Delegchoimbol A, Jamiyanjamts N, Sovd T, Mason K, Baral S. A cross-sectional evaluation of correlates of HIV testing practices among men who have sex with men (MSM) in Mongolia. AIDS Behav. 2013;17(4):1378–85. This study used a rigourous methodology and provided data on HIV prevalence, patterns and associations of HIV testing, and HIV related knowledge among MSM.PubMedCrossRefGoogle Scholar
- 104.Mathers B, Wodak A, Shakeshaft A, Merghati Khoei E, Dolan K: A rapid assessment and response to HIV and drug use in Mongolia. Sydney; 2009.Google Scholar
- 105.National Committee on HIV/AIDS: Mongolian National Strategic Plan on HIV, AIDS and STIs, 2010-2015. Ulaanbaatar; 2010.Google Scholar
- 106.Yasin F, Delegchoimbol A, Jamiyanjamts N, Mason K, Baral S: A cross-sectional assessment of HIV risk status and human rights abuses among men who have sex with men (MSM) in Mongolia [Poster]. XIX International AIDS Conference, July 22-27 Washington DC, USA 2012.Google Scholar
- 108.•Witte SS, Altantsetseg B, Aira T, Riedel M, Chen J, Potocnik K, et al. Reducing sexual HIV/STI risk and harmful alcohol use among female sex workers in Mongolia: a randomized clinical trial. AIDS Behav. 2011;15(8):1785–94. This study shows that even low impact interventions can achieve reductions of HIV and STI risk among FSW. Feasable and positively endorsed interventions are particularly important in low resourced settings.PubMedCrossRefGoogle Scholar