- Widespread injecting drug use among young men
- Rising rates of sex work among young women under 25
- High HIV prevalence in vulnerable groups (MSM, IDUs, sex workers) - don't have access to prevention services
- Rising STIs
- Low condom use
- Low HIV testing coverage
- Gender inequality
- Widespread HIV-related stigma and discrimination
- Population mobility and trafficking among women and young girls

• Without immediate and extraordinary action on AIDS, the region could soon witness an additional 12 million new infections by 2010 - higher than the current 8 million people living with HIV in the region.
• Countries in Asia and the Pacific stand at a crossroads. They face two options in tackling the AIDS epidemic - either "business as usual", which would lead to a rise in HIV infections and AIDS deaths, OR scaling up HIV prevention and care programmes that reach vulnerable groups, which could ultimately stop the epidemic in its tracks and minimize its human and economic costs.

2. Prevention - We must remember that 99% of people in Asia are still uninfected - there is a huge potential to prevent a larger epidemic. Treatment and prevention are complementary strategies in mounting a comprehensive response to AIDS.

• If comprehensive prevention services are rapidly expanded, 6 million infections could be prevented in the region by 2010.
• HIV prevalence in the region remains low, but even low prevalence translates into millions of cases due to the large population (China and India primarily).
• Low national prevalence often masks local epidemics at the provincial/state level - as seen in China, India, Cambodia, Myanmar, and Thailand.
• Years of low prevalence do not immunize countries from the danger of experiencing a major national epidemic.
• But countries like Bangladesh, East Timor, Laos, Pakistan, and Philippines have golden opportunities to pre-empt serious outbreaks of HIV.
• Good news - China's AIDS response has grown over the past few years through increased political commitment at the highest level (with Chinese Premier and President on board), increased funding for AIDS (doubling of government funding from 2003-2004 to US$95 million), growing HIV prevention and treatment efforts (launch of "four frees" and one care policy - free ARV treatment, free anonymous testing, free prevention of mother-to-child transmission, and free schooling for AIDS orphans as well as care of people living with HIV or AIDS), growing involvement of private sector, and the revised law on infectious diseases that bans discrimination against PWAs. In Yunnan province, with a population of 44 million, the governor is taking the lead in scaling up comprehensive prevention efforts that target vulnerable groups, including IDUs.
• Malaysia's Prime Minister announced that a comprehensive harm reduction programme will be implemented by end 2005 to reduce the spread of HIV among IDUs, focusing on needle exchange, condom promotion and methadone treatment. And Bangladesh has succeeded in reducing the spread of HIV among vulnerable groups, particularly sex workers (thanks to government support for NGO-led interventions). Without these interventions, HIV prevalence among sex workers would have been as high as 10% vs. the current prevalence of 1%.
• Other signs of progress - MOU between ADB and UNAIDS to generate additional funds for AIDS in the region; South Asian Association for Regional Cooperation (SAARC), APEC and ASEAN, and Pacific Islands Forum have all made HIV prevention and treatment a regional priority - challenge is to translate commitment into action.

3. Vulnerable groups - continue to have limited access to HIV prevention and treatment services due to stigma.

• Given that drug use and commercial sex are the biggest drivers of HIV in the region, the epidemic will only be reversed if IDUs and sex workers have access to prevention and care/treatment programmes. Supportive government policies and programmes are urgently needed.
• Despite some signs of progress, prevention and treatment coverage remain low in the region.
• In South and South-East Asia, only 19% of sex workers have access to prevention services; only 2% of MSM have access; and just over 5% of IDUs have access.
• While most countries have policy frameworks addressing vulnerable groups, few have actually implemented them.
• Only an estimated 14% of the 1.1 million people in South East Asia who need antiretroviral therapy are receiving it (from latest 3 by 5 Progress Report).

4. Women & young girls - HIV mixed with gender inequality is placing Asian women and girls in double jeopardy

• In Asia, 30% of girls are married before the age of 15, and 62% before 18, often with much older husbands who are more likely to be have been exposed to HIV infection.

5. Funding - still not enough

• By 2007, AIDS funding in the region will be more than twice what it was in 2003. But at US$1.6 billion, it will still be less than half of the US$5 billion needed.

6. Way forward - AIDS must be seen in a new light

• Tackling AIDS in Asia and the Pacific should become a global priority like AIDS in Africa.
• Governments should view AIDS as an exceptional threat to humanity that requires both an emergency-level response and long term planning and financing.
• National AIDS programmes should focus on scaling up HIV prevention, care and treatment programmes that reach vulnerable groups.
• Civil society groups must be part of national AIDS responses - and can help fight stigma associated with people living with HIV and other marginalized groups (sex workers, IDUs, MSM).