The large and diverse Asian region is home to significant numbers of people who inject drugs. They represent at least one-quarter of the total number of people injecting drugs around the world. HIV epidemics in many Asian countries are being driven by injecting drug use. At the regional level, it is estimated that 16% of people who inject drugs are living with HIV. Significant developments in policy and practice in parts of Asia have signalled a shift towards harm reduction in recent years. More countries in the region have introduced some form of needle and syringe programme (NSP) and have begun to prescribe opioid substitution therapy (OST) to some extent. However, across the region coverage remains far below levels necessary to have an impact on HIV epidemics.
The investment of funds into harm reduction in Asia is poor, with estimates suggesting that currently available funding for the region amounts to only 10% of actual need. A lack of supportive legal and policy frameworks in many countries continues to impede harm reduction responses, with several states prohibiting possession and/or provision of needles and syringes, methadone and/or buprenorphine. Imprisonment or detention in compulsory centres for drug users remains the dominant response to drug use in many Asian countries. Over half the countries in the region retain the death penalty for drug offences, with China, Malaysia, Singapore and Viet Nam considered ‘high-commitment’ states, executing death sentences with regularity.
* Please refer to the table below for ranges, where these are available. The maps display midpoint averages only.
|Country/territory with reported injecting drug use||People who inject drugs1||HIV prevalence amongst people who inject drugs1||Hepatitis C (anti-HCV) prevalence among people who inject drugs2||Hepatitis B (anti-HBsAg) prevalence among people who inject drugs2||Harm reduction response3|
|Afghanistan||20,000 (18,000-23,000)4||74||36||5.8||Y (19)5(NP)||Y (1)(M)5|
|Cambodia||1,900c 4||24.1||nk||nk||Y (2)||Y(1)8|
|China||2,350,0004||6.4d 4||67 (60.9-73.1)||9.6 (3.8-15.4)||Y (>900)4||Y (738)4(B,M)|
|India||177,000-180,0007||9.27||41||10.2 (2.7-17.8)||Y (261)7||Y (72)e 11(M,B,O)|
|Indonesia||105,784 (73,663-201,131)f 12||364||77.3||2.9||Y (194)4||Y (74)4(B,M)|
|Japan||400,000||nk||64.8 (55-74.5)||3.2 (2-4.3)||N||N|
|Korea (Republic of)||nk||nk||57||4||N||N|
|Macau||23813||1.3214||80.414||10.714||Y (4)14 (P)||Y (4)15 (B,M)|
|Malaysia||170,0004||8.74||67.1||nk||Y (297)4 g (P)||Y(674)4 h (B,M)|
|Maldives||793 (690-896)4||0i 15||0.7i 16||0.8i 16||N||Y(1)(M)|
|Nepal||(30,155-33,742)16||6.34||87.3 (80.5-94)||5.8 (5.5-6)||Y(43)||Y(3)4 j (B,M)|
|Pakistan||91,0004 c||27.24||84 (75-92.9)||6.8 (6-7.5)||Y(81)||N|
|Taiwan||nk||13.8 (2-25.6)||41||16.7||Y (1,103)||Y (90)(B,M)|
|Thailand||40,30017||21.94 l||89.8||nk||Y (10)(P)||Y (147)m (B,M)|
|Vietnam||158,4144||13.44 f||74.1||19.5||Y (297)4 (P)||Y (41)4 (M)|
nk = not known
a The number in brackets represents the number of operational NSP sites, including fixed sites, vending machines and mobile NSPs operating from a vehicle or through outreach workers. (P) = needles and syringes reported to be available for purchase from pharmacies or other outlets and (NP) needles and syringes not available for purchase.
b The number in brackets represents the number of operational OST programmes, including publicly and privately funded clinics and pharmacy dispensing programmes. (M) = methadone, (B) = buprenorphine, (O) = any other form (including morphine and codeine).
c Year of estimate: 2007.
d Figure represents national average only and may significant regional variations.
e Figure represents the number of sites managed by the National AIDS Control Organisation (NACO). Researchers in the region estimate that at least 80 additional sites are implemented by external development partners.
f Figure has been queried by civil society sources, with some estimating that it is closer to 60,000. A World Bank survey was underway at the time of writing.
g The total number of NSP sites includes 221 NGO sites and 76 government-run sites.
h Total number of OST sites includes 218 in government hospitals and clinics, 406 private healthcare practitioners
i Based on 2009 surveillance in two cities, Addu and Male.
j At least two additional sites were not included as part of this figure since anecdotal reports from civil society indicate that these sites provide buprenorphine for detoxification only rather than for maintenance therapy.
k Although there are no official programmes operating in Sri Lanka, anecdotal reports indicate that some psychiatrists and general practitioners prescribe methadone as OST.
l Estimate based on men who inject drugs only.
m Civil society and experts in the region have suggested that this estimate is too high and may not be representative of the actual level of OST provision in Thailand. It has been suggested that numbers may include clinics which require periodic detoxification and re-enrollment.
1 Unless otherwise stated, data are sourced from Mathers B et al (2008) for the Reference Group to the UN on HIV and Injecting Drug Use. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 372( 9651):1733 – 1745.
2 Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, Degenhardt L (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews Lancet 378(9791): 571 – 583.
3 Unless otherwise stated, data on NSP and OST coverage are sourced from Mathers B, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, Myers B, Ambekar A, Strathdee SA for the Reference Group to the United Nations on HIV and Injecting Drug Use (2010) HIV prevention, treatment and care for people who inject drugs: A systematic review of global, regional and country level coverage. Lancet 375(9719):1014-28.
4 UNAIDS (2012). Global AIDS Progress Reports. Available at: link
5 Personal communication with Harsheth Virk, Expert (HIV/AIDS Prevention and Care), Afghanistan Country Office, United Nations Office on Drugs and Crime (UNODC), 1 May 2012.
6 HIV Serological Surveillance conducted in six cities, with the highest prevalence reported among PWID in Kanshat at 95.7%. Bangladesh, Ministry of Health and Family Welfare 2011.
7 Petersen Z, Pluddemann A, van Hout MC, Dada S, Parry C, Myers B on behalf of the Secretariat to the United Nations Reference Group on Injecting Drug Use and HIV (2012) The prevalence of HIV among people who inject drugs and availability of prevention and treatment services: findings from 21 countries. A brief report. Parow: South African Medical Research Council.
8 HIV/AIDS Asia Regional Programme (2012) Cambodia Progress Updates. link Accessed 19 June 2012.
9 Aceijas C et al. (2006) Estimates of injecting drug users at the national and local level in developing and transitional countries, and gender and age distribution. Sexually Transmitted Infections 82: 10-17.
10 Cook C and Kanaef N (2008) Global State of Harm Reduction 2008: Mapping the Response to Drug-Related HIV and Hepatitis C Epidemics. London: IHRA.
11 Dr. Alok Agrawal, Programme Officer, National AIDS Control Organisation (NACO), India. May 1st, 2012.
12 Estimasi Populasi Dewasarawan Terinfeksi HIV (2009) Jakarta: Kementerian Kesehatan Republik Indonesia.
13 Department of Treatment and Social Reintegration (2011) Central Registration of Drug Abusers of Macau: Annual Report 2011, www.antidrugs.gov.mo, Macau: Social Welfare Bureau
14 Personal communication with Augusto Noguiera, President of the Association for Rehabilitation of Drug Abusers of Macau (ARTM), 18 May 2012.
15 UNGASS Country Progress Report 2010: Maldives Available at link
16 Sourced from recent mapping by NCASC and HSCB (2011) –see attached to email from Elina ‘Mapping and size estimation of most-at-risk population in Nepal’, p. 21)
17 Using the Multiplier Method to Estimate the Population Size of Injecting Drug Users (IDUs) in Thailand, 2009. Presentation by Aramrattana et al at The 10th International Congress on AIDS in Asia and the Pacific 26-30 August 2011, Busan, Republic of Korea.