Comparative burden of HIV and non-HIV sexually transmitted infections in Asia, 1990 to 2023

초록

Sexually transmitted infections (STIs) remain an important public health challenge in Asia, yet comparative evidence assessing human immunodeficiency virus (HIV) and non-HIV STIs within a unified regional framework is limited. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2023 estimates, we assessed HIV and non-HIV STIs (including syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes) across 5 Asian subregions (Central, East, South, and Southeast Asia, and high-income Asia Pacific) from 1990 to 2023. We quantified burden using age-standardized disability-adjusted life-year rates and prevalence rates, analyzed temporal trends using estimated annual percentage changes, and examined attributable risk factors including unsafe sex, childhood sexual abuse, drug use, and intimate partner violence. From 1990 to 2023, HIV burden increased across most Asian subregions, while non-HIV STIs generally declined. In 2023, Southeast Asia showed the highest HIV burden and the highest prevalence of non-HIV STIs. HIV exhibited regionally variable age peaks and a predominantly male burden, while non-HIV STIs were concentrated in earlier adulthood and showed discordant sex patterns, with higher prevalence in males but higher disability-adjusted life-year rates in females. Unsafe sex was the leading attributable risk factor across regions, except in Central Asia, where drug use predominated for HIV-attributable burden. These findings underscore the need for differentiated responses across Asia, including sustained HIV-case finding and treatment scale-up, targeted harm reduction, and strengthened STI surveillance and prevention in higher-burden settings.

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