The Changing Face of the HIV Epidemic in Taiwan: A New Challenge for Public Health Policy Strategies

The goals of this study were to examine trends, risk factors, and survival rates of people diagnosed with HIV/AIDS. We used national surveillance data reported to the Taiwan Center for Disease Control (Taiwan CDC). The subjects of this study were all confirmed HIV and AIDS cases in Taiwan. From 1990 through 2005, the number of people that have been reported to have HIV/AIDS is 9961. Among individuals with HIV/AIDS, the male-to-female ratio was 11: 1, the median age was 32 years. The number of HIV and AIDS diagnoses increased significantly for both men and women during the study period. The number of HIV cases among men who have sex with men (MSM) increased from 24 in 1990 to 527 in 2005, while diagnoses among injection drug users (IDUs) rose rapidly from 3 in 1990 to 2450 in 2005. The incidence-to-prevalence ratio (IPR) has risen sharply in recent years and has exceeded the epidemic threshold (IPR(t)=0.1) for IDUs, indicating a growing epidemic. The corresponding hazard ratios for the highly active antiretroviral therapy (HAART) era versus pre-HAART era in the earlier and late HIV diagnosis groups were 0.45 (95% confidence interval [CI] 0.36-0.54) and 0.39 (95% CI 0.31-0.49), respectively. There was no significant difference in the survival rate of HIV testers. The increasing number of HIV infection places Taiwan among the worst IDU-concentrated epidemic areas in Asia. HIV intervention and prevention strategies, especially targeting IDUs, are urgently needed to reduce the ongoing spread of HIV infections in Taiwan.