Taiwan's epidemic of HIV/AIDS began with the first case reported in December 1984. On 17 December 1990 the government promulgated the AIDS Prevention and Control Act. On 11 July 2007, the AIDS Prevention and Control Act was renamed the HIV Infection Control and Patient Rights Protection Act.Centers for Disease Control, R.O.C. (Taiwan), "Draft amendments to HIV Infection Control and Patient Rights Protection Act approved to address human rights", Centers for Disease Control, R.O.C. (Taiwan), February 5, 2015. 2016-05-03.

As of March 2016, there are 31,620 reported cases of Taiwanese testing positive, and 1,020 foreigners testing positive. Until January 2015, the original HIV Infection Control and Patient Rights Protection Act required foreigners who tested positive to be deported, therefore most of the reported foreigners are no longer in Taiwan. This policy was repealed in January 2015, allowing HIV/AIDS infected foreign individuals to remain in Taiwan.

HIV/AIDS patients' medical treatment costs are covered by Taiwan's National Health Insurance (NHI).

Epidemiology

The first reported case was reported in December 1984 on a foreign transit traveler. The first local infection was reported in February 1986.

According to the statistics of Taiwan's Centers for Disease Control, as of 6 February 2014, there were 26,646 cases of Taiwanese becoming infected with HIV.

Of all cases: 93.39% are male, 6.61% female 72.24% are 20–49 years old, 20.08% are 15–24 years old

Another 893 foreigners have tested positive, most of whom have been deported by the Taiwan government before the policy change. The CDC has not published an analysis of foreigners who tested positive.

The ratio of patients of drug users increases rapidly. Since 1984, incidence of infections through sexual contacts had accounted for 90% of all cases for most of time. But in 2005, drug using patients accounted for more than 50%. To prevent the disease from spreading to general population rapidly, the CDC announced the "Harm Reduction Pilot Projects for IDUs". The program includes expansion of the existing education and rehabilitation network, and the establishment of a harm reduction program unprecedented to the country.

HIV-1 epidemic Taiwan is entering a new and dangerous phase of its HIV-1/AIDS epidemic, which by far accounts for the majority of its total number of HIV infection cases.

By the end of 2006, 13,702 individuals (including 599 foreigners) had been reported as infected with HIV-1 to the Centers for Disease Control of Taiwan.Centers for Disease Control, ROC (Taiwan). HIV/AIDS data . 2006 (accessed Jan 30, 2007). In 2003, HIV-1 rates in first-time blood donors, military conscripts, and pregnant women were measured at 5.2, 57.0, and 12.0 per 100,000, respectively. Data from that year indicated HIV-1 rates of 0.09% for intravenous drug users, 0.2% for female sex workers, 1.9% for patients with sexually transmitted infections, and 6.7% for men who have sex with men in saunas or bath houses. Since then, the number of people living with HIV-1/AIDS in Taiwan has jumped sharply, from an 11% increase in 2003 to a 77% increase in 2004 and a 123% increase in 2005.

However, after the implementation of a harm-reduction program, a 10% decrease was seen in 2006. The current estimated number of HIV-1/AIDS cases in Taiwan is about 30,000, which suggests that the infection rate there could be greater than that in China: 30,000 per 23 million (1/767) compared with 650,000 per 1.3 billion (1/2000).Ministry of HealthPeople's Republic of ChinaJoint United Nations Programme on HIV/AIDSWorld Health Organization. 2005 update on the HIV/AIDS epidemic and response in China. Jan 24, 2005: (accessed Jan 23, 2007).

A risk-factor analysis of reported cases showed that the proportion of intravenous drug users infected with HIV-1 increased from 1.7% (13/772) in 2002, to 8.1% (70/862) in 2003, to 41.3% (628/1520) in 2004, to 72.4% (2461/3399) in 2005, and dropped to 68.6% (2017/2974) in 2006. The most important risk factor for Taiwanese intravenous drug users is needle-sharing, followed by the sharing of heroin diluents.Chen YM. Molecular epidemiology of HIV-1 infection among injecting drug users in Taiwan. 2005 Taipei International Conference on Drug Control and Addition Treatment, Taipei, Taiwan, Nov 22–24, 2005. A molecular epidemiological study showed that more than 95% of intravenous drug users with newly diagnosed HIV-1 in 2004 and 2005 were infected with CRF07_BC, a circulating recombinant form of subtypes B' and C.Chen YM, Lan YC, Lai SF, Yang JY, Tsai SF, Kuo SH. HIV-1 CRF07_BC infections, injecting drug users, Taiwan. Emerg Infect Dis 2006; 12: 703-705.Lin YT, Lan YC, Chen YJ, et al. Molecular epidemiology of HIV-1 infection and full-length genomic analysis of HIV-1 circulating recombinant form 07_BC strains from injecting drug users in Taiwan. J Infect Dis (in press). Previously, several studies suggested that CRF07_BC originated in China's Yunnan province as a mix of subtype B' from Thailand and subtype C from India. The subtype is believed to have moved to Xinjiang in China's northwest along a major heroin-trafficking route.Su L, Graf M, Zhang Y, et al. Characterization of a virtually full-length human immunodeficiency virus type 1 genome of a prevalent intersubtype (C/B') recombinant strain in China. J Virol 2000; 74: 11367-11376.

Of the 60,000–100,000 injecting drug users in Taiwan, 10–15% may be infected with CRF07_BC. If so, they probably represent the largest group of such intravenous drug users in northeast Asia. The circulating recombinant form might have followed a separate drug-trafficking route to Taiwan from Yunnan via southeast China, Guangxi, and Hong Kong.Piyasirisilp S, McCutchan FE, Carr JK, et al. A recent outbreak of human immunodeficiency virus type 1 infection in southern China was initiated by two highly homogeneous, geographically separated strains, circulating recombinant form AE and a novel BC recombinant. J Virol 2000; 74: 11286-11295.Cohen J. Asia and Africa: on different trajectories?. Science 2004; 304: 1932-1938.Lim WL, Xing H, Wong KH, et al. The lack of an epidemiological link between HIV type 1 infections in Hong Kong and Mainland China. AIDS Res Hum Retroviruses 2004; 20: 259-262. There have been enormous increases in the amount of heroin smuggled into Taiwan and in the number of intravenous drug users since 2002, when five intravenous drug users from southern Taiwan were diagnosed as the country's first HIV-1 seropositive cases infected with CRF07_BC. Even though the Hong Kong authorities identified three cases of CRF07_BC infection in 2001, a serious outbreak in that city's population of intravenous drug users is believed to have been blocked by a methadone maintenance program.

Monitoring

Close monitoring of emerging HIV-1 subtypes related to intravenous drug use and implementing harm-reduction programs has been and continue to be vital in preventing similar outbreaks in other populations of intravenous drug users in neighboring countries. In 2005, Alex Wodak, Gerry Stimson, and other harm-reduction experts were invited to Taiwan to share their experiences with government officials, medical field-workers, and public-health professionals. After careful study of harm-reduction programs in place in Hong Kong and Australia, a pilot program was started in four of Taiwan's 23 administrative areas in September 2005. This program has since been expanded nationally, and consists of 427 service sites for syringe exchange plus centres for methadone maintenance therapy. Free methadone is provided to HIV-1-infected intravenous drug users while HIV-1 seronegative intravenous drug users have to pay about US$1600 a year. The Taiwan Centers for Disease Control plans to provide methadone maintenance to intravenous drug users in prisons, and the country's Bureau of Controlled Drugs will start producing methadone to assist in the government's commitment to providing methadone maintenance to 30,000 intravenous drug users by 2009.

All parts of Asia are reporting rising numbers of HIV-positive and AIDS patients in men who have sex with men. This is primarily because policy targets these groups of people for testing. Current Taiwanese HIV testing centers receive higher funding when they report testing homosexual men than any other gender or sexuality. This is due to the faulty belief that gay men are at higher risk for HIV contraction. Modern statistics indicate that heterosexual couples are at higher risk of contraction, in particular because they do not test as often as the homosexual population and are not targeted by country policy. What these skewed statistics show is that in Taiwan, HIV-1 infection rates in men who have sex with men in gay saunas in different cities currently range from 5.2% to 15.8%.Lai SF, Hong CP, Lan YC, et al. Molecular epidemiology of HIV-1 in men who have sex with men from gay saunas in Taiwan from 2000 to 2003. XV International AIDS Conference, Bangkok, Thailand, July 11–16, 2004: (accessed Jan 23, 2007).Ko NY, Lee HC, Chang JL, et al. Prevalence of human immunodeficiency virus and sexually transmitted infections and risky sexual behaviors among men visiting gay bathhouses in Taiwan. Sex Transm Dis 2006; 33: 467-473. The same population has high rates of syphilis, 8.1–13.8%, depending on the city. Taiwanese male homosexual and bisexual HIV-1/AIDS patients have also been diagnosed with significantly higher rates of syphilis than have heterosexual patients.Chen YM, Huang KL, Jen I, et al. Temporal trends and molecular epidemiology of HIV-1 infection in Taiwan from 1988 to 1998. J Acquir Immune Defic Syndr Hum Retrovirol 2002; 26: 274-282. Furthermore, the percentage of homosexual or bisexual HIV-1/AIDS patients under the age of 20 years is significantly higher than that of heterosexual patients, 3.0% versus 1.7%.Chen YM, Huang KL, Jen I, et al. Again, these statistics reflect policy and the groups of people that policy targets. Temporal trends and molecular epidemiology of HIV-1 infection in Taiwan from 1988 to 1998. J Acquir Immune Defic Syndr Hum Retrovirol 2002; 26: 274-282. One of the primary factors that leads to HIV risk is the lack of accurate information on risky behaviors that lead to HIV contraction increases the risk of contracting HIV and other sexually transmitted infections.

Taiwan's clinical spectrum of AIDS patients is similar to those reported in other developed countries, but significant differences have been noted in incidences of opportunistic infections. For example, the incidence of tuberculosis in patients with advanced illness is high in Taiwan (24.6%) and the rate of endemic fungal (Penicillium marneffei) infections is increasing.Hsieh SM, Hung CC, Chen MY, Hsueh PR, Chang SC, Luh KT. Clinical manifestations of tuberculosis in patients with advanced HIV-1 infection in Taiwan. J Formos Med Assoc 1996; 95: 923-928.Hsueh PR, Teng LJ, Hung CC, Chen YG, Luh KT, Ho SW. Molecular evidence on strain dissemination of Penicillium marneffei: an emerging pathogen in Taiwan. J Infect Dis 2000; 181: 1706-1712. On the positive side, the effort by the Taiwanese Government since April 1997, to distribute highly-active antiretroviral therapy for freeFang CT, Hsu SM, Twu SJ, et al. Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan. J Infect Dis 2004; 190: 879-885. has resulted in dramatic decreases in morbidity and mortality from HIV-1 infection.Hung CC, Chen MY, Hsieh SM, Sheng WH, Chang SC. Clinical spectrum, morbidity and mortality of acquired immunodeficiency syndrome in Taiwan: a 5-year prospective study. J Acquir Immune Defic Syndr Hum Retrovirol 2000; 24: 378-385.