Despite close population mobility and shared public health challenges between China and ASEAN countries, systematic comparisons of HIV/AIDS burden among people under 20 years remain scarce. This study quantified the spatiotemporal evolution of HIV/AIDS burden among children and adolescents in this region from 1990 to 2023 and projected future trends. Using GBD 2023 data, we analyzed HIV/AIDS prevalence, mortality, and disability-adjusted life years (DALYs) in the under-20 population of China and ASEAN. Age-standardized rates were applied to eliminate population structure bias. Trends and drivers were assessed via estimated annual percentage change (EAPC), hierarchical clustering, and Das Gupta decomposition, with ARIMA models projecting burden trajectories through 2038. In 2023, ASEAN’s age-standardized DALY rate (135.37 per 100,000) was ~ 9 times that of China (15.43 per 100,000). China showed a single peak-then-decline trend, while ASEAN had a recent prevalence rebound. The Philippines saw a significant upward trend, contrasting with declines in China and Thailand. Under-5 burden decreased with expanded prevention of mother-to-child transmission (PMTCT), but 15–19-year-olds (especially ASEAN males) had a sharp burden rise. Projections indicated China’s burden will remain low, while ASEAN prevalence will continue rising. Conclusion: China and ASEAN are at distinct epidemiological stages. With transmission shifting to adolescents, control strategies urgently need adjustment, focusing on 15–19-year-old high-risk interventions and psychosocial support to curb epidemic resurgence.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> What is Known: • HIV/AIDS is a major global infectious disease leading to high morbidity and mortality in children and adolescents, with mother-to-child transmission and high-risk sexual behavior as the main transmission routes in this population. • Existing studies have mostly focused on the general population or single countries, with a lack of systematic comparative analysis of the long-term HIV/AIDS burden among children and adolescents in China and ASEAN countries. </entry> </row> <row> <entry nameend="c2" namest="c1"> What is New: • This study systematically characterized the 33-year spatiotemporal evolution and population heterogeneity of HIV/AIDS burden among children and adolescents under 20 in China and ASEAN and found that the age-standardized DALY rate of ASEAN in 2023 was approximately 9 times that of China. • This study identified the epidemiological shift of HIV burden to the 15–19 age group, projected the burden trends through 2038, and provided evidence-based support for the formulation of targeted regional HIV prevention and control strategies. </entry> </row> </tbody> </tgroup> </Table>

The burden of HIV/AIDS among children and adolescents under 20 years of age in China and ASEAN countries from 1990 to 2023 and projections of future trends

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发表日期：

2026年7月15日

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Guojian Yang,
Yang He,
Qiuqiong Lin,
Bin He,
Hongsen Liang

摘要

Despite close population mobility and shared public health challenges between China and ASEAN countries, systematic comparisons of HIV/AIDS burden among people under 20 years remain scarce. This study quantified the spatiotemporal evolution of HIV/AIDS burden among children and adolescents in this region from 1990 to 2023 and projected future trends. Using GBD 2023 data, we analyzed HIV/AIDS prevalence, mortality, and disability-adjusted life years (DALYs) in the under-20 population of China and ASEAN. Age-standardized rates were applied to eliminate population structure bias. Trends and drivers were assessed via estimated annual percentage change (EAPC), hierarchical clustering, and Das Gupta decomposition, with ARIMA models projecting burden trajectories through 2038. In 2023, ASEAN’s age-standardized DALY rate (135.37 per 100,000) was ~ 9 times that of China (15.43 per 100,000). China showed a single peak-then-decline trend, while ASEAN had a recent prevalence rebound. The Philippines saw a significant upward trend, contrasting with declines in China and Thailand. Under-5 burden decreased with expanded prevention of mother-to-child transmission (PMTCT), but 15–19-year-olds (especially ASEAN males) had a sharp burden rise. Projections indicated China’s burden will remain low, while ASEAN prevalence will continue rising.

Conclusion: China and ASEAN are at distinct epidemiological stages. With transmission shifting to adolescents, control strategies urgently need adjustment, focusing on 15–19-year-old high-risk interventions and psychosocial support to curb epidemic resurgence.

What is Known:

• HIV/AIDS is a major global infectious disease leading to high morbidity and mortality in children and adolescents, with mother-to-child transmission and high-risk sexual behavior as the main transmission routes in this population.

• Existing studies have mostly focused on the general population or single countries, with a lack of systematic comparative analysis of the long-term HIV/AIDS burden among children and adolescents in China and ASEAN countries.

What is New:

• This study systematically characterized the 33-year spatiotemporal evolution and population heterogeneity of HIV/AIDS burden among children and adolescents under 20 in China and ASEAN and found that the age-standardized DALY rate of ASEAN in 2023 was approximately 9 times that of China.

• This study identified the epidemiological shift of HIV burden to the 15–19 age group, projected the burden trends through 2038, and provided evidence-based support for the formulation of targeted regional HIV prevention and control strategies.