Disease burden of HIV and its behavioral risks among adults aged 20–54 years in China and the Western Pacific Region from 1990 to 2021: an analysis based on the Global Burden of Disease Study 2021

The HIV epidemic remains a significant public health concern among individuals aged 20–54 years. However, comprehensive studies evaluating trends in HIV-related health burdens and associated behavioral risks in China and the Western Pacific Region are limited. This study utilizes data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to examine HIV burden indicators—including the age specific rates (ASR) for prevalence (ASPR), incidence (ASIR), mortality (ASMR) and DALYs (ASDR)—among individuals aged 20–54 years in China and the Western Pacific Region from 1990 to 2021. Long-term trends were analyzed using average annual percentage changes (AAPCs), while short-term trends were assessed through annual percentage changes (APCs). Furthermore, trends in HIV-related DALYs associated with behavioral risks were analyzed. In China, ASPR increased by 751.27% (AAPC = 7.19, 95%CI: 7.02–7.35), ASIR by 232.26% (AAPC = 3.8, 95%CI: 2.62–4.99), ASMR by 1535.29% (AAPC = 9.07, 95%CI: 8.51–9.63), and ASDR by 1379.27% (AAPC = 8.72, 95%CI: 8.22–9.23). In the Western Pacific Region, ASPR increased by 1101.91% (AAPC = 8.34, 95%CI: 8.2–8.47), ASIR by 354.24% (AAPC = 4.68, 95%CI: 3.91–5.45), ASMR by 1241.67% (AAPC = 8.56, 95%CI: 8.05–9.08), and ASDR by 1135.86% (AAPC = 8.28, 95%CI: 7.83–8.73). Regarding the HIV-related DALYs rate attributable to behavioral risks, the corresponding rate for unsafe sex, intimate partner violence, and drug use showed a significant increase from 1990 to 2021 in China and the Western Pacific Region (all AAPC > 0, p < 0.05). Notably, the HIV burden was consistently higher in males than females in both regions, with most of gender disparities widening over time. Despite significant progress in HIV/AIDS response, the burden remains substantial, with notable gender differences. Strengthened international cooperation, targeted prevention strategies, and expanded access to treatment are crucial to mitigating new HIV infections and improving health outcomes.