AIDS in South Asia

by Moses, Stephen A.; Blanchard, James F.; Kang, Han; Emmanuel, Faran; Paul, Sushena Reza

• ISBN13: 9780821367575
• ISBN10: 0821367579
• Format: Paperback
• Copyright: 2006-08-15
• Publisher: World Bank

Summary

South Asia's HIV epidemic is highly heterogeneous. As a result, informed, prioritized, and effective responses necessitate an understanding of the epidemic diversity between and within countries. Further spread of HIV in South Asia is preventable. The future size of South Asia's epidemic will depend on an effective two-pronged approach: firstly, on the scope and effectiveness of HIV prevention programs for sex workers and their clients, injecting drug users and their sexual partners, and men having sex with men and their other sexual partners; and secondly, on the effectiveness of efforts to address the underlying socio-economic determinants of the epidemic, and to reduce stigma and discrimination towards people engaging in high risk behaviors, often marginalized in society, as well as people living with HIV and AIDS.This review was undertaken to provide a basis for rigorous, evidence-informed HIV policy and programming in South Asia.

Table of Contents

Figures, Tables, and Boxes	ix
Foreword	xi
Acknowledgments	xiii
Abbreviations	xv
Executive Summary	xvii
1. Background and Rationale	1	(6)
Rationale	2	(5)
2. Analytic Framework	7	(8)
Epidemic Potential	7	(4)
Epidemic Phase	11	(1)
Biological Factors	11	(2)
Behavioral and Structural Factors	13	(2)
3. HIV and Related Surveillance in the South Asia Region	15	(6)
India	15	(2)
Nepal	17	(1)
Pakistan	17	(1)
Bangladesh	18	(1)
Sri Lanka	18	(1)
Afghanistan, Bhutan, and the Maldives	19	(2)
4. Sexual and Injecting Drug Use Behaviors	21	(10)
Female Sex Workers	21	(2)
Clients of Female Sex Workers	23	(2)
Men Having Sex with Men	25	(1)
General Population	26	(1)
Injecting Drug Users	27	(2)
Female Sex Workers, Clients, and MSM Who Also Inject Drugs	29	(1)
IDUs Who Also Have Risky Sex	30	(1)
5. HIV Prevalence and Spread	31	(10)
Female Sex Workers	31	(1)
Men Having Sex with Men	32	(1)
Injecting Drug Users	33	(2)
Other High-Risk Male Groups	35	(1)
General Population	36	(5)
6. Country-Specific Analyses	41	(38)
India	41	(19)
Nepal	60	(4)
Pakistan	64	(4)
Bangladesh	68	(3)
Sri Lanka	71	(3)
Afghanistan	74	(3)
Bhutan	77	(1)
The Maldives	77	(2)
7. Scaling Up HIV Prevention Programs	79	(4)
Distribution of High-Risk Networks	79	(1)
Elements of Scaling Up of Program Coverage	80	(1)
Tactics for Scaling Up Coverage	80	(2)
General Considerations	82	(1)
8. Summary of Recommendations	83	(6)
Recommendation 1: Build Capacity	83	(1)
Recommendation 2: Expand Prevention Programs	84	(1)
Recommendation 3: Devote Resources to Condom Use and Needle Exchange	84	(1)
Recommendation 4: Increase and Expand Baseline and Continued Surveillance	85	(1)
Recommendation 5: Conduct Additional Studies	85	(1)
Recommendation 6: Expand Mapping of High-Risk Populations	85	(1)
Recommendation 7: Improve Understanding of Rural Epidemics	86	(1)
Recommendation 8: Reduce Stigma	86	(1)
Recommendation 9: Improve Coordination by Expanding Cooperation	87	(2)
Appendix A: The World Bank Response to AIDS in South Asia	89	(2)
Appendix B: Definition of Targeted and General Population Interventions	91	(4)
Appendix C: Country Analysis Summaries	95	(6)
References	101	(8)
Index	109