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Sex Workers, Drug Use Spread HIV Infection in Asia
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Aug. 14 (Bloomberg) -- The number of South Asians infected with the HIV virus will grow rapidly unless countries including India and Pakistan improve prevention efforts among sex workers and drug users, a World Bank report said.
Successful approaches will better target the most-affected groups and address social stigma surrounding the disease in the eight-country region, the bank said in a report released today at the 16th International AIDS Conference in Toronto.
``The real issue in reaching the high-risk groups is that they're all outlawed and it's not easy to meet them face-to- face,'' Sujatha Rao, Director General of India's National AIDS Control Organization said at the meeting today. ``Ten years ago, sex workers were brothel-based but since then, police raids mean they've all disappeared into individual houses. They're hard to find like that.''
Infections in the region have grown 8.2 percent to about 5.9 million people since 2003, and India may soon have the biggest number of people living with HIV anywhere in the world, according to the United Nations. Poverty, illiteracy, the low social status of women, widespread migration and limited condom use are helping to spread the disease in the area, the World Bank said. Earlier estimates forecast HIV-infected populations of as many as 15 million in the region.
``Although some gloomy projections have turned out to be incorrect, there's no grounds for complacency in the region,'' Julian Schweitzer, director for Human Development in the World Bank's South Asia team said today. ``We can't stuff the genie into the bottle. It could burst out at any time if we get complacent.''
Tailored Programs
Fighting the disease successfully will require health workers to tailor their programs more specifically to local needs than is being done, Schweitzer said.
``The countries have similar cultures, similar socio- economic conditions but have very different levels of HIV,'' he said. ``A generic, one-size fits all approach is going to waste a lot of money. We're going to fail to hit a moving target.''
In Nepal, over 30 percent of the budget of the National Center for AIDS and Sexually-Transmitted Disease Control has been spent on prevention, care and treatment activities for the general population. Only 6 percent has been spent on harm- reduction programs for injecting drug users, even though sharing dirty needles is a major driver of the HIV epidemic in Nepal.
India
In India, most organizations have focused their HIV prevention work on migrant men rather than on the 1 million sex workers who are considered ``extremely vulnerable'' for HIV transmission, the World Bank said.
The other countries included in the report were Sri Lanka, Bangladesh, Afghanistan, the Maldives and Bhutan.
Infections in India are concentrated in eight states including Tamil Nadu, Andhra Pradesh, Maharashtra and Goa in the south, west and northeastern parts of the country, the report said. The states contain less than 30 percent of India's population but almost 70 percent of its HIV cases.
The prevalence of the disease in these states is at least five times higher than in the rest of the country. Much of the difference can be explained by sexual and drug-use habits, the report said.
Mobile Sex Workers
Controlling the disease in India is complicated by the fact that female sex workers are very mobile and may move as frequently as every two weeks, spreading the disease as they go. In the northeastern states, the spread of the HIV virus among intravenous drug users has left many women widowed. The infected women then move into sex work to support themselves.
The number of men having sex with men may also be underestimated in much of India, the report said.
Infection with the HIV virus in India is still ``highly dependent on connections to high-risk sexual of intravenous drug users networks or both.'' The conditions for a more generalized spread exist in some high-prevalence districts of Maharashtra, Karnataka and Andhra Pradesh, the study said.
The spread of HIV remains limited even among high-risk groups in Sri Lanka, which has about 5,000 infected patients out of a population of almost 20 million, the World Bank said.
``Early, affordable programs for sex workers and clients and men having sex with men and their other sexual partners, together with programs to detect growth in injection drug use can ensure that HIV remains at very low levels,'' the authors of the report said. ``The country has an opportunity that it must not lose.''
Intravenous drug users make up the biggest group of people infected with HIV in Pakistan, Bangladesh and Afghanistan, the report said.
Pakistan has few cases of HIV in the general population but the numbers are rising among drug users, the report said.
``This region is right on the edge of two major opium producers and heroin production is growing rapidly,'' Schweitzer said. ``This should be a cause for great concern among all countries of the region.''
Last Updated: August 14, 2006 15:47 EDT
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