The Issue
Since the first cases were defined in the early 1980s, more than 23 million people around the world have lost their lives to AIDS; by 2010 an estimated 45 million will have died. UNAIDS estimates as of November 2006 shows 6.1 million South Asians are living with HIV, including 1.7 million women and 140,000 children under 15, of whom 30,000 need antiretroviral therapy. The vastmajority of those infected in South Asia live in India, where UNAIDS estimates that 5.7 million people are HIV-positive. In 2006, an estimated 23,000 children died from AIDS and another 35,000 were newly infected with HIV in South Asia. Although HIV infection rates in all South Asian countries are below 1 per cent of the adult population, these low national averages mask serious epidemics concentrated in some geographical areas and amongst high risk populations such as injecting drug users, sex workers, and men who have sex with men. Among these groups, infection rates are high and rising and in many areas there is strong evidence that the epidemic is more rapidly diffusing into the general population. Widespread poverty, huge economic disparities, low literacy, deep-rooted and pervasive discrimination against women and their low levels of empowerment, and large mobile populations, aided by a wall of denial, are all now combining potently to spread the epidemic into the general population. What makes HIV/AIDS in South Asia an enormous challenge to overcome is that there is no single epidemic in the region, but a diversity of epidemics. The two interlinked generalisations that can be made are that across Asia the epidemics have all followed a similar pattern, and that the virus has spread mostly through identifiable risky behaviours that the majority of the population do not engage in. The epidemic starts among a few behaviorally linked at-risk groups such as intravenous drug users (IDUs), men who-have-sex-with-men, and female sex workers and their clients and then spreads to their lower-risk partners and through them to infants through mother-to-child transmission. Such delayed epidemics now include much of Nepal and Pakistan where HIV levels have grown more gradually and do not yet exceed 0.5 to 0.7 percent. Afghanistan, Bhutan, the Maldives and Sri Lanka have yet to see extensive HIV spread and still have national prevalence rates below 0.1 per cent, but there is evidence that risk behaviours are increasing. South Asian countries are still at relatively early stages of the epidemic curve, so there is still an opportunity to reverse the spread of HIV/AIDS if carefully focused and scaled-up prevention work is done now. A recent estimate suggests that, if nothing changes, 12 million new infections could occur across the Asia-Pacific region between 2005 and 2010. But it doesn’t have to be that way. If the region undertakes a determined response of comprehensive prevention, care and treatment, new infections can be held to 6 million. South Asia’s young people are now moving to the centre of the AIDS epidemic. More than 1.25 million people aged 15 to 24 are HIV-positive. Adolescent girls suffer a great disadvantage because in South Asia’s environment of pervasive gender bias, they are susceptible to many forms of abuse and exploitation and therefore are more vulnerable to infection, even though evidence suggests that boys engage in high-risk behaviours more than girls. Infection from mother to infant can take place during pregnancy, at birth or during breastfeeding. There is a 35 per cent risk that an HIV-positive mother will pass the infection on to her infant, and in several Indian states HIV prevalence among pregnant women has already crossed the one per cent threshold. Antiretroviral drugs, caesarean deliveries, and alternative feeding options for infants can reduce the risks, but for many these options are restricted by poverty, poor sanitation or limited access to quality health services. Families and communities are already coping with relatively large numbers of orphans due to factors like the high maternal mortality rate. The inevitable increase in the number of maternal, paternal, and double orphans due to AIDS-related deaths will greatly stress already weak and overburdened family and community safety nets unless systems to strengthen capacities over the long term are developed now. HIV and AIDS facts sheets by country
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