South Asia

Afghanistan

Afghanistan is one of the world’s leading producers of opium, and drugs are widely available. The use of opiates, such as heroin and opium, has seen a dramatic increase over the last four years with a 53 percent rise in the number of regular opium users and a 140 percent rise in the number of heroin users in the period 2005 to 2009.⁶⁴ Further to this, a study of three major cities in 2009 found HIV prevalence among IDUs had more than doubled since 2006.⁶⁵ As a result, Afghanistan is now considered to have a concentrated epidemic.⁶⁶ It is estimated that 8 percent of the adult population use drugs, yet only 10 percent of drug users access harm reduction services.⁶⁷ Moreover, awareness of the risk of HIV transmission is low among this high risk group, particularly among young IDUs. A study found that 85 percent of IDUs interviewed shared a needle or syringe when injecting drugs.⁶⁸

Prevalence among the general population is less than 0.5 percent, based on the most recent data available.⁶⁹ However, HIV surveillance is minimal. Conditions are in place for a generalised epidemic to develop, including high numbers of displaced people, high levels of illiteracy, low social status of women, and a shortage of health facilities. The epidemic among high risk groups must be curbed to avoid HIV bridging into the wider population.

Bangladesh

The first HIV/AIDS case in Bangladesh was reported in 1989. Since 1994, HIV infection levels have increased, although the problem is still relatively small scale, with around 12,000 adults – 0.2% of the total population – infected.⁷⁰ It is nonetheless predicted that Bangladesh may gradually be heading towards an epidemic, unless a greater response is developed. At the moment HIV is mainly confined to groups such as IDUs, migrant workers and MSM, and it is reported that this focus on risk groups has led to a lack of urgency among policy makers in dealing with the problem.⁷¹

India

The launch of a mobile HIV testing unit in India

India is experiencing a diverse HIV epidemic that affects states in different ways, and to different extents. In India the groups most affected include injecting drug users, sex workers, truck drivers, migrant workers, and men who have sex with men. Some have predicted that India will soon be experiencing a ‘generalised’ epidemic, where the HIV prevalence rate – currently 0.3% in India⁷² ­­– rises above 1%. Others have played down current estimates of the numbers infected, and have argued that, because HIV transmission in India still largely occurs among risk groups, it is unlikely that HIV will spread widely among the general population.⁷³ Regardless of the future path of India’s epidemic, it is undeniable that AIDS is having a devastating impact, and that there are still many major issues – including stigma and poor availability of AIDS treatment – that urgently need to be addressed.

Nepal

An estimated 70,000 people are living with HIV and AIDS in Nepal, which equates to an adult prevalence of 0.5%.⁷⁴ HIV is primarily transmitted through injecting drug use and unprotected sex. Seasonal labour migration is an important source of income for many Nepalese, but it is associated with a higher risk of HIV infection and nearly 50% of total HIV infections are recorded along the highway districts of country. ⁷⁵Around 41% of all HIV cases in Nepal are among seasonal labour migrants, 16% are clients of sex workers and 21% are partners or wives of HIV positive men.⁷⁶ The Nepalese government have responded to the epidemic despite political instability; in 2009 Prime Minister Madhav Kumar Nepal said the government would increase resources and actions for preventing, treating and controlling the country's epidemic.⁷⁷

Pakistan

Pakistan’s first reported case of HIV occurred in 1987. Until the late 1990s, most subsequent cases occurred in men who had become infected while living or working abroad. The most at risk populations in Pakistan include injecting drug users, sex workers and prisoners.⁷⁸ Despite a low overall HIV prevalence (0.1%), social and economic conditions in Pakistan – including poverty, low levels of education, and high levels of risk behaviour among IDUs and sex workers – are likely to facilitate the spread of HIV in coming years.⁷⁹ HIV prevalence among IDUs has already significantly increased - from 10.8 percent in 2005 to 21 percent in 2008.⁸⁰ Hijra (transgender) sex workers are also disproportionately affected by HIV/AIDS in Pakistan; HIV prevalence among this group is 6.1 %.