AIDS in South Asia: India asked to lead the campaign

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India asked to lead AIDS campaign

Washington, Aug 15 (IANS) South Asia's AIDS epidemic would grow

rapidly unless eight countries in the region, especially India, can

saturate high-risk groups with better HIV prevention measures,

according to a new World Bank report.

More than 5.5 million people are infected with HIV in South Asia,

with the epidemic increasingly driven by the region's flourishing

sex industry and injection drug use, said the report presented at

the 16th International AIDS Conference in Toronto, Canada, Monday.

Halting the spread of the epidemic will depend on a two-pronged

approach, says the report, " AIDS in South Asia: Understanding and

Responding to a Heterogeneous Epidemic " , released here.

First, establishing effective prevention programmes for groups at

increased risk of HIV infection such as sex workers and their

clients, injection drug users, and men who have sex with men.

Second, resolving the social and economic drivers of the epidemic

such as poverty, stigma, and trafficking of women for sex.

" Reaching and involving people at risk of HIV is the greatest

challenge in South Asia because they're frequently marginalised

within their own communities because of what they do, " says n

Schweitzer, Director for Human Development in the World Bank's South

Asia regional team.

Despite similar times of HIV introduction, epidemics in the various

countries have played out in remarkably different ways, the report

said noting that India could even be considered a continent in

itself, with individual states and even smaller geographic pockets

with unique epidemic patterns requiring different HIV responses.

Indeed, a major lesson from South Asia and also from Sub-Saharan

Africa - a region with approximately half the population of India

alone - is the need to understand how HIV transmission patterns can

be remarkably different both between and within regions and

countries, it said.

Focusing mainly on five countries in the region for which there is

adequate data - Bangladesh, India, Nepal, Pakistan, and Sri Lanka -

the report concludes that countries must tailor their HIV prevention

programmes to suit their own local conditions rather than rely on

generic global or regional approaches, which have failed to make a

difference in individual countries.

In India, for example, most NGOs have focused their HIV prevention

work on migrant men rather than on the one million sex workers, who

are considered an extremely vulnerable group for HIV transmission.

Moreover, South Asia's most severe epidemic is in parts of India,

particularly in a cluster of southern and western States, including

Tamil Nadu, Karnataka, Andhra Pradesh, Goa and Maharashtra where sex

work is the critical driver of HIV transmission.

The future size of India's HIV epidemic will depend above all on the

effectiveness of prevention programmes for sex workers and clients,

MSM (men having sex with men), and their sexual partners, together

with injecting drug users and their sexual partners, the latter

particularly in northeastern India.

The report says some of the major challenges in South Asia require

regional and cross-border programmatic cooperation. For example,

working on HIV prevention with injecting drug users in Afghanistan

and Pakistan would benefit from coordination with similar

initiatives in Iran and Central Asia.

" Preventing HIV infection among sex workers in Nepal would certainly

be more effective if they were coordinated with efforts in India

focusing on migration and sex worker trafficking, especially to

Mumbai, " says m Claeson, co-author of the new report and the

World Bank HIV/AIDS coordinator for the South Asia region.

" Another compelling example of why we need greater regional

cooperation is the cross-border drug trade and sexual networks

between the highest prevalence districts in northeastern India,

parts of Bangladesh, and Myanmar, which underscores the role of

migration, and clearly calls for countries to work together more

closely to prevent HIV from becoming widely established in the

region's general population. "

The World Bank has supported efforts to fight AIDS in South Asia

since the first National AIDS Control Project for India in 1992, and

has committed $380 million to support national programmes to date.

--By Arun Kumar

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