The spread of the disease will depend on an effective two-pronged approach: firstly, establish effective prevention programs for high risk groups such as sex workers, injection drug users, and men having sex with men; and secondly, address underlying socio-economic factors of the epidemic such as poverty, stigma, and trafficking of women.
The World Bank has been supporting efforts to fight HIV/AIDS in South Asia since 1992, and to date has committed US$380 million to support national programs. The main components of these projects are surveillance, monitoring and evaluation, targeted interventions for vulnerable populations, blood safety, efforts aimed at reducing stigma among the general population and strengthening public and private institutions for a multisector response.
Data collection key challenge
There is no reliable data on the prevalence of HIV/AIDS in Afghanistan, which has an estimated population of 22 million people. More information is needed for the government to develop an effective and targeted program of prevention and treatment. The immediate challenges are to rebuild the public health system; survey the population’s knowledge, attitudes, and practice regarding HIV/AIDS; and collect important data on the prevalence of HIV among high risk groups.
Low overall prevalence, widespread stigma
HIV/AIDS prevalence and the number of AIDS cases remain low in Bangladesh, but they are on the increase in some risk groups. Significant underreporting of cases occurs because of limited voluntary testing and counseling capacity. A concern is the significant number of injecting drug users who sell their blood professionally. Bangladesh relies on professional blood-sellers to meet most of the transfusion needs of its people.
Geographic isolation will not stop HIV/AIDS
Bhutan has a population of about 700,000 and only 72 cases of HIV detected as of March 2005. However, UNAIDS estimates that about 100 people were living with HIV/AIDS already at the end of 2003. This still amounts to a prevalence rate of less than 0.01 percent. International travel and behavioral risk factors, mean Bhutan could face a rapid growth of HIV cases in the future. There is still time for vigorous action.
Home to diverse HIV/AIDS epidemic
There are more than 5.1 million individuals infected with HIV in India. Some states experience a generalized epidemic with the virus transmitted from high-risk groups into the general population. A major challenge is to strengthen and decentralize the program to the state and district levels to enhance commitment, coverage and effectiveness.
Quick action pays off so far
The Maldives took action against HIV/AIDS before the first domestic case was reported in 1987 and, as a result, has so far kept the threat to a minimum. The country has seen a decrease in new infections. With few resources currently required for treatment, it has the opportunity to focus on better understanding risk factors.
Rapid increase among vulnerable groups
A narrow window of opportunity exists to prevent a full-scale epidemic among the general population and immediate and vigorous action is needed. Nepal's poverty and gender inequality, combined with low levels of education and literacy make the task all the more challenging, as will the denial, stigma, and discrimination that surround HIV/AIDS.
Risky behaviors and ignorance may fuel epidemic
Until recently, Pakistan was classified as a low-prevalence country with many risk factors that could lead to the rapid development of an epidemic. However, recent evidence indicates that the situation is changing rapidly. In 2004, a concentrated outbreak of HIV was found among Injecting Drug Users (IDUs) in Karachi, where over 20 percent of those tested were found to be infected.
Limited data and growing concerns
Despite an estimated low prevalence rate, there are mounting concerns because of the significant presence of risk factors and vulnerability. With underreporting due mainly to limited availability of counseling and testing and a prevailing fear of facing social stigma, the current ratio of HIV-positive men to women in Sri Lanka is reportedly 1.4 to 1, although in reality, there are probably far more men infected than women as in most early phase HIV epidemics.
This website contains ample information on the epidemic in South Asia, including World Bank supported projects and research, partnerships, and upcoming events.