South Asia's HIV epidemic is severe in magnitude and scope, with at least 60% of all people with HIV in Asia living in India. Because the HIV epidemic is highly heterogeneous, designing informed, prioritized, and effective responses necessitates an understanding of the epidemic's diversity between and within countries. This review was undertaken to provide a basis for rigorous, evidence-based HIV policy and programming in South Asia.
As a large and diverse region, South Asia has a complex, heterogeneous HIV epidemic, with considerable variation within and between countries. Rigorous analysis should inform the policies and programs needed to curb the epidemic. This chapter describes how the book undertakes such an analysis to provide a state-of-the-art assessment of South Asia's existing HIV epidemic; proposes a rigorous, evidence-based, practical HIV response strategy; and highlights priorities for greater emphasis in South Asia's HIV responses.
Between and within South Asian countries, the diversity of biological, behavioral, and structural factors can explain the substantial heterogeneity in HIV epidemiology and transmission dynamics. Formulating strategies to curb the region's HIV epidemic requires a comprehensive understanding of this diversity. Despite the large gaps in data, an analysis of existing data is sufficient to provide broad strategic guidance. This chapter outlines the book's descriptive and anticipatory analytic approach.
This chapter analyzes the quality of surveillance practices in South Asia. By the late 1990s, all five South Asian countries included in the core review had established some form of sentinel serological surveillance in adherence with the WHO's recommended practice of collecting and screening anonymous and unlinked blood samples.
This chapter analyzes behavioral trends across countries in South Asia. It uses surveys and studies to draw conclusions on how client load and consistent condom use may differ according to the type of sex work. It also looks at how consistent condom use and drug use patterns vary greatly across the region.
This chapter outlines the prevalence and spread of the epidemic in South Asia. It focuses especially on recent transmission trends among groups engaged in high risk behaviors, such as female sex workers, men having sex with men, and injecting drug users.
This chapter contains country-specific analyses, distills major trends within countries and links them to biological trends and program data. The country analyses have been undertaken following reviews of available literature, and country visits to Afghanistan, Bangladesh, India, Nepal, Pakistan, and Sri Lanka to interview key informants from governmental agencies, non-governmental organizations, and international agencies.
A critical strategy for curtailing the HIV epidemic in South Asia is to prevent further HIV transmission in areas with locally concentrated HIV epidemics that are driven by high-risk practices among networks involving sex workers, injecting drug users and men having sex with men. This chapter presents a general rubric for expanding coverage of focused prevention programs.
On the basis of the evidence presented in this report, this chapter presents a number of recommendations for improving the quality and scope of HIV prevention programming and building the necessary capacity to do so.
South Asia's HIV epidemic is severe but better prevention could halt its spread.
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World Bank HIV/AIDS Program in South Asia
Launching pad to all information on the World Bank's work on HIV/AIDS in South Asia.
World Bank Program in South Asia
Launching pad to all information on World Bank activities in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka.
A wide range of social and economic measures on South Asian countries, including links to the World Bank's most important online development databases.
Analysis and Research
Compilation of all the World Bank's publications on South Asian countries, with search options.