Between 2 and 3.5 million people in South Asia are living with HIV and AIDS.
Factors such as sex work and injecting drug use drive the epidemic in the region. HIV prevalence among vulnerable and often marginalized groups is high throughout the region and rapidly increasing in some places.
In India alone approximately 2.5 million people are estimated to be living with HIV and AIDS. India’s HIV epidemic is highly heterogeneous and appears to be stable or diminishing in some parts of the country. The majority of reported HIV infections are concentrated in six states where HIV prevalence is, on average, 4-5 times higher than in other states. These include the Mumbai-Karnataka corridor, the Nagpur area of Maharashtra, the Nammakkal district of Tamil Nadu, coastal Andhra Pradesh, and parts of Manipur and Nagaland. Recent data suggest that high levels of condom use in the context of sex work may have played a role in reducing HIV prevalence among young women in some southern Indian states. Still, enhanced efforts are needed to sustain and effectively reach high-risk groups.
Women account for a growing proportion of people living with HIV in India - particularly in rural areas. A large proportion of women with HIV appear to have acquired the virus from regular partners who were infected during paid sex. Although HIV prevention efforts targeting sex workers and their partners are being implemented, the law enforcement context of sex work often acts as a barrier.
In other countries in the region, such as Bangladesh, Nepal, Pakistan, and Sri Lanka HIV prevalence is low among the general population but significantly higher among key populations, such as injecting drug users, male and female sex workers and their clients, and men who have sex with men. These concentrated epidemics are extensive and affect a large proportion of vulnerable populations at high risk. As a result, HIV is spreading rapidly in some parts of the region.
Significant structural and socioeconomic factors across the region put many people at risk of HIV infection:
- - Stigma related to sex, sexuality and HIV
- - Structured commercial sex and casual sex with non-regular partners
- - Trafficking of women and girls into prostitution
- - Male resistance to condom use
- - High prevalence of sexually transmitted infections (STIs)
- - Low status of women, leading to an inability to negotiate safe sex
- - More than 35% of the population living below the poverty line
- - Low levels of literacy
- - Porous borders
- - Rural to urban and intrastate migration of male populations
In response to these risk factors, the World Bank in South Asia has focused on mobilizing countries to improve and accelerate their response to HIV and AIDS.
In South Asia, the World Bank provides support to countries and across the region through our analytical and advisory activities, evidence based policy dialogue and lending. The Bank has supported national efforts to slow the spread of HIV since the first India project in 1992, and has committed a total of US$661 million in IDA credits and grants to strengthen national programs in Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka to date.
The country specific support to strategic AIDS planning includes social mapping and size estimation of most at risk groups in, for example, Sri Lanka and the Maldives (2009-2010). We have adopted a strategic multi sector approach and focus our efforts on the drivers of the concentrated HIV epidemics throughout the region -- unsafe sex and injecting drug use -- working with governments and civil society, involving communities at highest risk.
The main components of Bank supported projects are surveillance, monitoring and evaluation, targeted interventions for key populations, blood safety, efforts aimed at reducing stigma among the general population, and strengthening public and private institutions for a multi-sector response.
In addition, the Bank has undertaken analytical work to help to inform policy and evidence-based decision making including AIDS in South Asia: Understanding and Responding to a Heterogeneous Epidemic (a synthesis of the epidemiology of HIV in the region) and HIV and AIDS in South Asia: An Economic Development Risk which highlights the economic development risks of HIV in low prevalence settings, especially the welfare impact and fiscal burden of HIV and AIDS in the South Asian setting, and underscores the cost-benefits of scaling up HIV prevention.
Finally, through the 2008 South Asia Region Development Marketplace (SAR DM) on Tackling HIV/AIDS Stigma and Discrimination, the World Bank and the SAR DM partnership supported 26 NGOs from six countries to pilot innovative HIV and AIDS-related stigma and discrimination reduction interventions.