Data and Statistics

The Regional Scenario

It is estimated that between 2 - 3.5 million people are living with HIV or AIDS in South Asia. Common structural and socioeconomic factors across the region put many people at risk of contracting HIV: internal and cross border migration, human trafficking, low literacy levels, stigma related to sex and sexuality, injecting drug use, structured commercial sex and male resistance to condom use.

Relatively low national HIV prevalence can mask large and diverse HIV epidemics within countries. Large concentrated epidemics among high risk groups (e.g. injecting drug users (IDU) and their partners, men who have sex with men (MSM), sex workers (SW) and their clients, etc.) are the driving force behind the epidemics in South Asia.

Throughout the region stigma towards people living with HIV and AIDS is widespread. The misconception that AIDS only affects men who have sex with men, sex workers, and injecting drug users strengthens and perpetuates existing discrimination. The most affected groups, often marginalized, have little or no access to legal protection of their basic human rights. Addressing the issue of human rights violations and creating an enabling environment that increases knowledge and encourages behavior change are thus extremely important to the fight against AIDS.

Afghanistan

Afghanistan’s HIV epidemic is at an early stage, concentrated among high risk groups, mainly injecting drugs users and their partners. Although HIV prevalence is low, there is potential for rapid spread due to the current increase in injecting drug use. A 2006 study among IDUs in Kabul city found that 3% of the IDUs were HIV positive. It is difficult to estimate the scale of spread of HIV associated with sex work or male-to-male sex. Although the officially reported number of HIV cases in Kabul is 71, UNAIDS and WHO estimate that there may be between 1,000 - 2,000 people living with HIV in Afghanistan.  

Bangladesh

UNAIDS estimated that approximately 11,000 Bangladeshi adults and children could be living with HIV and AIDS at the end of 2005. Sentinel surveillance in Bangladesh (2004-2005) showed an overall prevalence of 0.6%. Cases are underreported due to the limited voluntary testing and counseling capacity, and the social stigma attached to HIV and AIDS.

While overall HIV prevalence is low, prevalence is higher in risk groups such as sex workers, injecting drug users and men who have sex with men. Bangladesh’s large cities have relatively large subpopulations of brothel-based female SWs with a high client volume, indicating the potential for substantial concentrated epidemics. Some evidence suggests that the HIV epidemic could expand because of injecting drug use. The intersection between female SW and IDU networks could lead to a rapid expansion of the HIV epidemic if HIV prevention and harm reduction efforts are not intensified.  

Bhutan

UNAIDS estimates that about 500 people could have been were living with HIV/AIDS at the end of 2005. Among the cases reported between 1993 and 2002, heterosexual sex was the primary mode of transmission. The infected persons range in age from 15 to 35 years, with men slightly outnumbering women. The average age of infected women is about 23 years, significantly lower than the average age for infected men, which is 32 years. People living with HIV in Bhutan come from diverse occupational backgrounds. They are farmers, government servants, and female sex workers. Half the infections are reported from Thimphu, the capital, and Phuentsholing, a bustling commercial town bordering the Indian state of West Bengal.  

India

It is estimated that between 1.75 -3.15 million Indians are living with  HIV. India’s highly heterogeneous epidemic is largely concentrated in six states —in the industrialized south & west, and in the north-eastern tip. On average, HIV prevalence in those states is 4–5 times higher than in the other Indian states.

The Indian epidemic continues to be concentrated in populations with high risk behavior characterized by unprotected paid sex, sex between men, and injecting drug use with shared injecting equipment. Several high risk groups have high HIV prevalence, and sexual networks are wide and inter-digitating. According to India’s National AIDS Control Organization (NACO), the bulk of HIV infections in India occur during unprotected heterosexual intercourse. Consequently, women account for a growing proportion of people living with HIV (38% in 2005), especially in rural areas.

Recent data suggests that some southern states may be experiencing declining or stabilizing HIV prevalence among young women (Kumar et al. 2006). HIV infection levels have also fallen among men aged 20–29 who attended STI clinics in the south while there was no evidence of declining prevalence in northern states. The decline may be the result of a postulated rise in condom use by men and female sex workers in southern India.  

Maldives

HIV-related data are very sparse. However, 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 major mode of HIV transmission in the country appears to be heterosexual sex although recent observational reports suggest considerable growth in injecting drug use.  

Nepal

Nepal is facing increases in HIV prevalence among high risk groups such as sex workers, injecting drug users, men who have sex with men, and migrants. In addition, injecting drug use appears to significantly overlap with commercial sex. There is an urgent need to scale up effective interventions, especially among IDUs.

The first case of AIDS in Nepal was reported in 1988. Since then, the numbers have risen among the country’s 27 million people. By the end of 2005, more than 950 cases of AIDS and over 5,800 cases of HIV infection were officially reported, with three times as many men reported to be infected as women. However, given the limitations of Nepal’s public health surveillance system, the actual number of infections is expected to be much higher. UNAIDS estimates that 75,000 people were living with HIV at the end of 2005.  

Pakistan

According to UNAIDS estimates, about 85,000 people, or 0.1 percent of the adult population are infected with HIV. Officially reported cases are, however, much lower. As in many countries, underreporting is due mainly to the social stigma attached to the infection, limited surveillance and voluntary counseling and testing systems, as well as the lack of knowledge among the general population and health practitioners.

Although overall HIV prevalence is low in Pakistan, there is growing evidence to suggest that the substantial size and high-risk behaviors of IDUs, MSM and female SWs could contribute to local concentrated epidemics. The combination of high levels of risk behavior and limited knowledge about HIV among injecting drug users and sex workers could lead to the rapid spread of HIV.  

Sri Lanka

According to UNAIDS, Sri Lanka has a relatively small number of people living with HIV—about 5,000 adults. Officially reported cases are much lower, with underreporting mainly due to limited availability of counseling and testing, fear associated with seeking services and the stigma and discrimination associated with being identified as HIV positive. Of the total number of HIV cases reported the majority (85%) were transmitted through heterosexual sex, 10% through homosexual sex, and the remainder through peri-natal transmission and blood products. Transmission through injecting drug use has not yet been reported.

For more information, please refer to the report: AIDS in South Asia: Understanding and Responding to a Heterogeneous Epidemic.  

updated July 30, 2007