Publications

The present study describes complex drug and sexual risk in a group of male sex workers who were recruited in the context of a larger study of young heroin users in Hanoi, Vietnam. Male sex workers were significantly more likely than male non-sex workers to be migrants and to have unstable housing, to have lifetime exposure to marijuana, 3,4 methylenedioxymethamphetamine (MDMA, ecstasy), amphetamines, cocaine and morphine. Male sex workers are more likely to currently use MDMA, amphetamines, morphine and to 'smoke' as their most frequent mode of heroin administration. Male sex workers are more likely to have both male and female concurrent sex partners, to have a history of sexual victimisation, to have had more than three different sex partners in the past 30 days, and to have had partners who injected drugs before sex or who used drugs during sex. In their last sexual encounter with a client partner, approximately one-third (31.1%) reported having had receptive anal sex. In nearly three-quarters of these exchanges (71.4%), no condom was used. Similarly, in their last sexual encounter with a client partner, 42.2% reported having had insertive anal sex and in nearly half (47.4%) of these encounters no condom was used. Consistent with recent data from elsewhere in the region, there is an urgent need for additional research on male sex work in South-east Asia in order to properly situate behavioural interventions for male sex workers in this region.

Thailand has traditionally pursued an aggressive enforcement-based anti-illicit drug policy in an effort to make the country "drug-free." In light of this ongoing approach, we sought to assess impacts of enforcement on drug use behaviors among a cohort of injection drug users (IDU) in Thailand. We examined drug use patterns among IDU participating in a cross-sectional study conducted in Bangkok (n = 252). Participants were asked to provide data regarding patterns of drug use in the previous six months, including types of drugs consumed, method of consumption, frequency of use, and weekly income spent on drugs. We also conducted bivariate analyses to identify a possible effect of a reported increase in police presence on measures of drug use and related risk behaviors among study participants. One hundred fifty-five (61.5%) individuals reported injection heroin use and 132 (52.4%) individuals reported injection midazolam use at least daily in the past six months. Additionally, 86 (34.1%) individuals reported at least daily injection Yaba and Ice (i.e., methamphetamine) use. Participants in our study reported high levels of illicit drug use, including the injection of both illicit and licit drugs. In bivariate analyses, no association between increased police presence and drug use behaviors was observed. These findings demonstrate high ongoing rates of drug injecting in Thailand despite reports of increased levels of strict enforcement and enforcement-related violence, and raise questions regarding the merits of this approach.

Afghanistan is widely known and appreciated for its rich history, culture, literature and arts as well as its magnificent landscape. It is also widely known that large numbers of Afghans die, or live wretched lives, because violence is an everyday fact of life. Such violence is not openly condoned but neither is it challenged nor condemned by society at large or by state institutions. It is primarily human rights activists that make an issue of violence including, in particular, its impact on, and ramifications for, women and girls in Afghanistan. The report seeks to put back on the agenda some of the issues pertaining to the enjoyment of all human rights by all Afghan women that are being increasingly ignored. The problems identified in this report require further discussion and public debate, with a view to informing appropriate legal, policy and awareness-raising measures.

HIV second generation surveillance is a system of surveillance that conducts repeated surveys of both behaviors, HIV serology and prevalence of STI (which serves as a proximate measure for recent exposure to unprotected sex) among population most at risk of HIV infection. In 2008, the third round of HIV surveillance was needed in Lao PDR to investigate the state of the epidemic, estimate the impact of the program implemented since last round and adjust interventions accordingly.

The global economic crisis threatens recent gains in health and poverty reduction in developing countries. What is the effect of the crisis on HIV programmes, especially in high HIV prevalence countries? What are the possible consequences? What can be done to avoid negative impacts? Advanced economies are projected to suffer deep recessions in 2009, with their gross domestic product (GDP) contracting by 5% on average—the first such fall in 60 years. This is generating fears that official development assistance, and in particular resources for social sector spending, including funding for HIV services and commodities, would remain flat during the next few years.

In April 2008, ADB approved DOH’s request for funding to enable the conduct of studies and other activities under the project,“Supporting Women at-Risk and Vulnerable to HIV/AIDS in the Philippines.” ADB provided funding through the Gender and Development Cooperation Fund (GDCF) established under RETA 6143, which supports initiatives to promote gender mainstreaming in ADB operations, gender capacity development, and strategic partnerships.

Antiretroviral treatment (ART) is extending the lives of people living with HIV (PLHIV). Though ART has become more widely accessible globally since the early 1990s, getting antiretroviral drugs (ARV) to those who need it most continues to be a challenge. As access increases, so does the need to assure that systems are in place to report on outputs and outcomes in a timely manner. Such data are vital to ART programs, as not only do they assist in tracking progress towards achieving global goals, but they also inform the day to day implementation of treatment programs. Without an adequate measurement of what is being done, countries risk losing opportunities to prevent premature deaths and potential ARV resistance; they also do not have the information critical to assure PLHIV on ART receive appropriate care at the appropriate time to improve and maintain their quality of life. Acknowledging the need to share experiences and lessons learned in order to inform future direction, the U.S. Government (USG), World Health Organization (WHO) and other partners organized the first “Regional workshop on strengthening ART data use in Asia and the Pacific: examples from USG, national and multilateral partners” in Bangkok, Thailand from 18-19 May 2009. This two day workshop provided a forum for national and international experts to present lessons learned and discuss specific challenges faced in most resource-poor settings throughout the region.

Governments and UN agencies have failed to meet their international commitments and should be called to account. Despite the relative ease of delivering the antiretroviral prophylaxis to prevent vertical transmission progress has been slow, with global coverage rising from 9 percent in 2004 to 33 percent coverage in 2007. At least three quarters of HIV-positive pregnant women in 61 countries, including Cameroon, Ethiopia, India and Nigeria, are still not receiving this intervention. Moreover, it is not enough merely to ensure access to ARV prophylaxis. Quality is equally important, and in this regard too the options for women in poorer countries are far less appropriate and effective. In the developed world, all women who want and need ARV prophylaxis can obtain triple-dose combination therapy, which reduces the risk of vertical transmission to a mere 2 percent. About half of women receiving ARV prophylaxis in the global South, meanwhile, are provided with single-dose nevirapine treatment. This regimen reduces transmission risk by just over 40 percent, however, and puts women under the risk of developing resistance to nevirapine, which is the backbone of many HIV treatment regimens in general. Our research for this report, Missing the Target 7, has reinforced the need for governments, UN agencies, donors and indeed civil society to look beyond the magic bullet of administering a pill each to mother and baby in order to stem the annual toll of preventable infections and deaths in newborns.

Injecting drug users (IDU) are at increased risk of human immunodeficiency virus (HIV) infection. Their HIV prevalence however varies from place to place and may not be directly linked with the level of individual risk. This study explores the relative importance of individual and community level characteristics in the practice of HIV-related risk behaviors in IDU in Hong Kong where the HIV prevalence has remained low at below 1%. Methadone clinics were used as the channel for accessing drug users in Hong Kong. HIV-related risk factors in drug users attending these clinics were retrieved from a questionnaire routinely administered to newly admitted and readmitted clients, and assessed using logistic regression and multilevel analyses.

Violence against women is now widely recognised as an important public health problem, owing to its health consequences. Violence against women among many Indian communities on a regularly basis goes unreported. The objective of this study is to report the prevalence and other related issues of various forms of domestic violence against women from the eastern zone of India. The prevalence of domestic violence in Eastern India is relatively high compared to majority of information available from India and confirms that domestic violence is a universal phenomenon. The primary healthcare institutions in India should institutionalise the routine screening and treatment for violence related injuries and trauma. Also, these results provide vital information to assess the situation to develop public health interventions, and to sensitise the concerned agencies to implement the laws related to violence against women.