Publications

The newly established Islamic Republic of Afghanistan faces many challenges: pockets of instability around the country, low literacy levels, high levels of opium production, and a lack of basic infrastructure. But what is known about the Acquired Immunodeficiency Syndrome (AIDS) in Afghanistan? Is Afghanistan at risk of a Human Immunodeficiency Virus (HIV) epidemic, and if so what can be done? The looming potential of an HIV epidemic in Afghanistan has motivated academics, donors, the Government of Afghanistan, and Non-Governmental Organizations (NGOs) to undertake research, create policies, and implement programs for the prevention of HIV spread in Afghanistan. Although HIV has been explored to varying degrees by several agencies, data on HIV in Afghanistan remains sparse and information sharing has been largely ad-hoc and uncoordinated. This report aims to synthesize available information on the HIV epidemic in Afghanistan. The report explores regional HIV transmission patterns, the prevalence of risk factors for HIV in Afghanistan, and Afghanistan’s current programmatic and policy responses for HIV prevention.

In Pakistan, seven times more men are reported to be infected with HIV than women. Among the Pakistani population, modes of HIV transmission include infection through sexual contact, contaminated blood and blood products, injecting drug use, and mother-to-child transmission. Although most sexual transmission of HIV results from unsafe heterosexual contact, homosexual and bisexual contact also represent important modes of transmission. According to unpublished reports, the prevalence of HIV among homosexual and bisexual Pakistani men is reaching alarming proportions. We describe the Pakistani homosexual and bisexual culture, review statistics regarding HIV prevalence and risk behaviour, and identify areas of improvement in the HIV policy with specific focus on men who have sex with men.

The main focus of the handbook is female prisoners1 and guidance on the components of a gender-sensitive approach to prison management, taking into account the typical background of female prisoners and their special needs as women in prison.

Married Indian women who experience physical and sexual violence from husbands face a significantly increased risk of HIV infection as compared with women who are not thus abused, and this increased prevalence of infection is not affected by major risk behaviors within their control. Findings of the present study, based on both the large population-based sample and the use of standard diagnostic testing for HIV infection, should serve to confirm the nature of this relationship and move public health policy-makers and practitioners to increase recognition of IPV as a critically important target in the global fight against HIV/AIDS.

For the Government of Bangladesh (GoB), the Behavioral Surveillance Survey (BSS) is a significant step in understanding and monitoring the levels of risk behavior associated with HIV infection within selected, most-at-risk populations (MARP) in the country. The current BSS, under the umbrella of an internationally recognized second-generation HIV surveillance system documents the risk behaviors of the selected MARP groups leading to vulnerability for HIV infection. It also focuses on the situation analysis of the MARP risk behaviors between behavioral surveillance rounds.

Technical and funding support based on such evidence for large scale strategic interventions that address male-to-male and transgender sexualities and related HIV vulnerabilities is only now beginning to materialize in South Asia. One of the first steps needed in scaling up this response is to map the populations concerned and their representative groups, organizations and networks. This study was commissioned by APCOM and carried out by SAATHII, and aimed to map the situation of and HIV 'infrastructure' for transgenders in the South Asian countries of Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. The mapping study focused on transgenders, given that not enough is known about their specific vulnerabilities to HIV and the response that is already under way to address these vulnerabilities.

The risk of the HIV epidemic spreading from high-risk groups to the general population in Vietnam depends on sexual risk and bridging behaviors between high- and low-risk individuals. A crosssectional study was used to describe sexual activities of youth aged 18–29 years. Nearly half (41.4%) were sexually active. Premarital sex was reported by 43.3% of them; 78.3% of sexually active males and 13.5% of sexually active females. Multiple sex partners were reported by 31.0%; 56.7% of males and 9.2% of females. Almost 27% of males and 5% of females engaged in sexual bridging behaviors. Being unmarried was significantly associated with having sex with non-regular partners. Being unmarried and early age at first intercourse were associated with having sex with a sex worker. Consistent condom use was high with commercial sex workers but low with regular partners. Education to delay early sexual debut, increased employment, and strategies to inform young sexually active people to adopt safer behaviors are urgently needed.

India’s HIV epidemic is of global interest. 2 years ago, we showed that HIV pre- valence in young women declined by about a third between 2000 and 2004 in the southern states of Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu. HIV prevalence at young ages (15–24 years) is a useful proxy for trends in HIV incidence. We now present trends up to 2007.

The 2006-07 Pakistan Demographic and Health Survey (PDHS) is the largest household-based survey ever conducted in Pakistan. Teams visited 972 sample points across Pakistan and collected data from a nationally representative sample of over 95,000 households. Such a large sample size was required to measure the maternal mortality ratio at the national level. In fact, this is the first survey that provides direct estimates of the maternal mortality ratio at the national level.

ADB Regional Technical Assistance (RETA 6247) was financed by the Poverty Reduction Cooperation Fund from the United Kingdom's Department for International Development, with parallel financing from UNESCO. This RETA 6247 was, in part, a continuation of the previous RETA (RETA 6083, ICT and Preventive Education in the Cross-border Areas of the Greater Mekong Sub-region). However, it also built and expanded on the lessons identified from the previous project. The earlier RETA, jointly carried out by the Asian Development Bank (ADB), UNESCO and SEAMEO, was implemented during the period April 2003 to September 2004. Under it, ADB/UNESCO pioneered the use of linguistically and culturally appropriate materials in the form of radio soap operas (dramas) for transmitting HIV/AIDS, drug and trafficking prevention information to highly vulnerable ethnic minority populations often living in remote areas in the Greater Mekong Sub-region (GMS). It further established the use of Geographic Information Systems (GIS) for mapping, tracking and monitoring the spread of HIV/AIDS in Thailand, as well initiating the UNESCO-based Clearing House (CH) on Preventive HIV/AIDS education in the GMS.