By James F. Blanchard, Han Kang, Faran Emmanuel, Sushena Reza Paul,
South Asia's HIV epidemic is very heterogeneous. therefore, knowledgeable, prioritized, and powerful responses necessitate an knowing of the epidemic variety among and inside of nations. extra unfold of HIV in South Asia is preventable. the longer term dimension of South Asia's epidemic relies on an efficient two-pronged strategy: to begin with, at the scope and effectiveness of HIV prevention courses for intercourse staff and their consumers, injecting drug clients and their sexual companions, and males having intercourse with males and their different sexual companions; and secondly, at the effectiveness of efforts to deal with the underlying socio-economic determinants of the epidemic, and to lessen stigma and discrimination in the direction of humans carrying out excessive probability behaviors, frequently marginalized in society, in addition to humans residing with HIV and AIDS. This overview used to be undertaken to supply a foundation for rigorous, evidence-informed HIV coverage and programming in South Asia.
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Additional resources for AIDS in South Asia: Understanding And Responding to a Heterogenous Epidemic (Health, Nutrition and Population Series)
Sexual and Injecting Drug Use Behaviors • 25 Men Having Sex with Men Mapping studies from Pakistan demonstrate that, as with female SWs, large urban areas contain dense concentrations of men having sex with men (MSM) and male SWs (MSW). Those studies suggest that Karachi has almost 5,000 male SWs and 7,626 hijras (NACP 2005a), whereas Lahore has 7,500 male SWs and 2,000 hijras (NACP and Naz Foundation International 2005). These sites are therefore appropriate for HIV and second-generation surveillance among MSM, which Pakistan has initiated through the selection of populous cities for both serological and behavioral surveillance.
Mathematical models suggest that concurrent sexual partnerships may increase HIV transmission tenfold. Growing biological evidence of variability in viral load and infectivity 14 • AIDS in South Asia firmly supports those projections (Morris and Kretzschmar 1997). The size of HIV epidemics in South Asia depends to a large extent on rates and patterns of partner change—inside and outside commercial sex. Structural factors—including poverty, gender inequality, trafficking, large structured sex work industries, and oscillating migration— influence sexual behaviors and networking patterns.
Ultimately, transmission occurs somewhat independent of easily defined high-risk groups. Strategic responses to such situations should include both targeted interventions for high-risk groups and an early emphasis on reducing the potential for transmission in the more general population through enhanced sexually transmitted infection (STI) services, broader behavioral change programs, and aggressive condom promotion. 3 schematically depicts a generalizing epidemic. Generalizing epidemics occur in many countries of Sub-Saharan Africa, but as we discuss subsequently, many locations in South Asia do not exhibit the defining conditions—such as substantial transmission beyond the high-risk networks—to sustain and amplify this kind of epidemic.