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FHI - Family Health International
What Drives HIV in Asia?: A Summary of Trends in Sexual and Drug-Taking Behaviours
FHI, 2001, 61 pp

Funded by USAID through the IMPACT Project.
Reproduced with kind permission of Family Health International.


"Throughout the 1980s and 1990s, the spread of HIV in Asia was relatively slow, compared with other regions such as Africa and the Caribbean. However several countries have witnessed rapid increases in infection rates in the last few years. There is much debate about the future of the epidemic in this region, which is home to more than half of the world's people. Current trends in the sexual and drug-taking behaviours that spread HIV can help predict future trends in HIV infection. A few Asian nations have been collecting systematic information on trends in HIV-related behaviours for several years, and several more have started recently. Indeed behavioural trend data collected through Behavioural Surveillance Surveys (or BSS) are increasingly being integrated into core HIV surveillance activities in the region. They act as an early warning of potential risk for HIV, can help explain trends in HIV prevalence in sub-populations at high risk of infection, and reflect the success of HIV prevention programmes over time. BSS generally focuses on measuring behaviours among groups at especially high risk for HIV. In the Asian context that includes men who buy sex and the women who sell it, men who have sex with other men, and, increasingly, injecting drug users. Almost all countries in this report have measured risk behaviour in commercial sex, and a growing number are also including drug injectors and men who have sex with men in their behavioural surveillance systems. In addition, some countries occasionally monitor sexual behaviour among groups thought to be at low risk for HIV, such as students or factory workers. This document gathers together the results of BSS collected by a number of countries and states with technical assistance from Family Health International. The findings are extremely diverse, and hard to compress into a few paragraphs. In several countries and states in Asia, condom use in commercial sex has risen sharply over time. Over seven out of 10 encounters between sex workers and clients are protected by condoms in some countries. However this success is by no means universal. In a number of countries where almost all sex workers and clients know that condoms protect them against HIV, consistent condom use in paid sex still lags well below 10 percent. One of the most interesting findings of recent BSS work is that risk populations tend to overlap quite a bit. In other words a substantial proportion of sex workers inject drugs, while many male drug injectors regularly buy sex. Many men who have sex with other men also have sex with women, and this is true of male sex workers as well as of their clients. Clients of female sex workers may have numerous partners ranging from the sex workers to girlfriends, and a majority in several sites report also being married. Condom use with each of these partner types varies, and the potential for HIV to spread from high into lower risk populations can be clearly seen. On the other hand, the few BSS rounds that look at general populations tend to confirm that risky behaviour in the general population is not very widespread. When data from BSS and data from biological surveillance systems are combined, they strongly suggest that HIV prevention programmes in some parts of Asia notably Thailand and Cambodia are succeeding. In other countries, the failure of BSS to register any significant change in risky behaviour means much remains to be done."

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