India and China

India and China

Truck drivers being handed leaflets on HIV/AIDS prevention in Maharashtra, India

India harbours two quite separate HIV epidemics. In the south, where heterosexual sex is the main transmission route, prevention projects have largely focussed on sex workers and their clients. This approach is credited with reducing HIV prevalence among all young women in southern states from 1.7% in 2000 to 1.1% in 2004.⁴⁶ By contrast, the main driver of HIV in the northeast is injecting drug use, and responses there have been lacking. As in many parts of Asia, men who have sex with men have also been neglected.

Neighbouring China has a much lower HIV prevalence than India, but some parts of the country are much worse affected than others. In central China, tens of thousands of people became infected during the 1990s when they sold their blood to commercial agencies. Authorities eventually reacted by enforcing tighter regulations, and the blood donation system causes far fewer new infections than before. In 2005, around 94.5% of blood came from volunteer donors, compared to just 22% in 1998. Today, most HIV transmission takes place during drug use or unprotected sex.⁴⁷

China has traditionally taken a zero tolerance approach to drugs; the police are used to arresting drug users and sending them to compulsory rehabilitation centres. Recently, however, that attitude has started to change, and schemes providing methadone treatment and clean needles have been set up in several provinces. Some regions have also altered their approach to sex workers by introducing a 100 per cent condom use programme, peer education and treatment for sexually transmitted infections.⁴⁸ On a national scale, the government has introduced routine HIV testing of people thought to be at high risk of infection, including drug users, sex workers, former blood donors and patients at sexual health clinics. This has led to many more people being diagnosed, though some experts have voiced concern that some people may be pressured not to refuse testing.⁴⁹ Overall, China’s response to HIV is improving, but coverage is still too patchy to have a substantial impact.