Lao PDR
HIV/AIDS profile
After nearly 20 years of relative isolation, the landlocked Lao People’s democratic Republic (Lao PDR) is slowly developing into one of the most stable, low-profile economic and political systems in the region. Approximately half of the population of 6 million is ethnic Lao and the other half is made up of several ethnic minority groups. The five largest ethnic minorities - the Hmong, Katang, Khmu, Leu, and Phutai - total almost 2 million. In 2005, the percentage of people living on less than US$ 2 was over 73%. Per Capita Government Expenditure on health was estimated at US$ 22.
The first HIV infection in Lao PDR was identified in 1990 in a returning Lao female who was suspected to be a sex worker. The first AIDS case was reported in 1992 in a person with a history of frequent travel to northern Thailand.
In the 1990s, limited information was available on the spread of HIV/AIDS and sexually transmitted infections (STIs) in Lao PDR. Only in 2001, findings of the first complete HIV sentinel surveillance (2000-2001) showed that 0.9% of female service workers in entertainment sites were HIV-positive. In the capital city of Vientiane, about 1% of the almost 300 service women tested were found to be HIV-positive; in Savannakhet, the same HIV rate was observed among the 300 service women tested at that site. HIV prevalence in Lao PDR was estimated, as of the end of 2003, to be 1700, or 0.1% of the 15-49 year-old population.
Studies have also revealed high levels of sexually transmitted infections, especially Chlamydia, among sex workers. Surveys in 2002 showed high Chlamydia infection prevalence (32 %) in service women. Data from the Lao Red Cross blood transfusion service on the prevalence of syphilis markers among service women showed 3% to be positive (out of 4824 tests) in 1999. Another study involving 108 service women showed a total STI infection rate of 54%, which is higher than reported anywhere else in South-East Asia.
As of December 2004, the cumulative number of reported HIV cases was 1,470 out of 110,968 blood tests in 15 provinces (male 62%, female 38%), of which 835 had progressed to AIDS. A total of 556 AIDS-related deaths had been recorded. This includes 258 new HIV positive cases in 2004. Among 15 provinces where HIV test facilities are available, the largest number of HIV positive cases were found in five provinces e.g. Savannakhet (671), Vientiane Capital (393), Khammouane (111),Champassak (113), and Bokeo (83). Prevalence among service women was found to have increased from 0.9% (2001) to 2% (2004) nationwide.
From 1990 to June 2005, 1636 individuals were found to be HIV-positive, with 946 AIDS cases reported, including 584 deaths. In 2006, the number of HIV-positive people is estimated at almost 4 thousand - more than double the number of two years earlier - with an estimated adult prevalence of 0.1%. The majority of Laotians with HIV is located near the borders with Thailand and China, and in the capital, Vientiane.
Almost all HIV infections reportedly occur through heterosexual contact, and indications are that in Lao PDR women and men are equally at risk. High-risk behaviour is increasing in many subgroups of the population, including an increase in the number of individuals’ sexual partners, low condom use and high rates of STIs among the informal sex workers. Although, Lao PDR is one of the leading producers of illicit opium in the world, current research shows that injecting drug use remains low. However, it is expected to increase as drug users switch from alternative routes of drug administration to injection. At present, intravenous drug use is low in the Lao PDR but the use of Amphetamine Type Stimulants (ATS) is on the rise.
Due to the rapid socio-economic changes in the country, many developments and movement are taking place, such as infrastructure development, tourism and trade. With relatively high HIV prevalence rates in all of Lao PDR’s five neighbouring countries and population mobility increasing both within and across borders, the HIV/AIDS vulnerability of Lao PDR is clear.
As Lao PDR becomes more economically integrated with neighbouring countries, its vulnerability to HIV/AIDS will increase. Several major roads are under development to link the country to Thailand, Viet Nam and Yunnan, Province of China. The construction of these roads will attract many migrant workers and after the construction is completed, the mobility of trucks and workers along these roads will further increase. Along these roads and at other big infrastructure development sites such as airports and bridges, services and entertainment such as hotels, guesthouses, restaurants, night-clubs, and beer shops increase significantly. There is significant concern about the possibility of concentrated epidemics among vulnerable populations, especially those living and working in border areas and along infrastructure development sites.
The population groups considered most likely to engage in behaviours which put them at risk of contracting HIV include mobile groups such as internal and external migrant workers, service workers in entertainment sites, truck drivers, military, police, and others who travel regularly in the course of their work, e.g. government officials and business people. There is increased youth labour migration both internally and externally, which puts young people at higher risk for HIV transmission. A high number of school dropouts with limited access to vocational and higher education or meaningful employment is an important factor in this trend.
Seasonal migration in Lao PDR, especially of its ethnic minorities, to northern Thailand and Bangkok is large and a significant proportion of migrants operate as sex workers. According to cumulative case reports, more than 50 % of HIV positive cases were found among Lao migrant laborers who returned from neighboring countries.
Women are considered to be particularly vulnerable to HIV/AIDS, not least because of their low literacy, education and health status, which often results in a general lack of knowledge about sex, STIs and HIV/AIDS. Less empowerment and skills in negotiation for safe sex with their partners, and less economic advantage often drives them into greater risk behaviour. Culture norms often make it difficult for women and girls to access the information and services required in order to protect themselves for HIV. One group perceived to be vulnerable to HIV are those women whose husbands have multiple sex partners and who visit sex workers.
Efforts of national and international organizations over recent years have resulted in an increase in awareness of HIV/AIDS and sexually transmitted infections among the general population. Behaviour is changing, especially in urban areas, as evidenced by the increase in condom use. With heterosexual intercourse being the primary mode of transmission, sex workers and mobile populations remain the most vulnerable groups. Activities such as peer education, life skills training and other behaviour change activities are already targeting these groups.
National Strategic Framework
In the period 2002-2005, the Government of Lao PDR implemented its first National Strategic and Action Plan on HIV/AIDS/STD with a strong focus on developing a multi-sectoral response. The Strategic Plan was supplemented by the Advocacy Strategy and Action Plan on HIV/AIDS 2003-2005.
Despite significant progress made under the 2002-2005 plan, the following constraints were identified through a review of the National Strategy and Action Plan 2002-2005:
- Most of the prevention, care and treatment programs were pilot initiatives and reached only a small portion of target populations.
- Comprehensive interventions reached only a fraction of the population in need.
- There were no or limited interventions for certain vulnerable groups, such as labour migrants, drug users and men who have sex with men.
- Implementation capacity remained low at all levels.
- Research information was not effectively shared and applied by different partners.
The National Committee for the Control of AIDS Bureau (NCCAB) - under the Ministry of Health - has developed and launched the National Strategic and Action Plan on HIV/AIDS/STI 2006-2010 which will serve as its tool to guide all partners engaged in the national response on HIV/AIDS in the critical years ahead.
Based on epidemiological information and the review of the 2002-2005 plan, the following priorities were defined:
- Reaching full coverage of targeted and comprehensive interventions in prioritized provinces/districts in a phased approach.
- Establishment of an enabling environment for an expanded response at all levels.
- Increased data availability to monitor both the epidemic and the response (strategic information).
- Capacity building of implementing partners at all levels.
- Effective management, coordination, and monitoring of the expanded response.
The information presented in the HIV/AIDS country watch originates from the web site of the Joint United Nations Programme on AIDS (UNAIDS) – www.unaids.org (November 2006).
For more information please visit:
http://www.unlao.org/team/UNAIDS/page.htm
