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The first case of HIV was detected in 1990 and since then, HIV/AIDS has primarily affected sex workers and their clients as well as mobile cross-border populations, albeit at low levels. At present, the majority of Laotians with HIV is located near the borders with Thailand and China, and in the capital, Vientiane. Ninety-six per cent of HIV infections reportedly occur through heterosexual contact, and indications are that in Lao PDR women and men are equally at risk. Studies have revealed high levels of sexually transmitted infections, especially Chlamydia, among 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.

The spread of HIV/AIDS and sexually transmitted infections in Lao PDR is slowly becoming more apparent as research in this field is increasing. Findings of the national second-generation surveillance in 2000-2001 showed that six of 811 (0.9%) female service workers in entertainment sites were HIV-positive. Another study involving 108 female sex workers showed a total STI infection rate of 54%, which is higher than reported anywhere else in South-East Asia.

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.

Approximately half of the population of five million (2003) 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 1.5 million (2003). Lao PDR borders Cambodia, Myanmar, Thailand, Viet Nam, and Yunnan, Province of China, where HIV/AIDS prevalence rates are relatively high. Seasonal migration, especially of its ethnic minorities, to northern Thailand and Bangkok, Thailand, is large and a significant proportion of migrants are sex workers. Hospitality workers, transport workers, traders, construction workers and migrant factory workers are among the most vulnerable groups in Lao PDR.

Burden adult prevalence (age group 15-49) is 0.05% (2002). At present, 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. Lao PDR faces an increasing challenge in addressing HIV/AIDS, especially since health-sector spending as a percentage of GDP is among the lowest in the world due to Lao PDR's limited resources.

As Lao PDR becomes more economically integrated with neighbouring countries, its vulnerability to HIV/AIDS will increase. Two 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. 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.

National Strategic Framework

The national strategic framework for HIV/AIDS has been completed for the period 2002-2005. Priority action focuses specifically on risk behaviours, including condom promotion; prevention and treatment of sexually transmitted infections; life-skills training; and strengthening of institutional arrangements. Development of the framework involved the organization of civil society and people living with HIV/AIDS in a national consultative workshop. The framework calls for a multisectoral integrated approach, involving various ministries and mass organizations, including youth organizations, women's organizations and trade unions.

The implementation plan has been completed and costed. Policies embodied in the plan include non-discrimination; confidentiality; access to care; involvement in decision-making of those infected and affected by HIV; and support for the condom programme. The plan will be implemented nationwide and will include a monitoring and evaluation component that is still in planning.

The Lao PDR Head of State committed to a strong government response to AIDS during the November 2001 ASEAN Summit. Despite this, there is still a relatively low budgetary allocation to the national HIV/AIDS response.