In India, the virus was found predominantly among sex workers and injecting drug users in the early years. It then started spreading into segments of society not recognized as being at risk such as wives who were monogamous but whose spouses had contracted the virus from sex workers or other sex partners belonging to the bridge populations. It is argued that what makes married women vulnerable is basically their inability to negotiate safer sex, a problem that is part of the generalized lack of control over their sexual and reproductive decisions, which is also reflected in other indicators of patriarchy, such as high fertility rates.

Shared vulnerabilities, shared realities: In south Asia, vulnerability to HIV is a “shared reality”. Hundreds of refugees and mobile populations in search of livelihood who move within and between Afghanistan, Bangladesh, Nepal, Pakistan, Bhutan and Sri Lanka are exposed to situations that increase their vulnerability to HIV/AIDS.

Unsafe blood transfusions and injections: According to a World Health Organization estimate, more than 50 per cent of blood transfusions in the region were not screened for HIV in 1995. Mandatory HIV screening of blood has yet to establish itself in many countries in the region, despite the enormous volume of blood transfusions. Bangladesh, which transfuses close to 200,000 units of blood each year, does not screen for HIV, according to the provisional report of the Monitoring of AIDS Pandemic Network Symposium, 1997. In Pakistan, an estimated 40 per cent of about 1.5 million annual blood transfusions elude HIV screening. Maldives has the highest incidence in the world of Thalassaemia minor. This hereditary blood disorder requires frequent blood transfusions, rendering the country vulnerable to HIV if blood is not tested for HIV. However, there are examples of positive state action on this issue, such as the improvement in the blood safety programme and quality of blood banking services in India.

Injections are a popular method of medical treatment in south Asia and are often given or demanded even when not necessary. Studies show that Pakistan has a high annual ration of 4.5 injections per capita and used injecting equipment is re-used for 94 per cent of the injections. According to WHO estimates, unsafe injections account for 62 per cent of cases of Hepatitis B, 84 per cent of Hepatitis C, and 3 per cent of new HIV cases.

HIV infection is common among injecting drug users since the sharing of needles rapidly spreads the infection. Injecting drug use followed the introduction of heroin and has expanded significantly in south Asia since the Nineties. It is replacing traditional modes of drug intake such as smoking. The shift from traditional drugs such as opium to life-endangering drugs such as heroin and brown sugar and further to pharmaceutical drugs is linked with the legal, social and economic developments in the last few decades. The fall in the availability and quality of drugs and rise in prices are among the factors that have led to increasing levels of injecting drug use. To date, the most serious co-existence of injecting drug use and HIV-positive people is seen in the states of northeastern India, notably Manipur.

Numerous drug users began using injections as heroin became more available from fields in Afghanistan and trade networks in that country and Pakistan. In eastern India and Bangladesh, drug trade with Myanmar contributed to increases in injecting drug use. There are an estimated 60,000 to 100,000 injecting drug users in Pakistan, 20,000 to 25,000 in Bangladesh 98,000 to 118,000 in India and nearly 300,000 in Iran. In the Maldives, too, rising drug use among youth is a cause for concern...

Injecting drug use does not seem to be a factor in Bhutan and Sri Lanka, and only a minor factor in Bangladesh. Though there is limited evidence about HIV infection among injecting drug users in Bangladesh, the potential certainly exists as needle sharing among injecting drug users is at a very high rate of up to 97 per cent. In central Bangladesh, needle sharing was found to be a routine matter among 93.4 per cent of over 500 injecting drug users. These drug injectors are not insulated from the general population, they are often married and are sometimes commercial sex workers or professional blood sellers.

The notion that young girls are less likely to be infected with HIV than women who are more experienced sexually has increased the recruitment of minor girls into the sex trade. A 1998 International Labour Organization study estimated that there were 30, 000 children who are sexually exploited in Sri Lanka. Male child sex workers — also referred to as “beach boys” because they operate in the coastal resort areas patronized, in particular, by European nationals — figure in travel advertisements.