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HIV transmission in intimate partner relationships in Asia

This report by UNAIDS, its cosponsors and civil society partners examines the issue of married or in long-term relationships women who are at risk of HIV infection due to their partners’ high-risk behaviours. It is estimated that more than 90% of the 1.7 million women living with HIV in Asia became infected from their husbands or partners while in long-term relationships. By 2008, women constituted 35% of all adult HIV infections in Asia, up from 17% in 1990.

The evidence from almost all the countries in Asia indicates that women are acquiring HIV not because of their own sexual behaviours but because of the unsafe behaviours that their partners engage in. The intimate partners of men who have sex with men, injecting drug users or clients of sex workers constitute the largest vulnerable population in Asia.

At least 75 million men regularly buy sex from sex workers in Asia, and a further 20 million men have sex with other men or are injecting drug users. Many of these men are in steady relationships: it is estimated that 50 million women in the region are of risk of acquiring HIV from their partners.

The report notes that men who buy sex constitute the largest infected population group – and most of them are either married or will get married. This puts a significant number of women, often perceived as ‘low-risk’ because they only have sex with their husbands, at risk of HIV infection.

The myriad issues that are at the root of the problem are discussed. The strong patriarchal culture in the countries of Asia, intimate partner violence, including sexual violence, the large-scale migration and mobility of populations in Asia and HIV-related stigma and discrimination all play a role in the vulnerability of women to HIV.

“HIV prevention programmes targeting the female partners of men with high-risk behaviours have yet to be developed in Asia, but are clearly essential,” said Dr Prasada Rao, Director, UNAIDS Regional Support Team Asia and the Pacific.

The report recommends four main strategies that should be implemented in addition to increased services for key populations:

 HIV prevention interventions must be scaled-up for men who have sex with men, injecting drug users, and clients of female sex workers and should emphasize the importance of protecting their regular female partners.  Structural interventions should be initiated to address the needs of vulnerable women and their male sexual partners. This includes expanding reproductive health programmes to include services for male sexual health.  HIV prevention interventions among mobile populations and migrants must be scaled-up and include components to protect intimate partners.  Priority should be given to operations research to develop a better understanding of the dynamics of HIV transmission in intimate partner relationships.

It is hoped that the report will be a wake-up call that highlights the effects of the HIV epidemic on this hitherto most-neglected population. (August 2009)

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