HIV/AIDS Politics and Policy in South Asia
Authors: Rajapaksha Nayani , Abeysena Chrishantha 
Published: January 2021

Human immunodeficiency virus (HIV) is a major global public health issue. In 2019, an estimated 38 million people worldwide were living with HIV. Of these, 2–3 million HIV cases were estimated to be in the South Asia region. In South Asia, India has the largest population (1.366 billion), whereas the Maldives has the smallest (0.54 million) population.

In line with global strategies, most of the countries adapt strategies to end HIV in 2030. The rights-based approach is a guiding principle of HIV policy in most countries. Integrated HIV testing and counseling services are implemented through facility-based and community-based services. The percentage of people who are on Anti-Retroviral Treatment among the diagnosed, is highest (81%) in Nepal. The Maldives and Sri Lanka achieved elimination of mother-to-child transmission of HIV in 2019.

Coverage for preventive programs is low in all the countries. Condom usage is low in all the key population groups in the region except India, Nepal, and Sri Lanka. Sex education is integrated into the school curriculum in Nepal and Sri Lanka. Knowledge of HIV prevention among the young population is low in all the countries. India, Nepal, and Pakistan provide both needle and syringe programs and opioid substitution therapy. A high percentage of people who are injecting drug users (IDUs) have safe injecting practices in all the countries.

The prevalence of HIV is low in all the countries, but concentrated epidemics continue in some countries. A higher prevalence of HIV is reported among IDUs in all the countries except Bhutan. The prevalence of HIV is also higher among transgender people in Nepal and Pakistan. Since 2010, a declining trend in new HIV infections has been observed in Bhutan, India, Nepal, and Sri Lanka, and an increasing trend has been observed in Afghanistan, Bangladesh, and Pakistan.

Some South Asian countries have many punitive laws, while others have introduced legal protection for key populations. Sex work is criminalized in all the countries. In Bhutan, when men who have sex with men and IDUs seek health services, the health worker is obliged to report them to the police. Nepal became the first South Asian country to identify the existence of “sexual and gender minorities” in its constitution. There is a protective legal environment for homosexuality in Nepal. India also has several laws protecting homosexuals, transgender people, and IDUs, and laws against sexual harassment in the workplace. India has become the first South Asian country to implement special protective laws on HIV/AIDS. India has criminalized discrimination against people living with HIV/AIDS.

The presence of stigma and discrimination is a major critical factor for the national approach to HIV prevention in all South Asian countries. Stigma and discrimination are observed in healthcare facilities, within families, in employment, and in educational institutions, and many countries have developed antidiscrimination policies in response.

Throughout the region, poverty, low literacy, outbound migration, tourism, internal displacement, disasters, poor infrastructure of healthcare systems, population size, and social and cultural values have hampered the response to HIV.