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Looming threat of "catching up" on HIV prevalence

Kinoy Phongdeth, 34, was infected with HIV after working as a singer in a Bangkok nightclub between 1990 and 2000. He was among the first people in Laos to receive antiretroviral therapy and now heads the Lao Network of people living with HIV/AIDS
Natalie Bailey/IRIN

Kinoy Phongdeth, 34, was one of the first four people given antiretrovirals (ARVs) when the medication initially arrived in Laos in 2003. Now, there are 1,600 people on treatment and the number is expected to jump to 7,000 by 2015, according to the government.



Out of a total population of 6.3 million, the national prevalence of 0.2 percent among 15-49-year-olds puts the 8,500 reported HIV/AIDS cases in Laos nearly a decade behind that of its neighbours.



As reported by governments, Thailand's HIV prevalence is at 1.3 percent, or more than half a million people living with HIV; Cambodia's is estimated at 0.6 percent, translating to nearly 70,000 people living with HIV.



"The goal is to stay 10 years behind in the AIDS epidemic," said Chansy Phimphachanh, director of the Centre for HIV/AIDS/STI (sexually transmitted infections) in the Ministry of Health.



According to the Laotian government's National Strategic and Action Plan on HIV/AIDS/STI Control and Prevention for 2011 to 2015, overall HIV prevalence among sex workers is an estimated 0.43 percent; among their clients, mainly electricity workers, it is 0.8 percent.



Border breakdown



But as the socialist country increasingly opens its borders, health workers are bracing for a potential concentrated, "catastrophic" outbreak in a country where HIV prevention is not yet a priority.



"What was protecting the country is not there any more," said Pascal Stenier, country coordinator for UNAIDS, referring to Laos' previously closed borders and economy, which is now increasingly global and growing by about 8 percent annually, according to the World Bank.



Among men who have sex with men and sex workers in concentrated areas like Vientiane, the reported prevalence is above 5 percent. "The figures are small now, which is why it is worth investing in prevention. If we don't, we will have an increase," Stenier said.



The concern is an emerging epidemic among these at-risk populations.



Nationwide, there are at least 11,000 high-frequency sex workers, 50,000 men who have sex with men and 40,000 amphetamine-type stimulant users, including 1,600 injecting drug users, according to the government.



Hot spots are not only in the capital, Vientiane, but also in remote areas, such as across the border from Vietnam, with a reported 45 percent prevalence of HIV/AIDS among drug users. Reaching these populations is not only essential, but also expensive, said Stenier.



Programme financing



But the global recession has left health workers wondering what will happen to the country's US$43 million Global Fund HIV/AIDS grant, $24 million of which has been disbursed since 2003 to the government.



The HIV grant in Laos is up for review in June 2012, according to the Global Fund.



Because of donor cuts, the fund will finance only essential services for ongoing programmes that end before 2014, after which eligible countries can apply for continued support.



Other countries may have more bleak figures than Laos, but this is exactly why Laos should be a funding priority, said Katharine Bagshaw, an HIV officer with UNAIDS.



"This is an opportunity to prevent the same thing from happening in yet another country. We know what can happen," she said.



Regardless of the relatively low prevalence, the impact is as real as any other sizeable epidemic, said Phongdeth.



Now the director of the Lao Network of People Living with HIV/AIDS, Phongdeth was part of what is referred to as the first wave of infections in Laos, resulting from migrant workers returning home.



He said he contracted the virus after working in a Bangkok nightclub for 10 years as a singer and sex worker.



"It is true that in Laos there are not so many people living with HIV and AIDS, but we are still people and we need help," he said.



nb/pt/mw


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