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The HIV/AIDS Epidemics of South AsiaPromotingconstructiveattitudes amonghealthcareproviders andimproving thequality ofcounselling arepublic healthimperatives.and AIDS. However, testing is oftengiven precedence over counselling inmost South Asian countries.Promoting constructive attitudesamong healthcare providers andimproving the quality of counsellingare public health imperatives. A FamilyHealth International (FHI) sponsoredevaluation of counselling initiatives inthe South Asian countries in 2001found that the quality of counselling,including counselling skills, werecause for concern.Community-level initiativesl Outreach initiatives: Outreachprogrammes enable individuals tocirculate HIV-related informationwithin existing social networks.Outreach workers help stimulatebehavioural change in marginalisedgroups such as drug users, sex workersand their sexual partners. Outreachwork is characterised by harmreduction strategies such as providingcondoms to sex workers and does notnecessarily consider the vulnerabilityfactors associated with sex work.Outreach workers in South Asiaface difficulties in working withmarginalised and excludedcommunities given the environmentof stigma and discrimination.l School-based programmes: AIDSeducation has yet to find legitimacy inmany schools in the countries of theregion. Existing programmes providebasic AIDS information in theclassroom, and discussions ofsexuality and peer pressure arelimited. Some educators may sufferinhibitions during such discussionswhile others may consider sucheducation unnecessary and aspolluting young minds. Besides, thevast majority of children vulnerable toHIV/AIDS are outside the formalsystem of education.llCondom promotion and socialmarketing: Several studies fromvarious South Asian countriesidentify lack of access and poorcommunication with sexual partnersas major barriers to condom use. As aresult, most HIV preventionprogrammes include the distributionof free condoms with the aim ofimproving their availability. The poorsustainability and reliability of freecondom distribution programmesprompted the introduction of socialmarketing as a more viablealternative. In an effort to increasetheir social acceptability, condomswere made available at nontraditionaloutlets such as truck stops,bars and hotels. Social marketing hasalso helped promote voluntarycounselling and testing. Bangladeshand India have reported that thesimultaneous empowerment of sexworkers has helped expand the scopeof traditional condom distribution.SHAKTI, a HIV project of CAREBangladesh working with streetbasedfemale sex workers, helpedorganise sex workers into the DurjoyNari Shanga (Undefeatable Women’sCommittee) in 1988. 41 The groupassumed the responsibility ofmarketing condoms to sex workers.Though sales declined during periodsof police harassment, the group wasable to increase the overall sales withina short period. In December 1998, only39 per cent of all vaginal and anal sexualintercourse episodes had entailedcondom use, but the figure rose to 52.4per cent and 65.6 per cent over thesubsequent two years.Blood safety: Unsafe blood and bloodproducts have been major challengesto the containment of HIV sincethe beginning of the epidemic.Governmental efforts to prevent thespread of HIV through this route60Regional Human Development ReportHIV/AIDS and Development in South Asia 2003