Health and HIV Situation

In June 2007, the official cumulative number of registered HIV infections reached 2,400 of whom 1,523 were known to be AIDS cases and 775 had died of AIDS. Reportedly, 85% of such infections were transmitted through heterosexual contact. By the end of 2007, an estimated 700 people received ARV, which represents 60% of those in need, compared to 300 in 2005.

While the HIV prevalence rate has remained low in Lao PDR at 0.1%, HIV infections among the most vulnerable groups, including sex workers and their clients, and men who have sex with men (MSM), are on the rise.

In 2004, 2.2% of tested sex workers were HIV positive, compared to 0.9% in 2001. In addition, a recent survey on HIV infections among MSM in Vientiane has shown that 5.6% tested HIV positive and that 43% of them also had a female sex partner in the last three months.

The National Committee for the Control of AIDS of Lao PDR recently reported that more than half of registered people living with HIV/AIDS in Lao PDR were either migrant workers or farmers working outside of the country, especially in Thailand, and their partners.

Lao PDR is surrounded by neighbours with much higher infection rates and has a growing epidemic. Low levels of HIV awareness and limited access to prevention increase HIV vulnerabilities in Lao PDR and among Lao migrants.

National HIV Programme and Response

The National Strategic and Action Plan on HIV/AIDS and STI 2006-2010 developed by the National Committee for the Control of AIDS aims to expand national capacity for universal access to prevention, treatment, care and support. Priority areas include: expanding HIV counseling and testing services and data collection, monitoring, evaluation and surveillance mechanisms; strengthening prevention campaigns; increasing condom use; and building capacity of implementing agencies.

The Plan targets vulnerable groups, including sex workers and their clients, mobile populations, drug users, MSM and young people. Regarding HIV and mobility, the Plan aims to: raise HIV risk awareness among mobile populations and their families; provide pre-departure and post-arrival information and counseling at selected border crossings; promote behaviour change and increase condom use; provide confidential STI services; establish and strengthen voluntary counseling and testing (VCT) and referral services; and build local authorities' capacity to support mobile populations and their families.

The Plan expects that by 2010, 5% of mobile men and their partners will use VCT services, 75% of migrant men will use condoms, and that STI prevalence among mobile men will be reduced by 50%.

Companies sending Lao workers overseas must meet receiving countries' immigration requirements. HIV testing of migrants before departure is carried out with informed consent, counseling and confidentiality. The Ministry of Labour and Social Welfare recently approved a pre-departure orientation regulation that mandates labour export companies to provide HIV/AIDS education for outgoing documented migrant workers.

Overall, national progress in addressing the HIV epidemic has been noted in STI prevention and treatment, communication for behaviour change, peer education, life skills training in school, and community based interventions. In addition, the 100% Condom Use Programme has been expanded and covers 14 provinces. VCT services are available in 17 provinces and 16 districts, and drop-in centres have been established in five provinces with services targeting sex workers and MSM.

However, access to care remains limited and HIV awareness is low. In addition, Lao PDR experiences coordination challenges and lacks comprehensive monitoring and evaluation systems.

Migration Patterns

Lao PDR is both a source and destination country for migrant workers mainly employed in infrastructure projects, domestic and agricultural work, and the fishing industry. Malaysia and Thailand are the primary destination countries for Lao migrant workers.

Lao PDR is also a destination country for migrant workers, especially from Viet Nam and China. In 2006, 5,731 Vietnamese migrant workers worked in Lao PDR, while in 2008 an estimated 300,000 Chinese workers were in the country as well.

The Lao population is vulnerable to trafficking due to high poverty levels and porous borders. Lao PDR is a source country for trafficked men, women and children to Thailand and a destination country for trafficked Vietnamese, Chinese and Burmese women and girls.

HIV Response for Migrant populations: Gaps and Opportunities

The National Strategic and Action Plan on HIV/AIDS and STI 2006-2010 shows commitment to address HIV and mobility issues with provisions on HIV prevention, testing and counseling for mobile populations and their families.

Pre-departure HIV information and linguistically and culturally appropriate prevention programmes for prospective migrants need to be expanded, as do comprehensive HIV prevention, care, treatment, VCT and support services for returning migrants.

To successfully address HIV and mobility issues, it is important to develop a more comprehensive surveillance system including gender based data to target HIV interventions among migrant and mobile populations.