Social Determinants of Infectious Diseases in South Asia

Abstract

South Asian countries have developed infectious disease control programs such as routine immunization, vaccination, and the provision of essential drugs which are operating nationwide in cooperation with many local and foreign NGOs. Most South Asian countries have a relatively low prevalence of HIV/AIDS until now, but issues like poverty, food insecurity, illiteracy, poor sanitation, and social stigma around AIDS are widespread and are creating formidable challenges to prevention of further spread of this epidemic. Besides that, resurgence of tuberculosis along with the emergence of the drug resistant (MDR-TB and XDRTB) strains and the coepidemic of TB and HIV are posing ever-growing threats to the underdeveloped healthcare infrastructure. The countries are undergoing an epidemiological transition where the disease burden is gradually shifting to noncommunicable diseases, but the infectious diseases still account for almost half of the total disease burden. Despite this huge burden of infectious diseases in South Asia, which is second only to Africa, there is yet any study on the social determinants of infectious diseases in a local context. This paper examines various issues surrounding the social determinants of infectious diseases in South Asian countries with a special reference to HIV and tuberculosis. And, by doing so, it attempts to provide a framework for formulating more efficient prevention and intervention strategies for the future.

Figure 1

South Asia poverty dynamics. Figure 1 shows the trend of total population and population living below poverty line in South Asia. Though the incidence of poverty is decreasing slowly since 1995, it still remains noticeably high. Source: World Bank poverty database and Global Poverty Statistics.

Figure 2

Incidence of TB per 1000 population. Figure 2 illustrates that incidence of TB is remarkably lower in the developed countries like USA and Japan than in the third world countries like in South Asia. India and Bangladesh have one of the highest incidence rates of TB in the world. Source: World Health Statistics and Global Disease Burden.

Figure 3

Prevalence of HIV among adults aged 15–49. Figure 3 shows that Pakistan had about 130,000 cases of HIV in 2011 which is the highest in the history of the country. Nepal and Sri Lanka have relatively lower incidence of HIV comparing to Pakistan and Bangladesh. Source: adapted from World Health Statistics.

Figure 4

The nexus between the social determinants and the infectious disease. Four main social determinants of the infectious diseases are shown in the red letters.