1. Introduction

South Asia is strategically located between the opium producing regions of Southwest and Southeast Asia. During the past two decades, injecting of opioids has diffused in the South Asian Association for Regional Cooperation (SAARC) countries, particularly, India, Nepal, Pakistan and Bangladesh. The UN Reference group estimates that there are 3.3 million injecting drug users (IDUs) in South and Southeast Asia (Aceijas et al, 2004). Unlike in many other parts of the world where heroin is the preferred opioid for injecting among injecting opioid users, considerable proportions of injectors in India and its neighbouring countries are using pharmaceutical preparations such as buprenorphine, dextropropoxyphene and pentazocine, often cocktailed with diazepam and antihistaminics (chlorpheniramine maleate and promethazine). India is a large manufacturer of pharmaceuticals and though the existing law regulates their production and sale, there is no uniformity in the monitoring of compliance with the law thereby contributing to an increase in the abuse of pharmaceutical drugs (UNODC, 2005).

With every country in the region reporting HIV infection and most among drug users (India, Nepal, Bangladesh, Pakistan, Bhutan), HIV/AIDS among drug using populations is a regional problem. Serological surveillance indicated a rise in HIV prevalence among IDUs in Central Bangladesh with prevalence rising from 1.4% in 1999-2000 to 4 °/o in 2002 and remaining at 4 °/o during 2003-2004 (Azim et al, 2004). Although during 2003-2004 the HIV prevalence has remained at 4°/o, in one particular neighbourhood of Dhaka city, the prevalence was recorded at 8.9°/o (GoB, 2004; Azim et al, 2004a; Azim et al, 2005). An epidemic of HIV coupled with hepatitis C infection among IDUs has been reported from the Himalayan region of eastern India that borders Bhutan, Bangladesh and Nepal (Sarkar et al, 2006). Ever since the first report of HIV infection amongst IDUs in northeast India in 1989, there has been diffusion of HIV among IDUs in different parts of India. In the HIV/AIDS epidemiological surveillance for the year 2005, the national HIV prevalence among IDUs in India is reported to be 10.2°/o; of the fourteen states in which IDU sentinel surveillance is operational, HIV prevalence among IDUs is > 5°/o in nine states (NACO, 2006). Between 1995 and 1997, HIV-1 seroprevalence among IDUs of Kathmandu, Nepal rose from 0% to 40-50% (Oelrichs et al, 2000). Nepal is experiencing a concentrated epidemic, particularly among IDUs and sex workers. Among IDUs in Nepal, HIV prevalence reached 50% in 2002 (UNAIDS, 2006). Sri Lanka is a low HIV-prevalence country and the national prevalence of HIV is estimated to be below 0.1% (UNAIDS, 2006a).

Thus, injecting drug use (opioids and pharmaceuticals) and HIV associated with IDUs has diffused rapidly in the South Asian region. Further, the sexual transmission of HIV from the injecting drug users to their non-injecting sexual partners has been established in Asian settings (Panda et al, 2005). It is important to develop appropriate responses to deal with this emerging problem.

Rapid assessments are used increasingly to assist in the development of public health interventions for drug related problems. Patterns of drug use, injecting and associated consequences vary between areas and social groups within the same country, and can change quickly over time. The responses to problems can also vary within the country and are influenced by social, cultural, economic, religious and political factors. Conventional research has serious limitations in developing responses to the rapidly emerging problems. Rapid assessments in the country/region help to identify resources and opportunities for interventions; identify (or develop) socially, culturally, politically, and economically appropriate interventions; identify factors that impede or enhance the effectiveness of interventions; and develop action plans for interventions.

The United Nations Office on Drugs and Crime Regional Office for South Asia (UNODC ROSA) is implementing a regional project RAS/H13 titled "Prevention of transmission of HIV among drug users in SAARC countries". Through this project a rapid situation and response assessment (RSRA) of HIV related risk behaviours, adverse health consequences and knowledge, attitudes relating to HIV/AIDS amongst drug users and their regular sex partners was carried out in the countries of Bangladesh, Bhutan, India, Nepal and Sri Lanka. The primary purpose of this document is to provide an overview of major findings and recommendations based on the key findings of RSRA.