HEALTH, HEALTH CARE AND DISEASES IN LAOS

HEALTH IN LAOS

Life expectancy at birth: total population: 63.14 years, country comparison to the world: 182; male: 61.2 years; female: 65.17 years (2013 est.). In the 1980s, the life expectancy in Laos was only 53 years. "Life expectancy" is an abstract and complicated concept a complex formula that attempts to predict the lifespan of children born today by subjecting a hypothetical child born today to the current risk of dying in each bracket he or she mature through until, in effect, the accumulated risk of death is 100 percent.

Infant mortality rate: total: 56.13 deaths/1,000 live births, country comparison to the world: 34; male: 61.91 deaths/1,000 live births; female: 50.11 deaths/1,000 live births (2013 est.). Maternal mortality rate: 470 deaths/100,000 live births (2010), country comparison to the world: 20. [Source: CIA World Factbook]

Maternal mortality rates are dramatically high in rural and remote areas where women tend to deliver at home and benefit from neither pre nor post natal care. A little more than half of the population has access to a water supply and safe clean drinking water, and less than half has access to improved sanitation facilities.

Illness among many people in Laos has traditionally been explained by imbalances in the body’s spirt, spirit possession and things as simple as the weather. However, Western notions of germs and disease are widely understood. People use medicines and antibiotics when they can get them but often rely on traditional herbal medicines and spirit cures when they can’t get them. In rural Laos, villagers rely on traditional herbal medicines such as a special tree bark that supposed to guarantee long life when ground and boiled with rice. The writer Dervla Murphy objects to the haphazard introduction of Western medicines because they “can quickly undermine respect for what is accessible and affordable.”

Lao PDR Lao PDR has been undergoing momentous social and economic transformations since the introduction of market - based economic reforms in 1986. These changes have significantly improved the nation’s health status and health development. A land - locked country, Lao PDR shares b order with Cambodia, Vietnam, China, Myanmar and Thailand. Such geographic proximity generates significant connection and influence between these countries on health matters, including cross - border disease transmission and movement of people to obtain treatment in a neighboring country. Despite its status as a low - income country, with 25.6 percent of its ca. 6.2 million people living below the poverty line, Lao PDR has made significant progress in socio - economic development that has increased life expectancy and decreased infant mortality. Nonetheless, the health status remains one of the lowest in the WHO Western Pacific Region. The relatively poor health infrastructure and inaccessible terrain in the poorest parts of the country pose significant challenges to effective health services delivery. The National Growth and Poverty Eradication Strategy adopted by the Lao Government in 2003, focuses on achieving a goal of “liberating the country from the status of a least - dev eloped country” by 2020. The fundamental objective of the government’s health strategy is equality in access to health care thus contributing to poverty reduction. [Source: World Health Organization (WHO)]

Malnutrition in Laos

Children under the age of 5 years underweight: 31.6 percent (2006), country comparison to the world: 13. [Source: CIA World Factbook]

In the 1990s it was estimated that malnutrition stunted the growth of nearly half of Laos's children. Many children in rural villages are chronically undernourished. Acute or chronic diarrhea is life-threatening because it results in dehydration and can precipitate severe malnutrition.

Despite steady economic growth over the last 15 years, Lao PDR continues to have very high chronic malnutrition rates: nearly every second child under the age of 5 in Lao PDR is chronically malnourished and every fifth rural child is severely stunted. These rates are even higher in remote areas and among some ethnic groups. [Source: World Food Program <^>]

Natural disasters such as floods, droughts and pests are common and can lead to acute undernutrition since the infrastructure is weak and overall coping strategies are limited. In addition, micronutrient deficiencies affect large parts of the population, with over 40 percent of children under 5 and 63 percent of children under 2 suffering from anemia, and almost 45 percent of children under 5 and 23 percent of women between 12 and 49 years of age affected by sub-clinical vitamin A deficiency. <^>

Health and Development in Laos

Health systems development. Despite the market - oriented economic gr owth that takes place in the country, the Ministry of Health remains virtually the only provider of health and is strongly administrative. A few ( government al) mass organizations and a range of international non - governmental organizations play an increasingly important role in the health sector. Utilization of many rural health facilities remains low. The shortage and unequal distribution as well as the poor quality and motivation of many staff in the health sector remain critical issues. [Source: World Health Organization (WHO) ~~]

The health sector is governed by several policies and four laws including the Law on Health Care of 2005. Priority areas in the current national health strategy include primary health care, maternal child health, health systems development, and aid effectiveness and coordin ation. Communicable disease remains the most significant cause of morbidity and mortality in Lao PDR. Lack of proper sanitation and water supply, malnutrition, poor health awareness and lack of good hygiene habits, all in the context of inadequate access t o quality health care, promote the spread of communicable diseases in Lao PDR. Non - communicable disease and disabilities are on the increase in Lao PDR and pose a major challenge to an already overstretched health system. ~~

Tobacco and alcohol - related illnesses, illicit drug use and related crimes and road traffic - related injuries reflect the changing lifestyles of the people of Laos. Lao PDR needs to further strengthen its public health surveillance and response system and capacity and be prepared for early detection and rapid response to any kind of emerging disease , including cross - border transmissions and other public health events. Neglected tropical diseases , namely soil - transmitted helminthiasis, food - borne trematode infection, schistosomiasis and lypha tic filariasis are important public health problems. Lao PDR is a low HIV prevalence country with increasing risk related to injecting drugs. ~~

There is also a need to increase awareness of safer sex practices. The incidence of tuberculosis is still high wit h majority of them are pulmonary smear positive. Surveillance must be intensified. Lao PDR has successfully controlled the serious burden of malaria with 90 percent of its target population – at - risk are protected and the epidemic now is contained mainly in remote, hilly and forested areas of the country . Despite major progress has been made, Lao PDR’s maternal and child health status is still a pressing issue, with high maternal mortality ratio and relatively high child and infant mortality rates. ~~

Health and Health Care in Laos the 1990s

Health and health care in Laos were poor in the early 1990s. Although diets are not grossly inadequate, chronic moderate vitamin and protein deficiencies are common, particularly among upland ethnic groups. Poor sanitation and the prevalence of several tropical diseases further eroded the health of the population. Western medical care is available in few locations, and the quality and experience of practitioners are, for the most part, marginal, a situation that has not improved much since the 1950s. [Source: Library of Congress, 1994 *]

The life expectancy at birth for men and women in Laos was estimated in 1988 at forty-nine years, the same as in Cambodia but at least ten years lower than in any other Southeast Asian nation. High child and infant mortality rates strongly affected this figure, with the Ministry of Public Health estimating the infant mortality rate at 109 per 1,000 and the under-five mortality rate at 170 per 1,000 in 1988. The United Nations Children's Fund (UNICEF) believed these figures underestimated the true mortality rate but still represented decreases from comparable rates in 1960. Regional differences were great. Whereas the infant mortality rate for Vientiane was about 50 per 1,000, in some remote rural areas it was estimated to be as high as 350 per 1,000 live births; that is, 35 percent of all children died before the age of one. *

Children's deaths are primarily due to communicable diseases, with malaria, acute respiratory infections, and diarrhea the main causes of mortality as well as morbidity. Vaccination against childhood diseases was expanding, but in 1989 Vientiane's municipal authorities still were unable to vaccinate more than 50 percent of targeted children. Other provinces have much lower rates of immunization. Malaria is widespread among both adults and children, with the parasite Plasmodium falciparum involved in 80 to 90 percent of the cases. *

Although nutrition appears to be marginal in the general population, health surveys are of varying quality. Some data indicate that stunting--low height for age--in the under-five population ranged from 2 to 35 percent, while wasting--low weight for height--probably does not exceed 10 percent of the under-five population. These figures reflect village diets based predominantly on rice, with vegetables as a common accompaniment and animal protein--fish, chicken, and wild foods--eaten irregularly. Children aged six months to two years--the weaning period--are particularly susceptible to undernutrition. The nutritional status of adults is related closely to what is being grown on the family farm, as well as to dietary habits. For example, fresh vegetables and fruits are not highly valued and therefore are not consumed in adequate amounts. As a result, it is likely that vitamin A, iron, and calcium deficiencies are common in all parts of the country. *

Health Care in Laos

Most villages lack a clinic or other formal government-provided health services. A little over 75 percent of the whole population of Laos has access to primary health care (urban 98 percent, rural 71 percent). The country’s geography plays a significant role in defining access to health facilities. In rural areas, in particular, people are forced to walk long distances to seek medical help and health care services.

Health expenditures: 4.5 percent of GDP (2010). country comparison to the world: 155. Physicians density: 0.27 physicians/1,000 population (2005). Hospital bed density: 0.7 beds/1,000 population (2010) [Source: CIA World Factbook]

Western medical care is seldom available outside provincial or a few district centers and even then is very limited. Child and infant mortality is high, and life expectancy is the lowest in Southeast Asia; the population, however, is increasing at a rapid rate. Since the end of World War II significant differences in education, health, and demographic conditions have prevailed among the ethnic groups and between rural and urban populations. [Source: Library of Congress, 1994 *]

Despite government promises that the urban-oriented health system inherited from the RLG would be expanded to support rural primary health care and preventative programs, little money had been allocated to the health sector as of 1993. According to figures from 1988, less than 5 percent of the total government budget was targeted for health, with the result that the Ministry of Public Health was unable to establish a management and planning system to facilitate the changes envisioned. UNICEF considered the effort to construct a primary health care system to have failed entirely. *

Official statistics identified hospitals in fifteen of the sixteen provinces, plus several in Vientiane, and clinics in 110 districts and more than 1,000 tasseng (subdistricts). In reality, most subdistrict clinics are unstaffed, unequipped, and unsupplied, and in 1989 only twenty of the district clinics actually provided services. The physical condition of the facilities is poor, with clean water and latrines unavailable at most health posts, and electricity unavailable at 85 percent of district clinics, rendering vaccine storage impossible. Drugs and equipment stored in the central warehouses are seldom distributed to outlying provinces, and in most situations, patients had to purchase Western pharmaceuticals from private pharmacies that imported stock from Thailand or Vietnam. *

Health Care Workers and Doctors in Laos

The number of health care personnel has been increasing since 1975, and in 1990 the ministry reported 1,095 physicians, 3,313 medical assistants, and 8,143 nurses. Most personnel are concentrated in the Vientiane area, where the population per physician ratio (1,400 to one) is more than ten times higher than in the provinces. In 1989 the national ratio was 2.6 physicians per 10,000 persons. [Source: Library of Congress, 1994 *]

Training medical personnel at all levels emphasizes theory at the expense of practical skills and relies on curricula similar to those used prior to 1975. International foreign aid donors supported plans for a school of public health, and texts were written and published in Lao. As of 1990, however, the school did not exist, because of delays in approval of its structure and difficulties in finding trainers with the appropriate background. *

Rural and provincial health personnel work under conditions similar to their counterparts in education: salaries are low and seldom paid on time, necessary equipment and supplies are unavailable, and superiors offer little supervision or encouragement. In these circumstances, morale is low, job attendance sporadic, and most health care ineffectual. In general, the population has little confidence in the health care sector, although some village medics and a few district or provincial hospitals are respected by their communities. *

Use of traditional medical practitioners remains important in urban as well as rural locations. Healers who know how to use medicinal plants are often consulted for common illnesses. The Institute of Traditional Medicine of the Ministry of Public Health formulated and marketed a number of preparations from medicinal plants. Spirit healers are also important for many groups, in some cases using medicinal plants but often relying on rituals to identify a disease and effect a cure. Many Laotians found no contradiction in consulting both spirit curers and Western-trained medical personnel. *

In the absence of a widespread system of health workers, local shops selling drugs became an important source of medicines and offered advice on prescriptions. However, these pharmacies are unregulated and their owners unlicensed. As a consequence, misprescription is common, both of inappropriate drugs and incorrect dosages. In rural areas, vendors commonly make up small packets of drugs--typically including an antibiotic, several vitamins, and a fever suppressant--and sell them as single-dose cures for a variety of ailments. *

WHO Goals and Challenges for Improving Health and Development in Laos

The Lao Government, in collaboration with its development partners, has formulated and made significant efforts to draft, approve and implement a number of strategies in order to address key issues of health development in the country. Government's expenditure on health stays very low. The relatively poor service quality and access barriers in the poorest parts of the country pose challenges to effective health services delivery. Consequently the utilization of public health facilities remains low. Coverage by current social health protection schemes low. Equal access to quality health care, particularly by the poor and vulnerable groups, will remain difficult if not unachievable under present conditions due to high out - of - pocket spending. [Source: World Health Organization (WHO) ~~]

Current investment to address the future burden of non - communicable diseases, injuries and mental health is still minimal. Groups involved in health development in Laos include the WHO, the Asian Development Bank, Australia, European Commission, Franc e, Japan , Luxemburg, UNAIDS, UNDP, UNEP, UNFPA, UNICEF, UNIDO, US Centers for Disease Control and Prevention, USAID and the World Bank. Key areas for cooperation include health sector development, emerging and infectious disease surveillance and response, HIV/AIDS, tuberculosis, malaria, maternal and reproductive health, immunizations and vaccines, child and adolescent health, non - communicable diseases, injury prevention, mental health , and environmental health. ~~

Lao PDR still relies heavily on international aid/ International collaboration is necessary to prevent and control infectious diseases, strengthen PHC service delivery and other health system building blocks, address environmental health issues, and regulate food product and drug safety. ~~

WHO Strategic Agenda (2012 - 2015): 1) Increase access to primary health care and reduce health inequities by strengthening the health system and improving aid effectiveness; 2) Improve the national health policy, strategy and planning processes; 3) Provide technical support to the implementation of the National Health Financing Strategy 2011 – 2015; 4) Advocate for and provide technical support to the implementation of the Health Personnel Development Strategy by 2020 to reach the 2015 targets; 5) Strengthen the implementation of the Health Information System Strategy for 2009 – 2015 and contribute to the achievement of the health related Millennium Development Goals (MDG); 6) Coordinate and provide inputs in contribution to the delivery of integrated MNCH and nutrition services to achieve MDG; 7) Continue to effectively control th e 3 diseases of HIV/AIDS, Tuberculosis and Malaria; 8) Contribute to reducing environmental risks to health with the focus on safe water and sanitation and prevent and control infectious diseases and public health events. ~~

8) Strengthen capacity of key partners, especially government agencies to prevent and control health security risks due to emerging and re - emerging diseases, food safety - related events and other health hazards; 9) Strengthen capacity of key partners, especially government agencies to prevent and control neglected tropical diseases; 10) Strengthen capacity of key partners, especially government agencies for preparedness and response to health security risks fo llowing natural and manmade disasters; 11) Address health risk factors to reduce non - communicable diseases, mental illness and injuries; 12) Advocate for and support the strengthening of non - communicable disease control, especially promotive and preventive services by addressing the modifiable causative factors; 13) Support disability prevention and rehabilitation with focus on road traffic accidents, violence, effects of unexploded bombs, blindness and visual impairment; 14) Scale up the care of mental, neurological and substance use disorders. ~~

Diseases in Laos

Major infectious diseases: degree of risk: very high. Food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever. Vectorborne diseases: dengue fever and malaria. Highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009). [Source: CIA World Factbook]

In the first malaria eradication program between 1956-60, DDT was sprayed over much of the country. Since 1975 the government has steadily increased its activities to eradicate malaria. The Ministry of Public Health operates provincial stations to monitor and combat malaria through diagnosis and treatment. Prevention measures involve chemical prophylaxis to high-risk groups, elimination of mosquito breeding sites, and promotion of individual protection. The campaign has had some success: the ministry reported a decline in the infected population from 26 percent to 15 percent between 1975 and 1990. [Source: Library of Congress, 1994 *]

As of 1993, diarrheal diseases were also common, with regular outbreaks occurring annually at the beginning of the rainy season when drinking water is contaminated by human and animal wastes washing down hillsides. Only a few rural households have pit or water-seal toilets, and people commonly relieve themselves in the brush or forested areas surrounding each village. *

See Dengue Fever factsanddetails.com and Malaria factsanddetails.com

Dengue Ravages Laos in 2012

In September 2012, Radio Free Asia reported: “Dengue fever cases have flooded hospitals in northwestern Laos. The disease is striking Laos and Cambodia in particular at a time when the two countries are contending with seasonal outbreaks of malaria and other infectious tropical illnesses, and as they struggle with weak health care infrastructure systems. Dengue fever is caused by a virus transmitted by mosquitoes and mostly affects younger children. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. The infection occasionally develops potentially lethal complications. [Source: Radio Free Asia, September 20, 2012]

In Laos, cases have more than tripled up to late August this year from the same period last year to 3,758 from 1,173, according to the World Health Organization (WHO). Nine deaths have been reported so far this year. In northwestern Laos, the country’s worst-hit Oudomxay province has seen hospitals flooded with patients as officials bring in dozens of additional beds to cope with the rising demand for treatment. But they say that the buildings are now overcrowded and that many people have been forced to sleep outside in tents. “The hospitals are packed. We set up 30 additional beds and tents outside of the building and along the hallways to accommodate the patients,” said one provincial hospital official, who asked to remain anonymous. “The number of cases keeps increasing.”

According to an official report, the number of patients in Oudomxay province suffering from dengue fever reached 1,124 on Sept. 9. The report said that all provincial and military hospitals had been filled and that the provincial health department has been forced to hire more health workers and volunteers to handle the recent increase in patients. The Oudomxay health official said that resources are strained in the impoverished province and called for assistance to meet the growing needs of health care workers trying to treat patients. “We are asking individuals and private businesses to donate money, water, and other materials to help health workers who are working hard, day and night. They are exhausted,” he said. “The most badly needed supplies are coffee and drinking water. We also ask that the public lend their support by helping to destroy the mosquito population and their habitat.”

Outbreak of Chikungunya Virus in Laos

In May 2013, Xayxana Leukai wrote in the Vientiane Times, “More than 100 people have become ill from the chikungunya virus in Champassak province this year.Director of the province’s Health Department, Dr Khampho Chaleunvong, said this was the first outbreak of the disease in Champassak.About 50 cases were recorded in Pathoumphone district while the rest were in Khong and Mounlapamok districts. “We believe the virus was transmitted from Champassak’s neighbouring province in Cambodia by Aedes mosquitoes as there has also been an outbreak of chikungunya over there,” she said. [Source: Xayxana Leukai, Vientiane Times, May 15, 2013 /+\]

“Dr Khampho said the virus is now under control. However, the public is encouraged to clear out any potential mosquito breeding places once a week, including shallow pools of water and the water that collects in old tyres. Getting rid of the source will not only combat chikungunya, but will also be an effective way of fighting the spread of dengue fever. The most effective means of prevention is through limiting contact with the disease-carrying mosquitoes. Other controls include using the appropriate insect repellents. Wearing long-sleeved shirts and trousers also offers some extra protection. /+\

“The chikungunya virus is transmitted to humans by the virus-carrying Aedes mosquito. There have been recent outbreaks in South-East Asia associated with severe illness. Dr Khampho said the virus causes a sickness with symptoms similar to dengue fever, with an acute fever phase lasting two to five days, followed by a prolonged period of pain that affects the joints and extremities. The incubation period of the chikungunya virus ranges from one to twelve days, but is usually two to three. Its symptoms include a fever registering a temperature of up to 40 degrees, a rash on the body and occasionally the limbs, and joint pain. In some cases, this joint pa in can last for weeks and even years. Other symptoms can include headache, conjunctivitis and partial loss of taste. Typically, the fever will last for a few days and then end abruptly. However, it may be accompanied by an intense headache and insomnia. Dr Khampho said there are no specific treatments for chikungunya, and no vaccine is currently available.” /+\

HIV-AIDS in Laos

Despite being surrounded by countries that have relatively high HIV infection levels (Thailand, China, Vietnam, Cambodia and Myanmar), Laos has a comparatively small HIV problem. There are various reasons for this: the government was quick to acknowledge AIDS when it first emerged in the country, and took action to warn people about it; Laos has not seen the same level of large-scale migration that has occurred in other parts of Asia; there are relatively high rates of condom use among sex workers and their clients; and it’s thought that very few people in the country inject drugs. However in recent years there has been an increase of HIV infection among the most vulnerable groups, especially MSM and migrant workers. [Source: Avert, International AIDS-HIV charity website]

There was no societal violence and no official discrimination against persons with HIV/AIDS, but societal discrimination existed. The government actively promoted tolerance of those with HIV/AIDS, and it conducted public-awareness campaigns to promote understanding toward such persons. [Source: 2010 Human Rights Report: Laos, Bureau of Democracy, Human Rights, and Labor, U.S. State Department, April 8, 2011 ^^]

HIV/AIDS - adult prevalence rate: 0.2 percent (2009 est.), country comparison to the world: 107. HIV/AIDS - people living with HIV/AIDS: 8,500 (2009 est.), country comparison to the world: 106. HIV/AIDS - deaths: fewer than 200 (2009 est.), country comparison to the world: 111. [Source: CIA World Factbook]

It is believed that AIDS spread from Thailand to Laos. The disease was initially most prevalent is Laotian towns along the Thai border that supply sex workers to Thailand. In the 1990s the number of AIDS and HIV cases in Laos was unknown because the government didn’t do any thorough survey or keep very accurate health records.

Permissive attitudes of Laotian men toward sex and prostitution facilitated the transmission of human immunodeficiency virus (HIV) during the 1980s and 1990s, making HIV infection and acquired immune deficiency syndrome (AIDS) a growing concern. In 1992 a focused sample of about 7,600 urban residents identified one AIDS case and fourteen persons who tested HIV positive. No other statistics were available as of mid-1994. [Source: Library of Congress, 1994 *]

The government convened a conference on AIDS in 1992, which noted the potential for a rapid spread of HIV in the population. Participants at the conference agreed that the spread of AIDS in Laos was inevitable, and, in fact, would likely be through young men who migrated to towns and then returned to their villages, as well as through women who entered the sex trades because of economic necessity. The numbers of HIV-positive people could increase to more than 10,000 within the next few years, although these numbers would likely not expand at the same rate as in Thailand--even though Thai men demonstrate similar attitudes toward sex and prostitution--because Laos's national policies forbid open prostitution. Through the early 1990s, Laos avoided widespread prostitution such as that found in neighboring countries, but it is likely to increase, as is the temporary migration of Laotian women to neighboring countries to work in the sex industry. Other possible routes of HIV infection include users of injectable illicit drugs and medical injections using unsanitary syringes. Should AIDS spread significantly in Laos, it will not only have a devastating effect on rural labor and the national economy, but will put impossible stress on the health care system. As the best means of preventing an epidemic, the conference report emphasized education in all sectors of the population through a variety of methods, including the media. *

High HIV Rate Among Gay Men in Laos

Michael Carter wrote in aidsmap.com: “HIV prevalence is significantly higher amongst men who have sex with men in Laos (Lao People’s Democratic Republic) than any other group in the country, according to a study published in the January 28th edition of AIDS. The study was conducted in the capital, Vientiane, and found that 6 percent of men who have sex with men were HIV-positive, and that attempted suicide was associated with HIV infection, a finding that the investigators believe “may point to the mental health needs of men who have sex with men.” [Source: Michael Carter, aidsmap.com, March 11, 2009; Sheridan S et al. HIV prevalence and risk behaviour among men who have sex with men in Vientiane Capital, Lao People’s Democratic Republic, 2007. AIDS 23: 409-14, 2007 |:| ]

“HIV prevalence in Laos is low compared to neighbouring countries such as Cambodia, Thailand and Vietnam. Research has suggested that 0.1 percent of the adult population in Laos are HIV-positive, and that approximately 1 percent of female sex workers are infected with HIV. Investigators were concerned that there were no data on HIV prevalence amongst men who have sex with men in the country. They therefore designed a cross-sectional (or snapshot) study involving men reporting sex with other men recruited from commercial venues in Vientiane in 2007. |:|

“Men attending these venues were approached by trained peer educators and asked to complete a questionnaire. All the men in the study reported oral or anal sex with another man in the previous six months. After completing the questionnaire, the men had oral HIV tests. Participants were instructed how to obtain their test result from a clinic one week later. All the men who returned received counselling and HIV-positive men were referred for confirmatory testing and medical follow-up. A total of 540 men were included in the study. Exclusive sexual attraction to men was reported by 40 percent of participants, 58 percent reported ever having sex with a woman, and 39 percent reported sex with a woman in the previous three months. Sex with more than one male partner in the previous three months was reported by 42 percent of men. |:|

“Anal sex with another man was reported by 84 percent of men and, of these, 42 percent said they were usually the insertive partner and 44 percent reported usually being the receptive partner. Receiving money for sex was reported by 22 percent, and 28 percent said they had paid for sex. Sex with a foreigner was reported by 16 percent of men and 29 percent said that they had been coerced into having sex. Condom use was low. Only 14 percent of men reported using condoms with a regular partner, 24 percent with a casual partner and 50 percent when having sex with a foreigner. |:|

Alcohol had been used by 96 percent of men in the previous three months; 59 percent smoked and 21 percent reported the use of illegal drugs. Attempted suicide was reported by 17 percent of men. A history of symptoms of a sexually transmitted infection was reported by 42 percent of men; 81 percent expressed concern about contracting HIV, but only 6 percent of men had ever had an HIV test. A total of 30 men (6 percent) were HIV-positive, but only four of these men returned for their test result. |:|

The investigators’ first set of statistical analyses found that two factors were associated with a higher risk of testing HIV-positive: suicidal ideation (p = 0.02) and inconsistent condom use when selling sex (p = 0.03). However, in subsequent multivariate analysis, only suicidal ideation remained significant (OR = 2.91, 95 percent CI = 1.26-6.72, p = 0.01). |:|

“HIV prevalence of 5.6 percent is the highest documented HIV prevalence for any group in the country. This elevated HIV prevalence compared with the general population is consistent with data from neighbouring countries,” comment the investigators. A number of factors are noted by the investigators that suggest that the HIV epidemic could accelerate amongst men who have sex with men in Laos. These include the number of reported sexual partners, the number of men reporting anal sex, high levels of drug and alcohol use, frequent buying and selling of sex, large numbers of reported sexually transmitted infections, and low rates of condom use. |:|

Suicidal ideation was the only significant factor associated with HIV infection. The investigators believe that this indicates the mental health needs of men who have sex with men in Laos. They do not believe that prior knowledge of HIV infection could explain this association “as only one HIV-positive person in our study reported having previously tested for HIV”. Recruitment of the men participating in the study from public entertainment venues means that the men may not be representative of the wider population of men who have sex with men in the country, caution the investigators. |:|

Nevertheless, they conclude, “this survey documents an HIV epidemic among men who have sex with men in Vientiane. The risky behaviours exhibited by these men indicate the potential for further transmission within this group. The sexual networking with women suggests that there may be transmission of HIV to the broader community unless action is taken.” |:|

Bird Flu in Laos

In March 2007, the BBC reported: “A 42-year-old woman has become the first person to die from avian influenza in Laos, officials have said. The woman lived in a village near the capital, Vientiane, where the H5N1 virus has been found in poultry. On Thursday, the country confirmed a 15-year-old girl, also from Vientiane province, had been infected with H5N1. She is being treated in Thailand. World Health Organization spokeswoman Dida Connor told the AFP news agency that it was likely that the 42-year-old woman had the virus but that there was no link between the two cases. [Source: BBC, March 4, 2007 \=\]

The woman fell ill after developing severe pneumonia and a high temperature at the end of February. In a statement, the WHO said "the woman's exposure to sick poultry is unclear at this stage and investigations are ongoing." Health officials in Laos said that the woman's family and relatives were being monitored closely but that none had so far shown any signs of infection. \=\

In January 2006, Keith Bradsher wrote in the New York Times, “Khamla Sengdavong, the manager of a state-owned farm here, still remembers his horror and dismay when bird flu suddenly killed a quarter of the farm’s 2,000 chickens in five days in January 2004. “They bled from the nose and the backs of their heads turned purple and then black, and then they died,” he said, gesturing with his hands. But bird flu seems to have disappeared almost as quickly as it appeared in Laos, and Mr. Khamla and others in this impoverished Communist country on China’s southern border have restocked their coops. Not one human case of bird flu was ever confirmed in Laos, and thousands of chickens have been tested in recent months without finding the slightest trace of the disease. [Source: Keith Bradsher, New York Times, January 14, 2006]

Laos Pressed by the West to Fight Bird Flu Despite Low Impact of the Disease

Despite its relatively light impact on Laos, bird flu has consumed a great deal time and attention of Laos’s best doctors and veterinarians in the mid 2000s, including two of Laos’s top disease fighters – Dr. Phengta Vongphrachanh, the country’s foremost epidemiologist; and Dr. Somphanh Chanphengxay, the director of veterinary planning. Keith Bradsher wrote in the New York Times, “Pressed by United Nations agencies, the United States, the European Union and other big donors, top officials at the health and agriculture ministries have set aside previous priorities – deadly scourges like tetanus, rabies, swine fever and poultry cholera – to focus on a disease that could someday set off a global epidemic but poses less of an immediate threat here. [Source: Keith Bradsher, New York Times, January 14, 2006 >>>]

“Laos is one of the world’s poorest countries. With the government able to spend less than $2 per person annually for health care, officials have been reluctant to take on debt. “We try our best to utilize the grants first, and we reserve the loans for emergency response,” Dr. Phengta said. That emergency response has not been needed. Unlike in neighboring Vietnam, Thailand and China, where live poultry is often transported large distances to markets, sometimes on bicycles, most chickens and ducks in sparsely populated Laos are raised in backyards and eaten by their owners. That limits the spread of the disease, Dr. Somphanh said. >>>

“Laotian government officials reported to the W.H.O. within hours in September 2005 the country’s only suspected human case of bird flu so far. A lab in Japan determined it was a false alarm. The quick notification was one of several signs that Laos does not appear to be concealing any bird flu cases, although it may be hard at times even for the government to determine what is happening in the one-third of Laotian villages that lie a day’s walk or more from the nearest road of any sort, said Dr. Dean A. Shuey, the top World Health Organization official in Laos. >>>

“Dr. Shuey of Nebraska says he worries that too much emphasis now on bird flu may create problems for Laos’s health system. “The intense donor meetings, the number of conferences, the travel is taking a lot of time for people who have other things to do,” he said. The United States, Japan and the European Union have donated advanced virus freezers and other high-tech gear to help Laotians gather any viral samples and ship them to labs in rich countries as fast as possible, where they can be analyzed for the possible creation of a vaccine. But with flu vaccine production capacity short in industrialized countries, no one expects Laos, with no vaccine factories, to receive more than a few doses of any vaccine. >>>

“American aid has included hundreds of sets of masks, goggles and full-body suits that would be sweltering in the tropical climate here and that have limited use except for slaughtering sick birds. Dr. Phengta called for general-purpose protective equipment. Health workers in Laos now receive only one gown and one surgical mask each year. >>>

Handicapped and People with Disabilities in Laos

The constitution provides citizens protection against discrimination but does not specify that these protections apply to persons with disabilities. The Ministry of Health has primary responsibility for protecting the rights of persons with disabilities. Because of the large number of disabilities resulting from unexploded ordnance accidents, the ministry works extensively on this issue, especially in coordination with the international NGO COPE. Regulations promulgated by the MLSW and the Lao National Commission for the Disabled protect such persons against discrimination; however, the regulations lack the force of law. The law does not mandate accessibility to buildings or government services for persons with disabilities, but the MLSW has established regulations regarding building access and built some sidewalk ramps in Vientiane. While there was some progress on accessibility, lack of resources for infrastructure slowed the retrofitting of most buildings. There were no reports of discrimination in the workplace. [Source: 2010 Human Rights Report: Laos, Bureau of Democracy, Human Rights, and Labor, U.S. State Department, April 8, 2011 ^^]

The Lao Disabled People's Association operated a care center for children with cerebral palsy; the cost was covered by foreign assistance. The Ministry of Health in conjunction with international NGOs operated the Cooperative Orthotic and Prosthetic Enterprise to supply prosthetic limbs, correct club feet, and provide education to deaf and blind persons.^^

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Laos-Guide-999.com, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.

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© 2008 Jeffrey Hays

Last updated May 2014

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