High HIV vulnerability of ethnic minorities after a trans-Asian highway construction in remote northern Laos

From 2004 to 2008 a new Asian highway was constructed through remote multiethnic areas of north Laos linking a low with higher HIV prevalence areas in bordering Thailand and China. We assessed the HIV vulnerability in four minority villages alongside the new road in Luang Namtha Province using structured interviews and voluntary counselling and testing (VCT) for HIV. Of 470 villagers aged 15-49 years old, 47.0% did not know any ways of HIV transmission yet 82.1% reported sexual contacts. Median age at first sex was 17.5 years. Sex of never-married 15-24 years old was associated with higher age (P = 0.002) and ethnicity (P = 0.013; Hmong odds ratio [OR] 7.27); 61.9% (86/139) used no condom at last non-cohabitant sex, especially women (OR 17.7, P < 0.001) and older villagers (P = 0.001). No HIV-infection was detected among villagers who received VCT in 2006 (924 of 933) and 2008 (538 of 1249). Nonetheless our findings reveal an alarming vulnerability for HIV among ethnic minorities alongside the new highway, and further culturally adapted prevention efforts are warranted.