Health risks stemming from betel-quid (BQ) chewing are frequently overlooked by people. Updated epidemiological data on the increased BQ use among Asian populations using comparable data collection methods have not been widely available. To investigate the prevalence, patterns of practice and associated types of oral preneoplastic disorders, an intercountry Asian Betelquid Consortium study (the ABC study) was conducted for Taiwan, Mainland China, Malaysia, Indonesia, Nepal and Sri Lanka. A random sample of 8,922 subjects was recruited, and the data were analyzed using survey-data modules adjusted for the complex survey design. Chewing rates among men (10.7-43.6%) were significantly higher than women (1.8-34.9%) in Taiwan, Mainland China, Nepal and Sri Lanka, while women's rates (29.5-46.8%) were higher than that for men (9.8-12.0%) in Malaysia and Indonesia. An emerging, higher proportion of new-users were identified for Hunan in Mainland China (11.1-24.7%), where Hunan chewers have the unique practice of using the dried husk of areca fruit rather than the solid nut universally used by others. Men in the Eastern and South Asian study communities were deemed likely to combine chewing with smoking and drinking (5.6-13.6%). Indonesian women who chewed BQ exhibited the highest prevalence of oral lichen planus, oral submucous fibrosis and oral leukoplakia (9.1-17.3%). Lower schooling, alcohol drinking and tobacco smoking were identified as being associated with BQ chewing. In conclusion, the ABC study reveals the significant cultural and demographic differences contributing to practice patterns of BQ usage and the great health risks that such practices pose in the Asian region.

Betel quid abuse is high in regions of Asia where it is customarily practiced, and such abuse correlates highly with OPDs. By recognizing abuse-associated factors, health policies and preventive frameworks can be effectively constructed to combat these oral preneoplasms.

Prisons are considered high-risk environments for HIV transmission. This study aimed to measure HIV and syphilis prevalence and risk behaviors among inmates in Indonesia. An integrated HIV and syphilis biological and behavior survey was conducted on random samples of 900 male and 402 female inmates in 2010. Male inmates from 18 general prisons and detention centers were randomly selected using probability proportional to size. Female inmates were randomly selected from nine eligible institutions. HIV tests included two rapid tests and enzyme-linked immunosorbent assay (ELISA) for quality control. A rapid test was used for syphilis. Audio computer-assisted self-interview was used for collecting risk behavior information. HIV prevalence was 1.1% among male and 6.0% among female inmates. Syphilis prevalence was 5.1% for male and 8.5% for female inmates. A history of injecting drugs was the most important risk factor for HIV infection in male inmates; for females, it was co-infection with syphilis and being sentenced for illicit drug use. Inmates' high-risk activities in prison included tattooing, piercing and inserting genital accessories without sterile equipment, and sex without condoms. The study found high-risk practices by male inmates and high HIV and syphilis prevalence in female inmates. Inmates need harm reduction initiatives.