InterPress News Service (IPS); 2 April 1997.
Johanna Son

These are two bright spots in the health picture of the Asia- Pacific, but the poorer countries in the region like Cambodia, India, Burma and China remain dangerous hotspots for the disease.

"Cambodia now has one of the highest estimated number of people with HIV per capita in Asia and the Pacific," the World Health Organisation said in its latest 'Surveillance Report' on the pandemic this week.

WHO data says Cambodia did not report its first HIV diagnosis until 1991. It has only 10.5 million people, but HIV prevalence among adults aged 15 to 49 is at 1.974 percent or 96,300 people.

But health experts say the tapering off of new HIV infections and AIDS cases elsewhere is a lesson for countries like Cambodia. It shows education and awareness can and do help in prevention.

"What does this mean? It is a clear sign that education and awareness programmes can be effective--and that there should be more of them," said Gilles Poumerol, regional adviser in sexually transmitted diseases and AIDS for the World Health Organisation in the Western Pacific.

But he says the full implications of these declines in HIV infections will not be clear until much later, due to the usual 10- year lag between HIV infection and onset of full-blown AIDS.

"If people in Thailand have changed their sexual behaviour in the last couple of years, we will observe the effects on the number of AIDS cases not before a decade or so," Poumerol said in an interview at WHO's Western Pacific office, based in Manila.

Indeed, many experts take a cautious attitude toward these trends and warn that developing countries continue to need aid and step up health care and prevention. By no means is AIDS on the decline yet, they say.

Some 4.7 million adults in Asia are living with HIV/AIDS, where the pandemic's spread has picked up speed in recent years. More than 90 percent of Asia's HIV-infected adults are in India, Thailand, Burma and Cambodia, and the main modes of transmission are heterosexual contact and intravenous drug use.

Various groups of researchers report a dropping off in HIV infections in Thailand after peaking in 1994 and 1995. WHO estimates that the prevalence of HIV among Thais aged 15 to 49 is 2.343 percent or 800,000 persons.

In the case of Thailand, epidemiologists at Johns Hopkins University in the United States say they have tracked a decrease in prevalence of HIV infections among young Thai men from 10.4 - 12.5 percent in 1991 and 1993, down to 6.7 percent in 1995.

The results of this study, published in the 'New England Journal of Medicine', show that the fall in HIV prevalence came after "substantial changes in high-risk sexual behaviour".

These include more than 90 percent condom use by these young men in commercial sex--a figure that rose from 50 percent usage in 1991--and decreases in the use of commercial sex services.

Poumerol says data shows a fall in new HIV infections among Thai military recruits in northern Thailand "which proves that young people have changed sexual behaviour".

Australia and New Zealand, whose first reported AIDS cases were in the mid-1980s, have been able to start controling the epidemic after an aggressive campaign in the homosexual community seriously hit by the disease.

Reported HIV infections have been falling in Australia since 1987, WHO figures show. After hitting a high in 1994, AIDS cases also began falling in 1995. In the past five years, reported HIV and AIDS cases have been decreasing in New Zealand.

Thailand is among the most well-documented countries in the world in terms of the AIDS epidemic. Experts say there are lessons to learn from its experience, especially since it was among the earliest in Asia to see AIDS cases.

Recently, a Thai health official described his country's AIDS history as going from 'no problem' when the first AIDS cases were reported around 1984 and 1985, to a 'health problem'. Later, officials began viewing it as a 'social and development problem'.

In 1991, Thailand launched an aggressive campaign toward 100 percent condom use among commercial sex establishments, education about AIDS in schools and workplaces.

But even if new infections among some groups are falling, it could well be rising among others. AIDS is no longer confined to high-risk groups like homosexuals, drug users or sex workers and is spreading among the general populace, women included.

Experts say Thailand is seeing the start of a decline in new HIV infections partly because the HIV/AIDS epidemic swept through it earlier than other countries. For most of the Asia-Pacific, the AIDS pandemic is fairly young compared to other parts of the world.

WHO identifies four main patterns of the HIV/AIDS epidemic in the Asia-Pacific. Transmission mode is mainly heterosexual in Cambodia, Thailand, India and Papua New Guinea. In Malaysia, China (especially the southern regions) and Vietnam, intravenous drug use is a leading method of the spread of HIV/AIDS.

Several countries, including Japan, Korea, Hong Kong and Philippines have HIV and AIDS cases but do not show signs of hosting explosive epidemics, Poumerol said.

But there are worrying statistics for other countries. Cambodia's HIV prevalence rate is exceeded only by Thailand's 2.343 percent and Burma's 1.596 percent. These three countries are followed by Malaysia, where HIV prevalence is estimated at .530 percent and India, with .514 percent.

India's prevalence rate is not as high, but its huge population means that figure already involves 2.5 million HIV- infected people.

Recent studies show that despite awareness of AIDS in Cambodia, where the anti-AIDS battle is complicated by lack of resources and a thriving commercial sex industry, few really understand it or change their risky behaviour.

A study released in February by the U.S. Agency for International Development and the Cambodian Red Cross said that while many men go to prostitutes, only 15 percent use condoms regularly. Only 3 percent use condoms with their wives. Nearly half of sex workers surveyed in Phnom Penh were HIV positive.

In Yunnan province in China, the prevalence of HIV among injecting drug users has reportedly exceeded 50 percent. HIV prevalence among drug users in Vietnam and Malaysia are in the 15 to 20 percent range, WHO reports.

The number of AIDS cases usually peaks some 10 to 15 years after the first HIV cases are detected, Poumerol says. That means the disease also will peak later in countries that more recently diagnosed its HIV infections.

"Since the earliest cases in many Asia-Pacific countries emerged in the early nineties the epidemic will peak in those places around the year 2000," he added. (END/IPS/AP-HE/JS/KD/97)

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