InterPress News Service (IPS); Wednesday, 29 October 1997.
Isagani de Castro

Last July, in Goa, India, the state government justified the eviction of commercial sex workers from a red light area as a move to curb the spread of AIDS.

Sahara House, a drug rehabilitation centre in New Delhi is overcrowded due to discriminatory practices in clinics and hospitals which refuse to admit drug patients.

In Cambodia, brothels were ordered closed in a bid to stop the spread of AIDS but it had the opposite effect. New brothels sprang in places less accessible to healthcare systems and AIDS volunteer workers, putting people at greater risk.

In December 1995, Malaysia's Minister for Islamic Affairs announced that from January 1997, all Muslim couples intending to marry would have to undergo HIV testing to protect future generations.

These measures are among the responses which have proved ineffective in curbing the spread of the pandemic in the region. They also highlight the fact that governments don't always have the rights responses.

What is needed is decentralisation, strong partnerships between governments and civil society organisations and consultations with HIV/AIDS victims, say participants to a UNDP-sponsored symposium on 'Governance and HIV' at the 4th International Congress on AIDS in Asia and the Pacific.

"Many governments remain, in terms of their policies, unresponsive to the problem of AIDS. Now that has to change if we are going to have an effective response," Desmond Cohen, director of the United Nations Development Programme (UNDP) HIV & Development, told IPS.

"An effective response against HIV/AIDS depends upon building the effective structures of governance, consulting closely the communities affected and at risk, involving people living with HIV/AIDS and their carers, promoting the empowerment of women, combatting poverty and fighting ignorance," said Michael Kirby, a former member of the World Health Organization Global Commission on AIDS.

He said an urgent and effective response is necessary since the region is expected to have the largest cumulative number of people with HIV infection by yer 2010. Around seven of total AIDS cases worldwide are already in Asia and there is a "particularly rapid spread of HIV in Thailand, India, Cambodia, and Myanmar."

In 1996, one million of the 2.7 million estimated new HIV infections in the world were in southeast Asia.

Cohen said that in many countries in the region, "there is an absence of good governance, of the principles that you hoped would be present in governments which is a true partnership between government and civil society and between the government and the private sector".

Two case studies sponsored by the UNDP Regional Project on HIV and Development outlined some basic elements for an effective response.

In upper northern Thailand, which accounted for 40 percent of total reported HIV/AIDS cases in the country, a policy of decentralization of funds, consultation of NGOs and HIV victims, and less red tape were adopted in the mid-1990s.

In 1994, Thai authorities set up the Upper Northern HIV/AIDS Prevention Committee with 32 members from government and NGOs. The committee strengthened the monitoring systems, coordinated with all sectors involved with HIV/AIDS, promoted AIDS education, reduced discrimination against victims, developed a support network to people living with HIV/AIDS.

A year later, 1.7 million dollars was directly allocated to the program and was used solely by the Upper Northern HIV/AIDS Prevention Committee which then allocated the money to all communities in the region.

"That was the first time in the history of the Thai budgetary system that a budget was provided for a programme not belonging to any ministry of the government," said Dr. Wiwat Rojanapithayakorn of the Thai Ministry of Public Health.

He said previous funds from the government were "inadequate, restricted to government agencies, and delivered in a context of maximum bureaucratic procedures and minimal flexibility". There was also little consultation with local communities, NGOs, and AIDS victims.

As shown in the upper northern Thai case, Cohen said, an effective response requires that "government begin to share authority and power with other civil society organizations because governments would otherwise be overwhelmed by the problems and would not be able to cope with the consequences when large numbers of people become sick and dying from AIDS".

It is unfortunate, he added, that Thai authorities did not act early. The HIV problem has worsened and there are now an estimated 850,000 HIV infections. "The Thai experience tells us that the best time for an effective prevention is when HIV rates are still low. If you wait until problems get worse, it could be too late."

In a case study involving Olongapo City, a former red light district outside the former US military facility, Subic Naval Base, it was found that an effective response to the fight against AIDS required the support of the local government, particularly, the city mayor of Olongapo.

In the early 1990s, Olongapo City faced an emergency situation when it was found to have 58 reported HIV cases, the most number in the Philippines.

The city established a multi-sectoral group comprising people from government, the academe, media, church, community, and sectoral groups.

Despite political differences over the presence of US military bases, the local officials who were pro-US bases and civil society organizations which were anti-US bases, were able to work together on the AIDS issue.

"The spirit of teamwork, trust, and friendship among key leaders and stakeholders...played a great role in the success of the [government-NGO] interface," said Dr. Fernando Aldaba, executive director of the Ateneo Center for Social Policy and Public Affairs.

"The parties to the interface also had respect for differences in opinion and were able to transcend politics for the sake of public interest."

Olongapo City managed to implement a major information campaign utilizing a community-based approach, reaching women, gays, the youth, seamen, drivers, rest, schools, media, NGOs.

As a result, there was increased use of condoms in the city among these sectors. A care and support program for people living with HIV/AIDS was also implemented and anti-discriminatory practices against victims were promoted.

"Through a successful interface, a more appropriate response to HIV/AIDS epidemic is implemented," Aldaba said. "This type of response maximizes the availability of human and financial resources, thereby increasing efficiency. Because the response is multi-sectoral, it also has the ability to raise additional resources if needed. The end result is the provision of better services and programmes."

Suzana Murni of the Asia Pacific Network of People Living with HIV and AIDS said an effective response must include HIV/AIDS victims. Otherwise, the response will have poor results.

She said governments must create a safe environment for victims to work and help in prevention programmes. In many cases, she said victims suffer from discrimination. For instance, commercial sex workers are often excluded due to society's attitudes of "stigma, shame, and blame".

"In countries with good governance, people with AIDS are treated as friends," Murni said. (END/IPS/AP-HE/IDC/RAL/97)

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