Inter Press Service - October 25, 1999
Johanna Son

In many ways, they are finding out that the economic battle in the larger war against HIV/AIDS is just as difficult as the battle to ease its health effects. Even for the world as a whole, the disease is spreading faster than people can find ways to cope with it.

''HIV/AIDS is spreading three times faster than the funding required to respond to it," says Mechai Viravaidya, a Thai businessman and activist named ambassador on HIV/AIDS issues by the UN Joint Programme on AIDS (UNAIDS) at the Fifth International Congress on AIDS in Asia and the Pacific.

Yet already, Asian countries' health budgets are spread thinly, used for basic health and other problems and hardly able to handle an HIV/AIDS epidemic on top of that.

East Asia's economic crisis had put added strain on health budgets, although WB economist Martha Ainsworth says the direct effects are not all too clear as yet. Still, she says, "HIV/AIDS programmes must be maintained or expanded in times of crises -- not cut".

Mechai adds that the already inadequate priority given by Asian countries to the pandemic was worsened by the East Asian crisis, which forced several governments to cut back on subsidies and treatment.

"Much money was used to prop up the financial sectors so HIV/AIDS has suffered severely," he says.

Likewise, UNAIDS executive director Peter Piot says falling incomes could force families with AIDS patients to spend the money for other needs and drugs for AIDS patients, especially imported ones, could become too expensive.

"Fewer resources could also mean new AIDS patients might be turned away by medical establishments with other priorities," he explains.

At the same time, experts say the HIV virus is becoming resistant to the anti-retroviral drugs that are already inaccessible to people living in developing countries.

"This is becoming a growing problem, so we need new drugs," explains John Mills, an Australian doctor who has studied the virus since the eighties. He cites a case in Melbourne where a person with HIV has been proven to be resistant to all available medication.

Comparing the virus to a "pathogenic stealth bomber" able to get past human defenses, he says that HIV "has learned and is learning to avoid anti-retroviral drugs".

Asia now has some 7 million people with HIV. But UNAIDS says infection rates are rising in places like China, Cambodia, India and Bangladesh, aided by migration, the sex trade and drug use.

Asia's situation is far from Africa, where HIV/AIDS has exacted the greatest toll and where countries have seen "generalised epidemics" that indicate prevalence rates of 5 percent or more of the population.

But Piot points out that in two states in India, the HIV prevalence rate stands at 2 percent and similar rates are seen among injecting drug users in Bangladesh.

Cambodia has nearly 180,000 people who are HIV-positive in a population of close to 11 million.

Piot adds that the fallout from Asia's crisis may well provide more impetus to migration and the sex trade. "More migrants might cross borders in search of employment, pushing up cross-border transmission of HIV," he says. If condom use falls in the sex industry, that could undercut what is a "cornerstone of AIDS prevention".

There are other warning signals. Life expectancy in parts of Africa have been slashed by 10 to 20 years because of AIDS, and the World Bank says that in countries like Cambodia and Burma, life expectancy is being shortened by two to three years already.

Mieko Nishimuzu of the World Bank says Asia's huge strides in cutting poverty incidence over the last three decades is to be put in peril by the HIV/AIDs pandemic. "But AIDS can cancel and reverse this progress, with impact on growth and size of economies," she explains.

The pressure on governments and communities to find other ways of sustaining programmes for people with HIV/AIDS will increase as the human and development toll of the pandemic sets in -- at a time when Asian countries' capabilities to respond are constrained.

In the process "the AIDS epidemic will overwhelm health financing," Nishimuzu says.

If a populous country like India reaches the point where HIV becomes a generalised epidemic and reaches five percent of the general population, the public expenditure required to respond to that would be greater than the funds needed to educate 10 million primary schoolchildren, she adds.

This does not include special medical therapy, Nishimuzu adds. In other words, "the epidemic will force very hard trade-offs in health" for governments. A complicating factor may be the fact that "most HIV/AIDS programmes are dependent on external funding," reports Fawzia Rasheed, a doctor and adviser to the Bangladesh government.

In several workshops here, activists and experts have called for new ways to raise the resources to counter the epidemic.

Mechai, involved in Thailand's successful programme to increase condom use to curb the pandemic's spread, says: "We (in Asia) have to be far more aggressive."

He urges NGOs involved in HIV/AIDS work to find ways to make their campaigns sustainable on their own. "We can't go begging forever and some are getting tired of (just) giving," he says, adding that NGOs can learn from the private sector in marketing and fund-raising skills.

Mechai also suggests innovative ways of stepping up programmes for HIV/AIDS, such as offering tax incentives for companies that pursue prevention and education campaigns. (END/IPS/ap-he- dv/js/99)
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