Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.

Reuters New Media - Thursday November 30, 2000
John Chalmers

"I still get very nervous here when people say 'we are not Africa'," he said. "It's another barrier to action."

True, the problem is still colossal in sub-Saharan Africa. The region is home to over 70% of the world's 36.1 million HIV-AIDS cases, and 3.8 million adults and children living there have been infected with HIV this year alone.

Only three Asian countries--Cambodia, Myanmar and Thailand--have HIV rates over one percent among 15-to 49-year-olds.

But such low rates conceal huge numbers of affected people because of large populations. Although the epidemic began five to 10 years later in Asia than in sub-Saharan Africa, the region already has 6.4 million HIV cases. Alexander reckons that could double in 5 years and double again by 2010 if nothing is done.

Such projections--although far from exact because the momentum of local epidemics is hard to determine--appear to be falling on deaf ears in some of Asia's worst-affected countries.

"I think by the efforts which we are now taking the progress of the disease will be checked," Indian Health Minister C.P. Thakur told Reuters a few days ahead of Friday's World Aids Day. "It will not increase in India, of that I am very certain."

UNAIDS said in a report this week that with the epidemic simmering at low levels in Asia, there is a risk of complacency.

It said that in East Asia and the Pacific, where the number of people living with HIV or AIDS represents just 0.07% of the population compared with 0.56% in South and Southeast Asia, there is ample room for growth of the epidemic.

"The sex trade and the use of illicit drugs are extensive, and so are migration and mobility within and across borders," it said. "China in particular is experiencing population movement that dwarfs any other in recorded history."

In addition, having almost eradicated sexually transmitted infections by the 1960s, China is now seeing a steep rise in these rates, which could lead to higher HIV spread down the road.

Chinese experts and the UN estimate there are 500,000 to 600,000 HIV positive people in China.

"China is on a fast track to having a big epidemic. The truth of the matter is that the 600,000 cases as it is now is just the beginning," said Edwin Joseph Judd, the United Nations Children's Fund representative in China.

"Unless there's really substantial action in the next 3, 4 years, the real danger is that we will have 10 million cases of HIV/AIDS in the year 2010, or worse."

In many Asian countries, the battle against HIV is a social and cultural one against open discussion of sexual health and the social stigma attached to the disease.

But last year China broke a long-standing taboo against public discussion of sexual health and launched a nationwide media campaign to curb the spread of HIV through unsafe sex.

The country has also launched pilot projects, among them a drive to place condom vending machines in bars, karaoke halls and universities, but these have been stymied by conservative officials who believe the problem is largely a foreign one.

Experts say HIV in India is moving steadily beyond its initial focus among commercial sex workers and their clients into the wider population. At the same time, sub-epidemics are evolving with potentially explosive spread among groups of injecting drug users and among men having sex with men.

Despite the health minister's dismissive remarks about the future, Alexander says Indian policy-makers have demonstrated increasing willingness to tackle HIV over the last 2 years.

In Thailand, the World Bank says about a million people have been infected with HIV since the epidemic took hold in 1984. The country's efforts to tackle the problem have been hailed. A campaign to encourage sex workers to use condoms has brought considerable success in braking the spread of the disease in Thailand's infamous sex industry.

But in a report this month, the World Bank said Thailand now had to alter its strategy to combat the changing face of the problem. It said the epidemic, mainly confined to the sex industry when it began, was spreading to other groups.

"The country's response--and in particular the government's response--needs to be flexible to respond quickly to the changes in the epidemic and keep ahead of those changes," said World Bank Country Director Jayasankar Shivakumar.

The Bank suggested three priorities for Thailand: expanding condom use beyond commercial sex, a new initiative to prevent drug-injection transmission and ensuring access to cost-effective prevention and treatment of opportunistic infections.

The outlook is bleakest for Myanmar. Although Yangon says only around 25,000 people carry HIV, the World Bank estimated that over 700,000 of its 48 million population are infected.

A growing sex trade and mounting use of intravenous drugs are expected to worsen the problem.

United Nations health officials in Bangkok say the military government is doing little to fight the epidemic, denying that there is a serious problem, and Myanmar's health system is deeply underfunded and unable to cope with the scale of the problem.

The theme of the UNAIDS campaign this year is "Men Make a Difference". It's an effort to underline that male behaviour contributes to HIV infections in women, who often have less power to determine where, when and how sex takes place. In Bombay--where HIV has reached more than half of the sex workers--80% of all new infections among women are those who have had only one sexual partner, usually their husband.

"Women can't negotiate the terms on which sex takes place. The condom in the family is a very difficult proposition," says Alexander. "So men's behaviour is crucial." (Additional reporting by Sarah Cheung in BEIJING and Andrew Marshall in BANGKOK).
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