United Press International - Wednesday, December 10, 2003
Ed Susman, UPI Science News

WEST PALM BEACH, Fla. -- For centuries, men have journeyed to the South Pacific, drawn by warm temperatures, blue lagoons and tempting women. Today, tourism remains crucial to the economies of many of the small island nations of the region, but their charms also have made them destinations of choice for sex tourists -- who seem to have caused the latest regional eruption of HIV infections.

"That is absolutely the situation in many parts of the South Pacific," said Stuart Watson, Pacific program coordinator for the Joint United Nations Programme for HIV/AIDS -- also known as UNAIDS -- in Suva, Fiji.

"We are fairly certain that AIDS was brought to the South Pacific by a tourist," said Joyce Yu, resident representative of the United Nations Development Programme in Apia, Samoa.

For many years, Asian countries such as Thailand, Korea and Taiwan were well-known destinations of sex tourists and harbors to widespread commercial sex industries. More recently, however, their red-light districts became hot spots in the global HIV epidemic. Despite efforts by governments and non-governmental organizations to promote safe practices during paid sexual exchanges, fear of infections seems to have contributed to the migration of sex the tourist trade to the South Pacific.

As a result, the global scourge now has been seen even in the smallest of the island nations, and the same factors that have been associated with AIDS elsewhere -- stigma, lack of education, hidden cases, poor surveillance, low recognition by governments and unprotected sexual activity -- are present in the South Pacific, the ingredients for an epidemic in paradise.

Officially, the prevalence of HIV/AIDS is lower in the South Pacific than any other area on the globe. Even in the hardest hit places -- New Caledonia, Guam and Papua New Guinea -- the prevalence rate is only about 0.2 percent. That is lower than in the United States and Western Europe, where about 0.3-percent of the population is infected with the human immunodeficiency virus, the organism that causes AIDS.

According to the latest figures, 5,664 people South Pacific islanders have become infected with HIV, of which 1,915 have developed AIDS-defining illnesses -- life-threatening, opportunistic infections due to a weakened immune system. To date, 488 deaths have been attributed to the disease.

As Watson cautioned, however, those figures mask exploding epidemics within certain population groups. For example, Papua New Guinea, the most populous nation in the South Pacific -- excluding Australia and New Zealand -- reports about 5,000 cases of HIV infection.

"There are ante-natal clinics in Port Moresby and Lae ... where the infection rate is greater than 1 percent," said Watson who worked with UNAIDS in Papua New Guinea before moving to Fiji. "The official number of people with HIV is low," Watson told United Press International in a telephone interview, "but there is considerable under-reporting of HIV/AIDS."

Watson said that in some countries the true prevalence of HIV infection can be estimated by multiplying the official case number by at least 10. "Surveillance for HIV infection is poor in many of these countries," he said.

Further complicating the picture is how people from places such as Samoa, Fiji and the Cook Islands are classified when they seek treatment in New Zealand. By doing so, Yu told UPI, a patient no longer is counted as, say, a Cook Island AIDS case, but rather as a New Zealand AIDS case.

In Fiji, Watson said, patients who visit sexually transmitted disease clinics in Suva and Nadi, the two population centers, rarely are asked where they live. For that reason, the disease may appear to be centered in those cities, leaving the government with no real handle on where infections actually may be originating among the rural parts of the island nation of 800,000.

Though there are 129,000 Samoans, the number of AIDS cases officially is less than 20 -- and unofficially it is closer to 50.

"The incidence of HIV/AIDS reported in Samoa is low even considering underreporting," Yu said. "Sex and tourism are important (issues) and (therefore) not ignored by some of the governments. Samoa in particular is quite vigilant in protecting its culture."

Some South Pacific nations have attempted to curb sexual tourism and especially its exploitation of children. Fiji and Australia have enacted laws to combat child sexual abuse and permit prosecution of Australians who travel to the island nations to abuse children.

In the Solomon Islands, authorities have conducted seminars and conferences to spotlight the dangers of commercial sexual exploitation of children. More than 100 girls under age 15 are involved in prostitution in Honaira. Although officially there is just one case of HIV infection among the 500,000 residents of the islands, the widespread commercial sex work involving girls and boys -- some as young as 7 -- troubles government officials.

At a regional meeting in Vanuatu in 1997, officials warned that crackdowns on pedophiles in the Solomons might result in increases in child molestation cases in some of the other tourism-hungry islands.

One of the problems in containing the spread of HIV/AIDS is the failure of governments and the public to fight the stigmatization of people living with the disease. This causes individuals to hide their condition, avoid testing programs and forgo both treatment that can extend life and the quality of that life and education that could prevent further spread of the disease.

"People with HIV/AIDS do face stigmatization in Samoa," Yu said. "That stigmatization may not be as intense as in other parts of the world, but it exists due to misinformation and fear. However, the stigmatization is mitigated by deep sense of family and culture among Samoans."

On the other hand, he noted, even in the island nations where the number of people living with HIV infection is lowest, the community impact can be great. For example, although there are only 12 known cases of HIV in Tuvalu, and only 10,000 people live in that string of atolls, "the impact there is devastating in that population," he said.

Watson said that when most people talk about exploitation of underage children for sex in the South Pacific, the focus is on young girls. "But there is also exploitation of boys," he said, "although that is less acknowledged and less frequently addressed."

Transmission of HIV/AIDS in the South Pacific differs from other regions in one respect, Watson said: it is almost exclusively through sexual contact. Incidences of injecting drug use are low in the islands.

Ed Susman covers medical research and health issues for UPI Science News. E-mail sciencemail@upi.com

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