United Press International - Friday, July 1, 2005
Ed Susman, UPI Correspondent

"If HIV prevention programs are urgently scaled-up," said Piot, UNAIDS executive director, "6 million HIV infections can be prevented in the next five years in the region. If Asian countries do not rise up to the challenge, then 12 million people will become newly infected."

Piot noted 8.2 million people in Asia and the Pacific already are living with human immunodeficiency virus, the organism that causes AIDS. That includes 1.2 million new infections in the past year. In 2004 an estimated 540,000 people in the region died from AIDS -- three times the number of people who died in the tsunami in December 2004.

"The risk of AIDS spreading further in Asia and the Pacific is now higher than ever," Piot said. "Low condom use, limited access to HIV testing, gender inequality, widespread injecting drug use and sex work are a dangerous cocktail that could provoke a rapid expansion of the epidemic."

The spread of the incurable, but treatable, disease was noted in a UNAIDS report:

-- The number of women living with HIV has increased by 20 percent since 2002, to around 2.3 million.

-- HIV has now spread to all of China's 31 provinces, autonomous regions and municipalities. Much of the current spread in China is attributable to injecting drug use and paid sex.

-- While the prevalence of HIV remains low in the region, its vast population means even low HIV-prevalence rates translate into millions of HIV infections. For example, India, with an adult HIV prevalence just under 1 percent, has nearly as many people living with HIV -- an estimated 5.1 million -- as South Africa, where prevalence exceeds 20 percent.

-- In India, serious epidemics in at-risk populations are under way. In the southern city of Chennai (formerly Madras), for example, 26 percent of drug injectors already were HIV positive when a sentinel site was established there in 2000; by 2003 about 64 percent of injecting drug users were infected. In southern Tamil Nadu state in India, HIV prevalence of 50 percent has been found among sex workers.

-- In Indonesia, one in two injecting drug users in the capital of Jakarta now test positive for HIV, while in Pontianak, an industrial provincial capital, more than 70 percent who request HIV tests discover they are HIV-positive.

-- Papua New Guinea has the highest HIV prevalence in the Pacific with 1.7 percent of adults age 15 to 49 infected, or close to 50,000 individuals. More than twice as many young women, age 15-24, as men have been diagnosed with HIV. A high incidence of rape, sexual aggression and other forms of violence against women appear to be aiding the epidemic.

-- A large number of new HIV infections in Asia-Pacific occur when men buy sex -- an estimated 5 percent to 10 percent of men in the region do so. Many of these men are married or in steady relationships and therefore risk not just contracting HIV, but also passing it on to their wives and partners.

On the other hand, Piot said: "Countries like Bangladesh, East Timor, Japan, Laos, Pakistan, and the Philippines are still seeing extremely low levels of HIV prevalence, even among people at high risk of infection. They have golden opportunities to pre-empt serious outbreaks of the epidemic if urgent action is taken.

"We must not lose sight of the fact that 99 percent of people in Asia and the Pacific remain uninfected," Piot said. "Effective prevention programs must be scaled up now more than ever. Universal access to prevention and treatment must not be a dream, but a reality."

In China, the government and pharmaceutical giant Merck & Co. are in a joint venture to attack the epidemic at the treatment, prevention, patient care and support levels.

"The first AIDS case was reported in China 20 years ago," said Kyra Lindemann, a spokesperson for New Jersey-based Merck. "Now there are an estimated 840,000 cases of HIV infection in China and 80,000 cases of AIDS."

She said the Chinese government in the past two years has turned its full attention to the developing AIDS epidemic in that country of 1.3 billion people.

"The government has given high priority to HIV/AIDS," she told United Press International. "This is the target and it is very clear and transparent."

The core elements of the Merck/Chinese government program involves targeting high-risk populations that drive the epidemic, such as intravenous-drug users and commercial sex workers; conducting disease awareness and education programs; expanding prevention and harm-reduction strategies, such as condom distribution, needle exchange and methadone maintenance therapy; offering care and treatment programs, including counseling and testing, antiretroviral treatment, healthcare worker and patient management training; and providing programs that will alleviate the negative social and economic impact of HIV/AIDS in affected communities, such as job-skills training.

Lindemann said the Chinese government has sought Merck's expertise in scaling up a comprehensive fight against AIDS -- expertise gained in working with governments in Botswana, Romania and elsewhere.

In Botswana, the African nation with the highest prevalence of HIV infection -- 40 percent of the adult population -- a consortium involving the Gates Foundation, Merck and the Botswana government has enrolled more than 40,700 people into Masa, the nation antiretroviral program. Masa personnel have initiated treatment of more than 36,400 individuals.

It is estimated that 100,000 people in Botswana should be receiving antiretroviral treatment. The program has been up and running for about three years.

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