Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.
Wall Street Journal - July 6, 2004
Marilyn Chase, marilyn.chase@wsj.com
As an expected 15,000 people begin arriving this week in Bangkok for the XV International AIDS Conference, Thailand plans an unusually frank display of its approach to AIDS and, in the process, hopes to draw world attention to the burgeoning epidemic sweeping through Asia.
While stamping visitors' passports, Thai officials plan to present a welcome gift of condoms to conference attendees. Police will pass out prophylactics in a program dubbed "Cops and Rubbers." Thousands of machines in public places will dispense a hot-pink two-pack for five baht (12 cents), officials said in a Kaiser Family Foundation Webcast. It is a stark departure from U.S.-favored prevention policies that stress abstinence and fidelity rather than condoms.
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Prevention Programs
The country has reined in HIV infections by reducing sexual transmission through programs promoting condom use and by treating pregnant women with drugs to prevent them from passing the virus to their babies. Although prostitution is illegal, the country endorsed a policy of harm reduction by promoting 100% condom use in brothels, helping reduce the virus levels among brothel-based prostitutes to 10% now from 30% in 1996, said Anupong Chitwarakorn, a senior expert in preventive medicine at Thailand's health ministry, during a conference in February. Overall, such programs slowed the annual increase in new cases of HIV infection to 19,000 in 2003 from 142,000 in 1992, Mr. Anupong said. Drugs to block the spread of the virus from mother to baby are saving 2,700 infections a year, according to the Thai Ministry of Public Health.
But the country is poised between China and India, Asian neighbors whose AIDS epidemics remain volatile. Meanwhile, global health officials fear India, with an estimated five million people infected, could see its AIDS epidemic explode to surpass even South Africa, which has 5.3 million people with HIV.
China, with a population of 1.25 billion, has an estimated one million people with HIV/AIDS in an epidemic spawned mainly by unclean needles -- both reused equipment in paid blood collections and needle sharing by intravenous-drug users. UNAIDS, an AIDS program sponsored by the United Nations and other groups, has estimated that China has about 200 million users of injecting drugs, with pockets of infection in some areas ranging as high as 80%.
Barring swift prevention steps, HIV cases in Asia are expected to mushroom, said Peter Piot, head of UNAIDS, an AIDS program sponsored by the United Nations and other groups. World-wide epidemic growth continues apace, though improved surveillance data in Africa are prompting UNAIDS to revise downward slightly its global total. Among its fastest-growing group of living victims are AIDS orphans -- children younger than 18 who have lost one or both parents to the epidemic -- who could number as many as 15 million world-wide.
Thailand also has become a model of access to generic drugs through its not-for-profit Government Pharmaceutical Organization. The state drug-manufacturing facility makes generic versions of six staple AIDS drugs and two combination pills, which cost about $30 a month. Achara Eksaengsri, a pharmacist with the organization, said the government soon hopes to expand access to 50,000 patients from about 35,000 earlier this spring.
Lingering Challenges
However, other risk groups remain a challenge, he said, including married women infected by their husbands, and people engaged in "indirect" prostitution, such as bar waitresses who may perform occasional sex acts for money on the side. Most challenging are intravenous drug users, who have been targets of a tough police crackdown in recent years. The crackdown has been criticized by groups such as Amnesty International and Human Rights Watch.
Beyond the Asian epidemic, the six-day AIDS Conference, which begins Sunday, also likely will focus on the yawning gaps in access to treatment. Despite a flurry of grant and drug-discount programs, many observers expect the World Health Organization's plan to get three million people on AIDS drugs by 2005 to miss its target.
"So many people have been taking bows and receiving kudos for talking about HIV/AIDS, but people are still dying in unspeakable numbers," said Jim Yong Kim, adviser to WHO Director-General J.W. Lee. "We're preparing to face disappointment, frustration and anger," he added.But he said it still is possible to meet the goal of the program, if countries quickly can use funds from President Bush's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, tuberculosis and malaria. If not, Dr. Kim said, "History will judge us harshly."
"Not only is it morally necessary, it's now feasible" to distribute drugs to countries in need, said Anthony S. Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, a unit of the U.S. National Institutes of Health in Bethesda, Md. However, he said the 2004 conference isn't expected to produce many big scientific advances. "The low-hanging fruit has been picked. What we'll see in 2004 are incremental increases in knowledge," Dr. Fauci said.
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