Wall Street Journal - July 12, 2004
Marilyn Chase, marilyn.chase@wsj.com

"The slowly evolving epidemics of Asia are very dangerous," said Tim Brown, senior fellow at the East-West Center, a Honolulu think tank. Thailand and Cambodia, hardest-hit among Asian nations, mounted an aggressive counterattack that boosted condom use to nearly 90% in the sex trade and helped check the spread of the virus. Elsewhere, prevention has lagged, Dr. Brown said, noting condom use in Bangladesh, China and the Philippines languishes at 10% to 20% among prostitutes and their clients.

"We're very worried about Bangladesh," Dr. Brown said, adding that 4% of injecting drug users already are infected in some hot spots of the country.

"What's dangerous is that steady trickling growth won't motivate policy makers to take aggressive action," he said. "The story of Asia is far from over."

The conference, which drew about 17,000 delegates to the meeting's first day, opened with pageantry and protest, including an appearance by United Nations Secretary-General Kofi Annan.

In remarks to the gathering, Mr. Annan chided world leaders for not doing enough to combat history's biggest epidemic and warned that women are increasingly bearing the brunt of infections. "We need leaders everywhere to demonstrate that speaking up about AIDS is a point of pride, not a source of shame. There must be no more sticking heads in the sand," he said. "No more hiding behind a veil of apathy."

Calling it a "terrifying pattern," Mr. Annan said women now account for nearly half of all adult infections in the world, and in sub-Saharan Africa the figure is as high as 58%. "And yet, one-third of all countries still have no policies to ensure that women have access to prevention and care," he said.

U.N. agencies said a range of factors conspire to make women the victims: poverty, abuse, lack of information and relationships with promiscuous older men who pull young women into a giant network of infection. "This can only be prevented by empowering women and girls to protect themselves against the virus," Mr. Annan said. "In other words, what is needed is the education of girls."

Thailand Prime Minister Thaksin Shinawatra announced several progressive moves, including an increased commitment to the production and distribution of generic AIDS treatments. In his speech, the prime minister said his country boosted its distribution of generic AIDS drugs to 40,000 of the country's estimated 600,000 people with HIV. He also vowed to approach the problem of drug addiction not nearly as a criminal issue but as a health issue and promised to offer intravenous-drug users so-called harm-reduction programs and better care.

However, several activists during the speech and in a news conference blasted Mr. Thaksin's attempts to soften the government's image, protesting Bangkok's history of hard-line crackdowns on intravenous drug users. Peter Piot, the executive director of UNAIDS, the joint U.N. program on HIV/AIDS, concurred, saying: "When it comes to HIV, repression has never shown any results."

The vortex of the Asian epidemic is India, which now has about 5.1 million infected -- close on the heels of South Africa with 5.3 million. Some experts at the conference said India's raw numbers of infected already may have surpassed South Africa, which has been the world leader in terms of total number of cases.

"India is the pivotal point of the AIDS epidemic, already very large and almost certainly the largest in the world," said Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "The Indian response is far short of what is necessary." Dr. Feachem said China's leaders are making progress but there, too, "denial isn't behind us."

As the virus spreads in Asia's financial growth engines, the economic threat may awaken leaders to action, Dr. Feachem said. "When I go to Japan and talk about AIDS in Africa, my audience goes to sleep. When I talk about China, they are on the edge of their seats."

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