Asia ripe for HIV/AIDS crisis

By Marwaan Macan-Markar
July 4, 2002

Bangkok - AIDS killed 435,000 people in the Asia-Pacific region last year, according to a new report released on Tuesday. And countries across the region are rife with the correct conditions to propel AIDS from a killer disease that is still on the margins to a regional pandemic.

According to the "Report on the Global HIV/AIDS Epidemic" by the Joint United Nations Program on HIV/AIDS (UNAIDS), the number of HIV/AIDS cases in Asia is increasing and governments aren't doing enough to prevent the spread of the human immunodeficiency virus and the deadly disease it causes.

"The epidemic is concentrated among many vulnerable groups in the region, those on the margins, yet the conditions are there for it to easily cross into the mainstream," said Anthony Lisle, head of the Southeast Asia division of UNAIDS. There are already traces of the disease spreading in the rural areas from its largely urban presence.

"It is the [same] case in Burma and parts of India. No area is immune," said Swarup Sarkar, former head of the UNAIDS South Asia division.

Some of the biggest warning signs of this full-blown pandemic lie in the lack of political will and resources put in by many governments in Asia, the world's most populous region. For instance, many governments have made public pledges to fight the disease but have not shown a real sense of urgency in translating such words into concrete action.

Another factor, observers say, is the inadequate resources being put into fighting the pandemic in the region. Governments are still slow to pump money into public health programs with full community participation to confront the march of HIV.

The report singles out Indonesia to reveal how the killer virus could rapidly spread after years of negligence. "The country is now seeing infection rates increase rapidly among injecting drug users and sex workers, in some places, along with exponential rise in infection among blood donors."

In Indonesia, which has 120,000 people with HIV, one drug-treatment center in Jakarta witnessed HIV prevalence rising from 15.4 percent in 2000 to more than 40 percent in 2001, according to the report.

"This shows the epidemic can appear suddenly and spread rapidly," said Sandro Calvani, East Asia and Pacific regional representative of the United Nations Office for Drug Control.

Asia-Pacific was home to more than 6.6 million people living with HIV at the end of 2001, the highest number for a region after sub-Saharan Africa, which has 28.5 million people with HIV. The figure includes 1.1 million adults and children who were "newly infected" last year, which means there were about 3,000 people infected every day.

The number of children orphaned by AIDS also rose last year to 1.8 million in the South and Southeast Asia and to 85,000 in East Asia and the Pacific.

"The factors facilitating the rapid spread of HIV/AIDS epidemics are present throughout the region," the UNAIDS report declares. "This is reflected in the fact that many countries are experiencing high HIV-infection rates among some population groups - mainly injecting drug users, sex workers and men who have sex with men."

In Vietnam's Ho Chi Minh City, for instance, UNAIDS researchers have evidence of the sharp increase in the number of sex workers with HIV since 1998 - one in five by 2000. And "upwards of 50 percent of injecting drug users already have acquired the virus" in Nepal, Myanmar and the Indian state of Manipur, the report states.

The world's two most populous countries - China and India - have fueled the rapid rise in infection rates. China has an estimated 850,000 people living with the killer virus, with "reported HIV infections having risen more than 67 percent in the first six months of 2001", according to the report.

India has an estimated 3.97 million people living with HIV, which, the report notes, makes it the country with the second-highest numbers of people with HIV in the world after South Africa, home to 5 million adults and children with the virus.

Three countries in Southeast Asia - Thailand, Cambodia and Myanmar - have HIV-prevalence rates above the benchmark of 1 percent of the population aged 15-49. UNAIDS classifies that as high. Thailand has 670,000 people with HIV, Cambodia has 170,000, and in Myanmar, unofficial estimates put the rate around 500,000.

Among the Pacific island countries, UNAIDS says Papua New Guinea has the highest infection rates. In Port Moresby, the capital, recent studies have revealed a 17 percent HIV-prevalence rate among female sex workers.

"We can't predict the nature of the epidemic and where it is going," said Lisle. "We don't know when the prevalence rates will peak."

The pandemic is also affecting food security in parts of Asia. In four countries - Cambodia, China, Laos and Myanmar - the UN World Food Program had to "coordinate a food-donation scheme for families affected by HIV/AIDS", the report states.

Other implications are gradually becoming visible. The report sheds light on a study in northern Thailand that revealed how "41 percent of AIDS-affected households reported having sold land, 57 percent used up their savings and 24 percent had borrowed from a cooperative".

However, the UNAIDS report says Asia has its own success stories that countries could draw lessons from. "Thailand and Cambodia have shown that the 'natural' course of the epidemic can be changed," it states.

In those countries, large-scale prevention programs aimed at high-risk groups as well as the general population have managed to stave off huge rises in infection rates. But these programs must be implemented as soon as possible.

Thailand, for instance, has undertaken an aggressive campaign to encourage regular condom use, a factor that helped reduce the number of new HIV cases each year.

But many countries are still to see the "well-funded" program that the Thais have mounted, according to the regional experts, who estimate that Asia-Pacific needs some US$3.72 billion a year to mount a successful battle against HIV/AIDS.

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