Asia must target AIDS

Epidemic could skyrocket if it isn't dealt with now

BY Daniel Sneider
August 2, 2004

Hanoi - The Communist propaganda billboards that used to loom over the streets of this Southeast Asian capital are largely gone. In their place, posters proclaim a new message: a warning about becoming infected with HIV/AIDS.

After ravaging sub-Saharan Africa, the AIDS epidemic is now poised to sweep through Asia, home to two-thirds of the world's population. Governments from Vietnam to India have just begun to realize this deadly disease could derail the region's economic boom.

That message was repeatedly communicated by researchers and health officials who gathered recently in nearby Bangkok, Thailand, for the 15th international AIDS conference.

"HIV/AIDS is spreading through Asia like termites in a house," said Dr. Nafiz Sadik, a senior UN official. "It is invisible at first but catastrophic in its impact. What is happening in Africa could happen in Asia if we fail to act."

Unfortunately, wishful thinking has been the norm in Asia.

If you look at the numbers one way, there seems to be a basis for complacency. The standard index for measuring HIV infection is the estimate of the adult population that has the virus -- more than 1 percent is considered an epidemic. On that basis, HIV/AIDS in Asia doesn't come close to Africa. The worst hit countries in Africa are places such as Botswana where more than 37 percent of adults have the virus, or South Africa, where almost a quarter are infected.

The worst case in Asia is Cambodia, where 2.6 percent of adults are affected. Thailand, which faced an early outbreak of the epidemic in the late 1980s, brought its infection rate down to 1.5 percent. But the sheer size of Asian populations dramatically changes those calculations. Take India. The infection rate there is less than 1 percent, but with a population of more than 1 billion people, there are already about 5 million adults living with HIV. India likely has passed South Africa as the country with the largest number of HIV/AIDS cases in the world.

Still, the Hindu nationalist-led coalition that ruled India until a couple of months ago was in almost complete denial about this. Until recently, it failed to alert people to the disease.

"In India, talking about sex is almost taboo," says Sheila Dixit, the chief minister of the New Delhi regional government.

"But there is an opening up now," she adds, one that is accelerating since her party, the Congress, took power. Congress leader Sonya Gandhi spoke to the Bangkok conference, a signal that this government is more willing to deal with the issue.

The Chinese government also refused to face reality until last year. Though it has a lower estimated infection rate, with such a huge population, China's HIV population is already close to 1 million and climbing fast.

The disease hits first among groups with a high risk of infection -- intravenous drug users and men who have sex with men. But it surges when it is transmitted to the broader population. In Asia, the transmission belt is well known -- it is the ubiquitous commercial sex industry. Asian men regularly visit prostitutes in very large numbers, researchers say.

As infection rises among the sex workers, the men bring the disease home to their wives, and, when their wives are pregnant, to their children.

The most effective way to prevent the spread of AIDS has been to protect sex workers and their clients. Thailand adopted a "100 percent condom use" campaign in the early 1990s that not only dramatically dropped the infection rate but also cut the number of men visiting prostitutes by half.

Spending on prevention in most of Asia, however, is still too low. UN officials estimate that $1.5 billion a year is needed but only $200 million has been spent.

And it doesn't help when ideology gets in the way. The Bush administration's catering to the Christian right bars funds from going to programs that distribute condoms or clean needles to drug users. Here in Vietnam, that leaves officials scratching their heads about how to use newly announced American aid to combat AIDS.

The window of opportunity to prevent Asia from going down the African road is still open, but not for long. If we fail to act, the victims will be measured not in the millions but in the tens of millions.

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