New Report Sounds Alarm Over AIDS in Asia
Cautions AIDS Will Spread Unless Rapid Action Rapidly Stepped Up; Warns Some Countries on Brink of Potentially Explosive Epidemics
October 4, 2001
-- A report released on the eve of the 6th International Congress on AIDS in Asia and the Pacific (ICAAP) warns that "there is clear potential for extensive population spread of HIV if preventive action is too little or too late." Early and large-scale preventive action have kept prevalence low in parts of Asia but according to "Status and Trends of the HIV/AIDS Epidemic in Asia and the Pacific," these low HIV infection rates do not necessarily mean rates will remain low forever.
The report argues that "some find reassurance in the fact that only three Asian countries have registered nationwide prevalence rates so far of over 1%," compared with much higher national rates in some African countries. Unfortunately, the report says, national averages are not particularly meaningful in the Asian context where epidemics have yet to mature. Furthermore, the report says that national infection rates of around 3% "in no way represent a 'natural limit' imposed by behaviour patterns in the region."
"Some countries in the region began prevention efforts early and they are reaping the benefits today," said Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "Elsewhere, however, epidemics will continue their natural course unless prevention programmes quickly reach the population groups most vulnerable to HIV." Dr Piot was speaking at a news conference to launch the report, published by Monitoring the AIDS Pandemic (MAP), an international network of HIV experts.
According to the report, recent HIV increases in specific locations should be seen as a serious warning that the country is poised for a more widespread epidemic. For example, in Guangxi province in China, 9.9% of sex workers were found to have HIV in the second quarter of 2000 but the figure rose to 10.7% by the fourth quarter.
In certain cities of Viet Nam, infection levels are rising quickly and in some cases exponentially. In Ho Chi Minh City, HIV infection rates among sex workers and their clients increased from virtually nil in 1996 to more than 20% in 2000.
"It is clear that in many countries, risk behaviour and HIV levels are on the increase," said Karen Stanecki, Chair of the MAP Network, "and that no society is immune to substantial spread."
Recent data from Indonesia -- where for many years the epidemic was virtually undetectable -- shows a significant increase in HIV. Indonesia has recorded a jump in HIV among sex workers from 6% to 26% in three sites, with several recorded HIV outbreaks among injecting drug users around the country. Nationally, the proportion of blood donors infected -- in this context, an indication of HIV spread in the population at large -- increased significantly, from almost nothing in the early 1990s to one per thousand in 1999-2000.
How Asia Stands Out
The Asian epidemic has its own particularities. First, only three Asian countries -- Cambodia, Myanmar and Thailand -- have registered nationwide prevalence rates over 1%. The report says these low rates mask an uneven geographic spread and warns that national figures require closer analysis. Second, when an epidemic is concentrated in a certain group, it is misleading to use HIV prevalence as a yardstick for the whole country. And finally, national figures are meaningless in huge countries like China and India, where some states or provinces have larger populations than most of the world's countries.
"What emerges from the report is that the epidemics of the region are geographically diverse. While HIV has made substantial inroads, the situation still varies dramatically between and within countries," said Rob Moodie, Co-chair of the Congress.
HIV infection among pregnant women, often used as an indicator of HIV penetration into the general population, is quite significant in some countries. Also, countries with low prevalence have no guarantee their epidemics will stay that way. On the contrary, the report warns, several countries -- including China, Indonesia and Viet Nam -- are in a transitional phase and may be on the brink of potentially explosive epidemics.
According to the report, Asia's epidemics are driven by five overlapping and closely intertwined waves of infection: men who have sex with men, injecting drug users, sex workers and their clients, wives and girlfriends, and newborn and breastfed infants.
"Most drug users are sexually active young men. Many have steady partners, many are sex work clients, and some finance their drug habit by selling sex. A recent phenomenon is that growing numbers of sex workers are turning to drug injecting," the report says, explaining the overlaps. "Similar crossovers and overlaps exist between the homosexual and heterosexual populations. Many men who prefer sex with men have casual and commercial sex with women too, and many if not most marry and raise families because of the social pressure to conform."
The Case for Containment
Despite the grim prospect of a widening epidemic, the report holds out hope. The fact that most of the epidemic in Asia at this stage remains concentrated is a "blessing in disguise" with "enormous potential for containment." The report acknowledges the serious hurdles to prevention -- such as the criminal nature of certain risky behaviours and lack of public support for their prevention. However, intensive prevention efforts in populations where HIV has already taken hold are both affordable and effective.
To mount an effective response, programmes targeting the general population must take place alongside programmes for high-risk groups through information, policies that reduce vulnerability, and sexual health education.
For more information, please contact Anne Winter, UNAIDS, Geneva (+41 22) 791 4577; Dominique de Santis, UNAIDS, Melbourne, (+41 79) 254 6803; Akhila Sivadas, UNAIDS, Melbourne (+91 98) 104 15066; Pensri Tasnavites, UNAIDS, Melbourne (+661) 810 3151 or Andrew Shih, UNAIDS, New York, (+ 1 212) 584 5024. You may also visit the UNAIDS Home Page on the Internet for more information about the programme.
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