- NEW DELHI (Reuters) - The
AIDS epidemic is on the move, and heading east. Sub-Saharan Africa may
still be the worst affected by a scourge that reared its head more than
two decades ago, but Asia is next in line.
- "We have a major challenge over the next five years
as this virus moves into the large demographic countries of Asia,"
says Gordon Alexander, senior programme adviser for UNAIDS in India, where
3.7 million people already live with HIV/AIDS
- "I still get very nervous here when people say 'we
are not Africa'," he said. "It's another barrier to action."
- As the world marks World Aids Day tomorrow, the problem
remains colossal in sub-Saharan Africa.
- The region is home to over 70 percent of the world's
36.1 million HIV-AIDS cases, and 3.8 million adults and children living
there have been infected with HIV this year alone.
- Only three Asian countries -- Cambodia, Myanmar and Thailand
-- have HIV rates over one percent among 15- to 49-year-olds.
- But such low rates conceal huge numbers of affected people
because of large populations. Although the epidemic began five to 10 years
later in Asia than in sub-Saharan Africa, the region already has 6.4 million
- Alexander reckons that could double in five years and
double again by 2010 if nothing is done.
- ASIA COMPLACENT
- Such projections -- although far from exact because the
momentum of local epidemics is hard to determine -- appear to be falling
on deaf ears in some of Asia's worst-affected countries.
- "I think by the efforts which we are now taking
the progress of the disease will be checked," Indian Health Minister
C.P. Thakur told Reuters a few days ahead of Friday's World Aids Day. "It
will not increase in India, of that I am very certain."
- UNAIDS said in a report this week that with the epidemic
simmering at low levels in Asia, there is a risk of complacency.
- It said that in East Asia and the Pacific, where the
number of people living with HIV or AIDS represents just 0.07 percent of
the population compared with 0.56 percent in South and Southeast Asia,
there is ample room for growth of the epidemic.
- "The sex trade and the use of illicit drugs are
extensive, and so are migration and mobility within and across borders,"
it said. "...China in particular is experiencing population movement
that dwarfs any other in recorded history."
- In addition, having almost eradicated sexually transmitted
infections by the 1960s, China is now seeing a steep rise in these rates,
which could lead to higher HIV spread down the road.
- Chinese experts and the U.N. estimate there are 500,000
to 600,000 HIV positive people in China.
- CHINA ON FAST TRACK TO EPIDEMIC
- "China is on a fast track to having a big epidemic.
The truth of the matter is that the 600,000 cases as it is now is just
the beginning," said Edwin Joseph Judd, the United Nations Children's
Fund representative in China.
- "Unless there's really substantial action in the
next three, four years, the real danger is that we will have 10 million
cases of HIV/AIDS in the year 2010, or worse."
- In many Asian countries, the battle against HIV is a
social and cultural one against open discussion of sexual health and the
social stigma attached to the disease.
- But last year China broke a long-standing taboo against
public discussion of sexual health and launched a nationwide media campaign
to curb the spread of HIV through unsafe sex.
- The country has also launched pilot projects, among them
a drive to place condom vending machines in bars, karaoke halls and universities,
but these have been stymied by conservative officials who believe the problem
is largely a foreign one.
- Experts say HIV in India is moving steadily beyond its
initial focus among commercial sex workers and their clients into the wider
population. At the same time, sub-epidemics are evolving with potentially
explosive spread among groups of injecting drug users and among men having
sex with men.
- Despite the health minister's dismissive remarks about
the future, Alexander says Indian policy- makers have demonstrated increasing
willingness to tackle HIV over the last two years.
- MEN MAKE A DIFFERENCE
- In Thailand, the World Bank says about a million people
have been infected with HIV since the epidemic took hold in 1984. The country's
efforts to tackle the problem have been hailed. A campaign to encourage
sex workers to use condoms has brought considerable success in braking
the spread of the disease in Thailand's infamous sex industry.
- But in a report this month, the World Bank said Thailand
now had to alter its strategy to combat the changing face of the problem.
It said the epidemic, mainly confined to the sex industry when it began,
was spreading to other groups
- "The country's response -- and in particular the
government's response -- needs to be flexible to respond quickly to the
changes in the epidemic and keep ahead of those changes," said World
Bank Country Director Jayasankar Shivakumar.
- The Bank suggested three priorities for Thailand: expanding
condom use beyond commercial sex, a new initiative to prevent drug-injection
transmission and ensuring access to cost-effective prevention and treatment
of opportunistic infections.
- The outlook is bleakest for Myanmar. Although Yangon
says only around 25,000 people carry HIV, the World Bank estimated that
over 700,000 of its 48 million population are infected.
- A growing sex trade and mounting use of intravenous drugs
are expected to worsen the problem
- United Nations health officials in Bangkok say the military
government is doing little to fight the epidemic, denying that there is
a serious problem, and Myanmar's health system is deeply underfunded and
unable to cope with the scale of the problem.
- The theme of the U.N. AIDS campaign this year is "Men
Make a Difference". It's an effort to underline that male behaviour
contributes to HIV infections in women, who often have less power to determine
where, when and how sex takes place.
- In Bombay -- where HIV has reached more than half of
the sex workers -- 80 percent of all new infections among women are those
who have had only one sexual partner, usually their husband.
- "Women can't negotiate the terms on which sex takes
place. The condom in the family is a very difficult proposition,"
says Alexander. "So men's behaviour is crucial."
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