Asia's AIDS efforts need to change direction

News release

The future course of Asia's AIDS epidemic will be determined by how the region treats some of its most socially marginalised people, a new report by the World Health Organization (WHO) says.

The report says the AIDS epidemic is concentrated on sex workers (and their clients) and injecting drug users in virtually all Asian countries - making the region's epidemic comparatively unique. Yet few countries are working to stop infection rising among these groups, who remain on the fringes of society and are often social outcasts and usually in conflict with the law.

In Myanmar, Thailand, Nepal, China's Yunnan province and Manipur in India, about 50% - or more - of injecting drug users are infected with HIV, the virus that causes AIDS.

"Relatively high rates of infection have been seen among sex workers in Myanmar and some Indian cities. [Those most] affected are all socially marginalized and engage in socially unaccepted and often illegal behaviour," notes the report, "HIV/AIDS in Asia and the Pacific Region". [They] are difficult subjects for government or official agencies to deal with "Currently, most countries are targeting efforts at the general public. But the report says the ""only responsible public health action to take" is to direct resources towards those most at risk.

It calls for countries to follow the example of Thailand and Cambodia, which both heavily promoted condoms in the sex industry. Their ""100% Condom Use"" programme has led to a dramatic fall in infection rates: Thailand, infection levels among sex workers dropped from 33% in 1994 to about 20% in 2000. In Cambodia, HIV infection among sex workers in brothels has fallen from a peak of more than 40% in 1998 to about 30% in 2000.

The report warns that, while Asian women generally have few partners outside marriage, the thriving sex industry is a serious concern. HIV can spread from a small ""core"" of infected sex workers to their clients, who can then infect their wives or girlfriends. Such a pattern has left a total of nearly 1 million Thais infected with HIV.

The report also calls for countries to "aggressively implement" HIV prevention programmes for drug users, including the provision of needles to ensure safe injection practices.

Rising burden of AIDS

Most of those infected in Asia presently are men, with up to five times more men infected than women in some countries. Most are young adults; some are breadwinners for their families.

The report warns that in the next few years, the burden of AIDS in Asia will be more acute, as more people fall sick and die of the disease. For most moderately-affected countries, annual deaths among adults will increase by 5% in the coming decade due to AIDS. For the countries most affected by the epidemic - Cambodia, Myanmar, Thailand and a few states in India - 40% more adults will die due to AIDS. India alone could see one-third of a million deaths due to AIDS in 2005. In Thailand, 55 000 fall sick with serious illnesses related to AIDS, and the same number will die of AIDS.

Ill-equipped health services will find it difficult to cope, while drug treatments will be unavailable for most of the sick. Only a few countries - Hong Kong (China), Japan, the Republic of Korea and Singapore - will have adequate resources to provide for both prevention and care.

The report says in nearly all countries AIDS prevention programmes are poorly funded, with only a patchwork of projects in scattered areas. It notes that in poor countries, donor support as well as national responses may determine the future of AIDS prevention programmes.

For more information, contact Mr Charles Raby, Public Information Officer at (632) 528 9983 or email:
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