Target AIDS prevention at sex workers and drug users, WHO urges
East Asia urgently needs to improve HIV prevention programmes for sex workers and drug users in order to control its AIDS epidemic, the World Health Organization's (WHO) Western Pacific Regional Office warned on Wednesday.
The Organization said that sex workers and drug users were ""focal points"" for high and increasing HIV infection in several East Asian countries. It warned that this could spread into a wider epidemic affecting the general public, as the virus spreads from the sex industry to clients and then to clients' wives.
In some areas, there is also a link between sex work and drug use. Surveys in China, Malaysia and Viet Nam have shown that an increasing proportion of sex workers inject drugs and become infected with HIV.
""There is a real danger that the epidemic could become much more more serious in future. It is urgent that we act to stop that from happening,"" said Dr Shigeru Omi, Regional Director for WHO's Western Pacific Region, which covers East Asia and the Pacific.
Currently, the level of HIV infection in many countries is still relatively low in comparison to rates in other parts of the world, yet there are indications that this could change.
The high and increasing levels of sexually transmitted infections (STI) in many areas indicate the presence of high-risk sexual behaviour, including low condom use.
Surveys on STI in some countries indicate the potential for an HIV explosion:
- 80% of sex workers had an STI in a 2000 survey in Kunming, Yunnan Province, China;
- 41% of sex workers in Kuala Lumpur, Malaysia had at least one STI and 31% showed evidence of syphilis infection, according to a WHO-supported survey;
- 36% of sex workers had chlamydial infection in one survey in the Philippines.
STIs greatly facilitate the spread of HIV by increasing the concentration of white blood cells - which contain HIV - in the infected area. It has been shown that effective STI services reduce the spread of HIV. However in many settings, STI services are not widely or readily available, particularly in the public sector.
WHO's Western Pacific Region has promoted a ""100% condom use"" policy in settings for sex work. Such a policy in Thailand and Cambodia has had a dramatic effect in bringing down HIV rates. Condom use in Cambodia almost doubled in two years, rising to nearly 80% in 1999.
The Organization has also urged that action be taken to stop HIV infection among drug users. In many areas of the Region, HIV infection among drug users has been a driving factor in the expansion of the epidemic. It still remains a key factor behind the epidemics in China, Malaysia and Viet Nam, where the numbers of people living with HIV are 850,000, 41,000 and 130,000, respectively.
In many countries, there are very limited, if any, programmes that directly work to stop HIV infection among drug users.
""Harm reduction"" programmes - which aim to reduce the possible harm from HIV infection among injecting drug users through education, needle exchange and drug treatment programmes - have been shown to be highly effective in Australia and New Zealand.
HIV infection among injecting drug users has remained consistently low in Australia due to the presence of highly effective harm reduction-based programmes.
""We have seen the results of these programmes. We know they work. We now need to put these programmes in place,"" said Dr Bernard Fabre-Teste, WHO's Western Pacific Regional Adviser for STI and HIV/AIDS.