UNAIDS Chief Warns Against Complacency in Battle Against AIDS in Asia

by UNAIDS

   Despite optimistic figures in some parts of the region, the AIDS epidemic in Asia continues to grow, Peter Piot, Executive Director of UNAIDS, told the 5th International Congress on AIDS in Asia and the Pacific on October 24, 1999.

    "China has more than 400,000 people living with HIV or AIDS, and Cambodia nearly 180,000, or close to one in 25 of the adult population. Viet Nam may have up to 135,000 infections by next year", Dr Piot said. In India, two states have an HIV prevalence of 2% -- in other words, 2% of the general population is HIV-positive. Bangladesh has equally high infection rates among injecting drug users.

   There is good news as well. "In the Philippines, the number of HIV infections remains low and is growing very slowly", Dr Piot said. "Similarly low numbers are being seen for the moment in Bhutan, the Lao People's Democratic Republic, Pakistan and the Republic of Korea." Both Australia and New Zealand maintain "managed" epidemics with few new infections, and Thailand's well-established pprevention efforts are yielding decreases in HIV prevalence among both pregnant women and young male soldiers.

   "A low rate of HIV infection is no cause for celebration, however", Dr Piot said. "Every infection is a human tragedy, affecting the family, loved ones and the community."

    Part of the epidemic in Asia is closely associated with injecting drug use. "In many large Asian cities, an HIV epidemic among drug injectors almost certainly preceded - or most likely will precede - a broader epidemic in the general population," Dr Piot told the Congress. "It is arguable that only in the major cities of India and Cambodia did a sexually-transmitted epidemic occur first." Despite the urgency, HIV prevention among injecting drug users is neglected, delayed, and often ineffective, he said.

    The spread of HIV in Asia is also associated with migration and with the sex trade, where things could get worse as a result of the economic crisis. More migrants might cross borders in search of employment, pushing up cross-border transmission of HIV. In the sex trade, changes that lower condom use - a cornerstone of AIDS prevention - could include an increase in the number of young girls and housewives drawn into "informal" prostitution, as well as an eventual shift towards a less-organized sex trade based in hotels or karaoke bars. A recent study in Kuala Lumpur indicates a willingness among sex workers strapped for money to attract a dwindling pool of clients by offering them unprotected sex.

    The economic crisis could also have a number of impacts on the care of AIDS patients. A drop in a family's income caused by job loss might force it to divert money normally used for AIDS patients towards the young and the elderly, and drugs for AIDS patients could become too expensive, especially imported ones.

   "Fewer resources could also mean new AIDS patients might be turned away by medical establishments with other priorities", Dr Piot said. "This would raise some critical ethical questions and force hospitals to make difficult choices, with the poorest AIDS patients facing discrimination."

   Asia's economic crisis has pushed down household incomes, raised unemployment, and cut living standards for all but the wealthiest. At least US$30 billion are believed to have fled from Indonesia, Malaysia, the Philippines and Thailand in 1997-1998.

    "Budget cuts might also affect some key prevention programmes such as free condom distribution and needle exchanges, but it is still too early to know what will happen. The worst impacts of the crisis may not yet be over for the AIDS epidemic", Dr Piot said.

October 24, 1999