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There's good news and bad news; AIDS in South-East Asia
HEALTH / AIDS July 2, The Economist
There's good news and bad news; AIDS in South-East Asia Good prevention work has tamed the AIDS epidemic in some countries, yet it
is getting much worse in others "BOOM!" That, in a word, is how one epidemiologist describes the spread of
AIDS in Vietnam. Infection rates may be higher in Africa, but AIDS is
growing faster in South-East Asia than in any other part of the world.
What is more, in populous countries like Vietnam and Indonesia, even small
increases in the proportion infected means millions of new cases. Until recently, South-East Asia was considered a beacon of hope in the
fight against AIDS. Thailand and Cambodia, where the epidemic took hold in
the 1990s, have managed to reduce the incidence of the disease through
vigorous and well-funded public-health campaigns. In Cambodia, the
proportion of adults infected by HIV, the virus that causes AIDS, fell
from 3% in 1997 to a still high 1.9% in 2003. In Thailand, the number of
new cases has fallen each year for the past decade. Even as Thailand and Cambodia get to grips with AIDS, however, the disease
has been taking hold in other countries in the region. Myanmar and Papua
New Guinea, with estimated infection rates of 1.2% and 1.7% respectively,
face what the United Nations AIDS programme calls generalised epidemics. Several others, including Indonesia and Vietnam, are witnessing
sky-rocketing infection rates among drug users, from whom the disease
might soon start spreading to the wider population. In East Asia as a
whole, the number of people living with HIV rose by 24% in 2004 alone,
according to a UNAIDS report, to be released on July 1st at a regional
AIDS conference in Kobe, Japan. AIDS is spreading so quickly because those most in danger are still taking
risks. A recent survey of injecting drug users in three Indonesian cities
found that 88% had used unsterilised needles in the previous week. No
wonder, then, that half of all drug users in Jakarta and Bali have HIV. By
the same token, repeated surveys find that relatively few prostitutes use
condoms in Indonesia. Infection rates among them have risen as high as 17%
in some parts of the country. In Ho Chi Minh City, in Vietnam, over a
third of prostitutes inject drugs, and half of those are HIV positive. People in the region remain worryingly ignorant about AIDS. Last year, the
World Health Organisation reported that prevention programmes had reached
only 19% of prostitutes in Asia and the Pacific, 5% of drug users and 1%
of gay men. People in risky situations use condoms only 8% of the time, it
reckoned. Only 1% of Indonesian women have ever been tested for HIV. Most governments are responding pragmatically. After years in which AIDS
was denounced as a social evil, Vietnam's communist rulers have begun to
attend AIDS-awareness functions and promote AIDS-prevention schemes. In
neighbouring Laos, soldiers are taught about AIDS as part of their
training. Indonesia is running needle exchanges and handing out methadone
to heroin users, although only at a handful of clinics. But when Malaysian authorities announced that they would start similar
programmes earlier this year, religious leaders reacted with horror. The
government of the state of Perak said it would distribute condoms only to
married men. In 2003, the Philippines' Catholic bishops succeeded in
blocking a proposal to spend government money on condom distribution. The
military regime in Myanmar has not yet allowed any prevention campaigns on
radio or television. Even Thailand, which mounted a much-imitated "100%
condom" campaign in the 1990s, is uncomfortable with any policies that
imply forbearance in the face of drug use. Even when governments are willing to tackle the problem, funds are often
in short supply. UNAIDS reckons that AIDS prevention and treatment
programmes in the region will get less than half the money they need this
year, and less than a third of what they require in 2007 ()see related
story on page 82. The Philippines has slashed its AIDS budget by more than
three-quarters since the Asian financial crisis in 1997. One of the hardest hit places in the region is New Guinea. Both the
Indonesian portion of the island in the west, and the independent country
of Papua New Guinea in the east have infection rates of over 1%. This
seems to be linked to Papuans' relative promiscuity: the majority of
Papuan men report multiple sexual partners. Yet New Guinea's awkward
geography, poor infrastructure and myriad ethnic divisions make it
difficult to mount an effective prevention campaign. Myanmar presents even more daunting challenges. There too, AIDS has
already spread beyond the most susceptible groups to the general public.
In the city of Hpa-an, for example, 7.5% of pregnant women test positive
for HIV. High rates of drug abuse (Myanmar is the world's second biggest
producer of heroin) help spread the disease. So does the civil war that
rages in much of the country, displacing many people and making others
difficult to reach. There is no independent media, so a frank discussion of the country's
problems is impossible. The junta is suspicious of NGOs and activists,
while donors and aid agencies are leery of it. The generals are not good
administrators at the best of times, and the health system is a shambles.
Indeed, as bad as things sound, no one really knows how bad: the
government conducted only 28,000 HIV tests last year, in a country of more
than 50m.
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