AIDS in Asia

Stepping Back from the Brink?

Saturday 1 March 2003, by Jeremy GANS

On February 4th, representatives of South Asian nations - including ministers, members of parliament, religious and civil leaders, youth groups, and people living with HIV/AIDS - convened in Kathmandu, Nepal, to develop a coherent strategy for waging war against the HIV/AIDS epidemic.

The meeting was organized by the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations Children’s Fund (UNICEF). Titled "Accelerating the momentum in the fight against HIV/AIDS in South Asia," it identified poverty, illiteracy, gender inequality, sexual exploitation, and (in particular) poor leadership as the biggest obstacles to combating the disease. They warned that the region is on the brink of a health catastrophe, but said that if its governments act quickly and deliberately, the spread of the epidemics could be reversed.

"South Asia stands at what epidemiologists call the ’tipping point’ in the trajectory of the disease," said UNICEF Executive Director Carol Bellamy. South Asia, Southeast Asia and even parts of East Asia are seeing infection levels approach those of Sub-Saharan Africa. India alone has approximately 3.97 million people living with HIV, a number second only to that of South Africa. It is predicted that within a decade, India and China will have half of all the HIV-positive people in the world.
"Immediate action can prevent at least 5 million new HIV infections by 2010, and successfully begin to turn back the HIV/AIDS epidemic," said Dr. Peter Piot, Executive Director of UNAIDS, who was also at the conference. HIV/AIDS will not only take a considerable toll of human lives, but will also weaken Asia’s already-fragile economy. Labour forces will be decimated and social services strained to exhaustion and collapse. This crisis has already begun; in 2000, Cambodia had 169 000 people infected with HIV, but only 8 000 hospital beds available to treat them.

China, in the course of two years, saw its number of infected citizens jump from 500 000 to a staggering 1.5 million. But in China’s conservative society even talking about sex is taboo; subjects like sexually transmitted diseases, the sex trade and intravenous drug use are difficult to broach.

Asia is suffering from the same stigmatization which enveloped the disease when it was first discovered in North America and Western Europe, and continues to inhibit progress in Eastern Europe and Africa. "In all wars, truth is almost always the first casualty. So let us not be diverted by the mythology that has accompanied so many debates about the relative impact of HIV/AIDS," stressed Ms. Bellamy to the conference’s participants. "Asia hasn’t learnt from Africa," said a representative from the Malaysian AIDS Council. "Trying to get attention to the problem is still difficult."

Attention to the problem is exactly what UNAIDS and UNICEF is trying to gain by staging events like the Kathmandu Conference. Participants, who came from Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka, were expected to adopt the "Kathmandu Call Against HIV/AIDS in South Asia." It reiterated the goals of the UN Special Session on HIV/AIDS to which all of the attending governements had previously committed. But this time, delegates from UNAIDS and UNICEF hope that their commitment is sincere. "It is time for leaders in South Asia to speak out about HIV/AIDS," said Dr. Nafis Sadik, the UN Secretary-General’s Special Envoy for AIDS in Asia. "One of the most serious obstacles is the silence and stigma surrounding the disease."

The stigmatization of the disease has created a culture of discrimination and fear. In such an environment people living with HIV are scared to publicly acknowledge their condition. People with the virus, or even suspected of having it, are often refused health care, employment, and are shunned by friends and family. The most effective way of combating this phenomenon, and HIV/AIDS in general, is through openness and government accountability. But that means those governments will have to confront social issues that are rarely, if ever, addressed. Sexuality, intravenous drug use, the sexual trafficking of women, and safe sex are all issues which need to be addressed by governments.
There are several examples of Asian governments taking positive steps towards addressing the problem. In Laos , the government has implemented a successful condom awareness and safe sex campaign, which has kept the country’s infection rate at bay. The Indian state of Tamil Nadu launched a successful awareness campaign, while other Indian states created programmes to minimize mother-to-child transmission. Education is absolutely essential in reducing infection rates. According to a World Bank study, 95% of 15- to 19-year-olds living in Bangladesh are unaware of even a single method of preventing the transmission of HIV.

Poverty is another factor contributing to the rise of infection rates on the continent; it can lead to intravenous heroin use, and has pushed some into the sex trade, both of which are considered high-risk behaviours. This is nowhere more obvious than in the Golden Triangle, the triple border that connects China, Myanmar and Thailand. Intravenous heroin and amphetamine use, along with a lack of condoms and little access to health care, have all contributed to an explosion in the region’s infection rate.

With Asia standing on the edge of a crisis, governments will have to respond quickly. But in the war against HIV/AIDS, until a viable medical remedy is discovered, greater awareness is the best weapon money can buy.

Jeremy Gans, Alternatives media intern

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