AIDS Analyst Gives Overview of Asia's Rising HIV Epidemic

The face of AIDS in 2000 is changing, and it is becoming increasingly Asian, says Chris Beyrer, MD, MPH, director, the Johns Hopkins Fogarty AIDS Program, Department of Epidemiology, the Johns Hopkins School of Public Health. Dr. Beyrer, who himself has tracked the spread of the human immunodeficiency virus (HIV) along major heroin routes out of Burma, has written an overview of the AIDS epidemic in Asia for the December 2000 issue of Washington Quarterly.

After sub-Saharan Africa, Asia is now the world's most HIV/AIDS-affected region, notes Beyrer, with an estimated 7.2 million cumulative HIV infections by 2000. One-fifth of Asia's infections occurred in 1999 alone, more than half of these in Asians under the age of 25. With the exception of Thailand and a handful of positive trends in a few other states, Asian governments have been slow to respond to the threat of AIDS and have largely failed to contain the spread of the virus among their peoples.

"Now at risk are some of the largest human populations and most important states worldwide," says Beyrer. "The window of opportunity to respond to HIV in Asia is narrow and closing. The time for immediate action is now." Among Beyrer's recommendations for the region: End official denials; reform and expand drug treatment programs; override cultural taboos so that frank sexual health initiatives can be established for all; reform blood collection policies; reduce the trafficking of women and girls; assess the impact new highways and bridges will have on the spread of HIV/AIDS.

Beyrer has watched several trends emerging in the region that demand responses:

HIV spread related to drug use. Opium, heroin, and amphetamine production are increasing in Burma, Afghanistan, and Laos, as is the availability of drugs throughout the region. In Russia and China, for instance, dual epidemics of injection drug use and HIV infection among drug users have led to explosive outbreaks. The emergence of a major heroin economy in Taliban-controlled Afghanistan is a disaster for the entire region.

The trafficking of women and girls. The trafficking industry today appears to be, if anything, increasing. Nepal, for instance, is at risk for a major HIV epidemic because of an extensive influx of Nepali women and girls into the Indian sex industry.

The social status and educational levels of women and girls. Most Asian women at risk or currently infected with HIV are young, married, and monogamous. "They are, in fact, at risk largely because they are married," says Beyrer.

  Labor and social mobility. Asia has large populations of internal migrants, migrant laborers, internally displaced persons, refugees, and workers such as truckers whose jobs require mobility. Such large-scale movements are tailor made for the spread of HIV.

Blood and blood products safety. The World Health Organization (WHO) estimated that in 2000 only one-third of the world's blood supply could be considered safely screened for HIV and other blood-borne infections. In China and India, for instance, official inaction, corruption, and profiteering in the industry remain significant barriers to reform.

Sexual health education and services. Frank and effective sexual health education and programs remain woefully inadequate across Asia. Beyrer sees China's greatest threat, for example, as HIV's spread beyond drug users and blood donors to its enormous numbers of sexually active young adults.

Militaries and security forces. A prime example: With the coming of the UN Transitional Authority in Cambodia (UNTAC), HIV rates among sex workers shot up, as did outbreaks of HIV among UNTAC forces from Indonesia, India, Uruguay, and the United States.

Beyrer cites Thailand as the first example of a developing country controlling HIV at a national level. To date, although roughly one million have been infected in its population of 58 million and at least 300,000 have died, Thailand has fought back. Among its weapons: a vigorous "100 percent" condom campaign, aggressive treatment of STDs, blood bank reform, and public education. Rates among Thai military conscripts have now decreased from the high in 1991 of 12.5 percent of all recruits in northern Thailand to less than 4 percent in 1999. General population prevalence is estimated to have decreased from 2.7 percent of all adults to 2.3 percent over the last five years -- the first example of population-level declines in a severe epidemic in Asia.