"Explosive" HIV Epidemic Threatens Asia, Study Says

John Pickrell
for National Geographic News
June 24, 2004
Time is running out to tackle an impending "explosive" AIDS epidemic in the Asia Pacific region according to a new report from the World Health Organization and other bodies.

"Inequality, poverty, unequal status of women, stigma against people living with HIV, and cultural myths about sex contribute to an explosive epidemic," write the authors of a new report. The report outlines proposed steps in the global battle to fight the disease and will be published tomorrow in the research journal Science.

According to the report more than a million people were newly infected with HIV in the Asia Pacific region in 2002 alone. Ten million people could be living with HIV in China within six years unless infection rates are slowed, according to the authors.

Eastern Europe and Central Asia are also at the center of rapidly growing epidemics, which now affect 1.5 million people.

The article was penned by Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS); Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and Lee Jong-wook, director general of the World Health Organization (WHO).

Their report highlights areas of discussion for the International AIDS Conference to be convened on July 11 in Bangkok, Thailand.

The authors write that strong national leadership and commitment to fighting the disease are among the most important factors required to slow the spread of the Asian HIV/AIDS epidemic.

Sickening Figures

Today some 40 million people are infected with HIV worldwide. UNAIDS figures released in December suggest that up to 28 million of those infected with HIV live in sub-Saharan Africa, while 7.4 million are HIV-positive in the Asia Pacific region.

The prevalence of HIV infection in some African countries is over 30 percent. Some experts predict that these countries could face economic collapse if their epidemics are not reigned in. Vic Salas, a senior program officer with the U.K.-based nonprofit International AIDS Alliance, says Africa's AIDS epidemic has outpaced that of the developing nations in Asia for many reasons.

These factors may include poverty, massive population movements due to conflicts and civil unrest, and a very poor health infrastructure (which allowed the disease to spread rapidly and undetected), according to Salas.

Salas says evidence also suggests that HIV started spreading in Africa ahead of some other regions.

Spreading Epidemic

Signs increasingly warn that massive HIV epidemics also threaten China, India, and other Asian nations. According to the new WHO report, 10 percent of the world's HIV-positive population already resides in India. AIDS is the leading cause of death in people under the age of 50 in Thailand, according to Salas, and the disease threatens to overrun Cambodia's health care system.

The Chinese government says that 850,000 people in the nation have contracted HIV, but other estimates are much higher, said Tom Hurley, of the Geneva-based Global Fund to Fight AIDS, Tuberculosis, and Malaria.

Hurley says stigma and discrimination are some of the factors contributing to the spread of the disease in Asia. "People in China, for example, are terribly stigmatized because of misconceptions about how the disease is spread," he said. "Many believe HIV can be passed through casual contact." The misconception dissuades sufferers from seeking tests or treatment.

Hurley says ignorance about the disease poses a big problem in many Asian countries and is further exacerbated by the unequal status of women.

In India, for example, literacy rates are much lower for women than men, and women have less access to education and information that might protect them against contracting the virus.

Cultural phenomena such as Southeast Asia's enormous commercial sex industry are also possible reasons behind the rapid spread of AIDS.

Salas, of the International AIDS Alliance, said many Asian countries have denied the existence of the AIDS epidemic for a long time. "When you are in denial, then it is difficult to formulate a coherent response to anything," Salas said.

Leadership Challenge

Piot and co-authors of the new WHO HIV/AIDS report write that there are several major challenges in the battle against HIV and AIDS that should be addressed during next month's International AIDS Conference in Bangkok.

One challenge will be providing the funding, infrastructure, and human resources to prevent and treat the disease. (In their report, the authors argue that as drug prices fall, the lack of health workers could be a major factor holding up treatment and intervention.)

The authors also write that some countries have not been quick enough to recognize the scale of their epidemics. Also, other countries have failed to stop local infections from spreading into national ones, the authors say.

The report says that one major challenge to keeping the Asian epidemics under control will be to prepare governments. The report states: "At the heart of every national success story against HIV/AIDS is strong and visible national commitment and leadership."

Piot and his co-authors point to the examples of Cambodia and Thailand, which have already contended with severe epidemics. Strong government programs to educate people and prevent the spread of the disease in those countries have now stabilized the rates of infection.

Thailand's national "100 Percent Condom Use" program, for example, has caused a significant drop in HIV rates. The effort makes condoms available to all sex workers and encourages condom use.

The authors write: "Ultimately, the most critical element of a sustained global response to AIDS is the willingness and ability of nations to take ownership of the problem."

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