Accelerating and Disseminating across Asia

After sub-Saharan Africa, Asia is the world's most HIV/AIDS-affected region, with an estimated 7.2 million cumulative HIV infections in 2000. ¹ Given the enormous populations of the region, this figure, with a few exceptions, does not generate population infection rates approaching Africa's catastrophic burdens. One-fifth of Asia's infections occurred in 1999 alone, however, and more than half of those were in Asians under the age of 25. HIV/AIDS is spreading with unprecedented speed across the region. The Asian epidemics that have occurred in India; Cambodia; Burma; Thailand; the Russian Far East; and in the south, southwest, and north of China have been explosive, were not well predicted, and generally have been poorly managed. 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 threats of AIDS. They have largely failed to contain the spread of the virus among their peoples. The result: The face of AIDS in 2000 is changing, and it is increasingly Asian.

The patterns of HIV infection across Asia have differed considerably from those in Africa or the West. With the exception of Cambodia, where the HIV epidemic began in the sex trade, most affected states first saw HIV spread among injecting drug users. HIV came late to Asia, with the epidemic beginning between 1988 and 1990, at least a decade later than the West and probably more than a decade later than Africa. ² In the Asian countries where HIV has become a public health problem, the pattern of its spread has taken similar paths. Drug users formed the initial high-risk groups in many countries where the virus next hit the sex trade. ³ After sex workers and their clients were infected, the disease spread to wider populations of sexually active adults and their infants. Unfortunately, because both the regional sex industry and increasing drug availability as well as drug use in Asia have roughly coincided with the arrival of HIV, preventing and controlling HIV has become a tremendous challenge.

Though the pattern of the origins of the HIV epidemic is very similar in Asian countries, each faces its own circumstances enabling the disease's spread, as well as unique barriers to prevention and care. In Asia, no longer can one speak in terms of potential threats, but rather of current realities and of the need for difficult political and social decisions for these states and their partners.

How are we to make sense of these diverse epidemic situations? As we look at these trends, it is clear that the last several years have seen three principal epidemic trends for HIV/AIDS in Asia:

• The first has been the rapid dissemination of HIV into new countries and into populations that were spared in the first two decades of the pandemic.

• The second has been the acceleration of concentrated epidemics, often among drug users and sex workers, into wider groups.

• The third is the success of some states in prevention, and the first real evidence of control, of HIV at a national level. Now at risk are some of the largest human populations and most important states worldwide.

HIV Attacks Asia

China

[Table 1] An explosive spread among injecting drug users is occurring in several provinces of China. ⁴ The current Joint United Nations Programme on HIV/AIDS (UNAIDS) estimate is perhaps 500,000 cumulative infections. But these estimates, Chinese authorities agree, remain highly imprecise. In addition to poverty and relative isolation, the most highly infected provinces share the misfortune of being on heroin trafficking routes out of Burma, Laos, and Vietnam. ⁵ Evidence from molecular studies, using DNA fingerprinting technology to trace HIV variants, has demonstrated the tight connection between heroin trafficking, injecting drug use, and HIV infection in these affected areas.

China's second major HIV threat is less understood, but is likely to emerge in coming years as a significant challenge to the government. There...