Asia and the Pacific: Fertile Ground for HIV/AIDS

March 2003—When the U.S. National Intelligence Council (NIC) released its "Next Wave of HIV/AIDS" report in September 2002, it counted India and China among the five nations most likely to experience a significant rise in HIV infection rates in this decade. The NIC report, which claimed that India could have as many as 25 million HIV/AIDS cases by 2010, was met with anger and derision in that country as being grossly exaggerated. But if the numbers were subject to dispute, the document nonetheless served to underscore the potentially dire consequences of HIV/AIDS if left unchecked in this most populous region of the world.

Until the late 1980s, no Asian country had experienced a major AIDS epidemic, but by the late 1990s, the disease was well established across the entire region. UNAIDS reports that in 2002, nearly 1 million people were newly infected with HIV in Asia and the Pacific, bringing the total number of people living with HIV/AIDS in the region to 7.2 million. Today, the prevalence of HIV in some Asian countries remains relatively low, but with a population that is roughly 60 percent of the world total, even low prevalence translates into huge numbers of HIV infections and often masks serious, localized epidemics.

These pinpoint epidemics affect vulnerable populations such as male and female commercial sex workers (CSWs), injection drug users (IDUs), sex industry clients, migrant workers, and the sexual partners of people within these groups. There is also evidence of increases in mother-to-child transmission of HIV, rising infection rates among men who have sex with men, and, in parts of China especially, exposure to HIV-contaminated blood and blood products.

Sexual transmission of HIV is exacerbated by population mobility, with migrant workers spending long periods of time away from home and frequenting commercial sex workers-then returning home to infect their spouses, who in turn pass the virus to their newborns. Ironically, the highest risk factor for HIV infection among women is often marriage, as men are much more likely to engage in extramarital affairs or commercial sex, while women have little power to insist on condom use.

Growing poverty among those who have not benefited from Asia's inclusion in the global economy is driving increased injection drug use, and few countries have mounted an effective response to the drug-related HIV epidemic through either peer education or syringe exchange programs. Very high rates of needle sharing have also been documented among drug users in Bangladesh and Viet Nam, with evidence that many sex workers also inject drugs.

The Asian epidemic has seen especially rapid growth in the so-called "Golden Triangle," the source of 20 percent of the world's heroin, which includes northern Thailand and Myanmar, northeast India, and portions of southern China. A major trade and transportation hub, the spread of HIV/AIDS across this region has been fueled by a lethal combination of impoverished rural women and men driven to commercial sex work for survival, and a widespread and growing epidemic of injection drug use.

There is still a strong stigma associated with HIV/AIDS in Asia, and many people living with the disease are discriminated against by their families, communities, and sometimes even by medical facilities. It was reported in March 2003, for example, that more than 90 percent of doctors in Tamil Nadu refuse to treat people with HIV/AIDS, forcing patients "to go to the highly stigmatized sexually transmitted disease wards of government hospitals, even for common colds" (The Hindu).