A new report says Asia is at risk for a surge in HIV infection if governments fail to take action. The report says the relatively low HIV rates in Asia do not mean the region is immune from a worse epidemic. Only three Asian countries Burma, Cambodia, and Thailand - have nationwide HIV rates over one percent. By comparison, the hardest hit countries in southern Africa have rates of 10 to 15 percent of their populations.
An international AIDS monitoring group of more than 100 experts from 40 countries says it is not reassured by Asia's relatively low rates. The group is named Monitoring the AIDS Pandemic, and its chairwoman, Karen Stanecki of the U.S. Census Bureau, says it may be only a matter of time before Asian infection rates climb. "In the early 1990s, there was absolutely very little evidence of HIV infection in southern Africa, and now that's where we're seeing the highest levels of HIV infections," says Ms. Stanecki. "So sometimes it's only a matter of timing. The risk behaviors will be there and it's just a matter of when it starts to take off."
Ms. Stanecki's group issued its report on the eve of the sixth International Congress on AIDS in Asia and the Pacific, in Melbourne, Australia. It says low national HIV averages are not meaningful in Asia, where epidemics have yet to mature. If pregnant women are the standard, the report says several Asian countries, such as India and Burma, have serious epidemics.
The chief epidemiologist for the United Nations AIDS program, UNAIDS, Bernard Schwartlander, says certain high-risk Asian populations like prostitutes, male homosexuals, and intravenous drug users are beginning to experience HIV epidemics. But Mr. Schwartlander says the outbreaks may not remain limited to these groups. "All of the members of these so-called high-risk populations also, for example, have contacts, heterosexual contacts, outside these primary risk populations," says Mr. Schwartlander. "Therefore, there is absolutely no guarantee that HIV will not spread beyond these groups. Indeed, we have a lot of evidence that it has happened in many countries."
The report notes that HIV infections among Chinese prostitutes rose from none to almost 90 percent in just four years. HIV rates quadrupled among Vietnamese sex workers in just two years, while they multiplied 10 times in the same period among Indonesian blood donors. Half of Nepal's drug users are infected, and in some areas of Iran, rates among drug users have reached 63 percent.
The report documents successes, notably Thailand, where condom use during encounters with prostitutes has soared to nearly 90 percent. Similar trends and even a drop in encounters have occurred in Nepal, Cambodia, and India, which has more than half of Asia's 6.5 million HIV infections.
Mr. Schwartlander says Asia has the opportunity to keep its overall HIV rates low if it substitutes complacency with action. "It's the political commitment that we still think is too low. That certainly will be one of the points of discussion for this conference," he says. "It's an opportunity to bring together not only technical experts but also political leaders to give this problem more weight than it has been in the past."
Both UNAIDS and the Monitoring the AIDS Pandemic report say that programs targeting the general population must co-exist with special programs for high risk groups to mount an effect response to HIV.