Sunday, April 29, 2001

Asia may be
experiencing lull
before the storm
of full-blown
AIDS epidemic

Many Asian countries still
do not regard the disease
as a priority

---

By Edward Haugh
and Indu Bhushan
Special to the Star-Bulletin

MANILA >> Asia stands on the brink of a full-blown HIV/AIDS epidemic. The disease is well-established in Asia and the Pacific and that it has not yet reached epidemic proportions may be more due to luck than good management.

China and India account for most of Asia's HIV/AIDS cases because of their large populations. Cambodia, Myanmar and Thailand are wrestling with entrenched epidemics.

The danger is that, since earlier forecasts of the infection's explosive growth have not yet materialized, many countries still do not regard HIV/AIDS as a priority problem. Many are avoiding policies that confront sensitive social, cultural and moral issues.

Thus, despite the serious consequences of an epidemic, Asia has yet to move to prevail over this challenge.

Yet many Asian countries are potential incubators for a rampant spread of the infection because they have:

>> High rates of sexually transmitted infections;

>> Groups of needle-sharing drug users;

>> Large pools of tuberculosis victims;

>> A rapid expansion of transfusion services using poor quality blood;

>> Increasing migration of young men and women to the cities from rural areas to engage in commercial sex.

If urgent preventive measures are not taken, large-scale transmission of HIV/AIDS will ravage the labor force, strain social services, overextend resources, decimate human capital, and drastically constrict economic development.

CAMBODIA HAS an estimated 170,000 people infected with HIV but the number of hospital beds is less than 8,000. Care of all the infected would overwhelm the country's health system. Few public health risks in history could have caused such disruption as an HIV/AIDS epidemic.

HIV/AIDS and poverty are inextricably linked. The infection pushes poor households deeper into poverty. That exacerbates AIDS because the poor are more vulnerable to high-risk behavior such as sex work and drug use by injection. They are also less likely to use condoms and to seek prompt treatment for infections.

The challenge calls for a vigorous response led by governments and external aid agencies need to step up their efforts. For its part, the Asian Development Bank is preparing a project to halt the spread of HIV/AIDS in the Greater Mekong area. The bank is stepping up assistance in countries that border on the Mekong River, such as Cambodia, Laos, Thailand and Viet Nam.

STUDIES HAVE identified the most vulnerable groups in high-risk areas. A $600,000 project to strengthen Cambodia's National Aids Agency is under way. Another grant to support government officials in the Sixth International Congress on AIDS in Asia, scheduled for October 2001 in Melbourne, Australia, has been approved. An $8 million regional project, expected to be approved in May, will help Cambodia, Laos and Viet Nam prevent HIV transmission.

This project will seek behavioral changes, distribute condoms and support treatment of sexually transmitted infections for mobile populations, including truck drivers, construction workers, seafarers and hospitality industry workers. The ADB is also prepared to support other responses to HIV/AIDS. Early action could prevent an epidemic. The alternative could be catastrophic.

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Edward Haugh and Indu Bhushan are manager and
senior project economist, respectively, in the Asian Development Bank's
Education Health and Population Division (West).