HIV/AIDS

Social stigma stifles some prevention efforts, but patient care is improving

JAKARTA, Indonesia » Young women at a drop-in center for people with HIV/AIDS told similar stories: They were infected by husbands who were injecting drugs and did not use condoms during sex.

Yesterday Hawaii's defense against the deadly Avian virus requires vigilance by other countries. Tomorrow Dengue fever cases have doubled in Vietnam with most patients under age 15.

An 18-year-old mother of two said she was only 15, still in school, when infected by her husband. "I knew nothing about drugs. ... I only knew about HIV after my husband died," she told a group of U.S. and Asian journalists visiting the Yayasan Pelita Ilmu center.

She was eight months pregnant, and both she and the baby, delivered by Caesarean section, were positive for the virus, she said.

The center was established by the Pelita Ilmu Foundation, the first nongovernmental HIV/AIDS organization in Indonesia. It provides comprehensive services, including counseling, testing and community support.

More than 90 percent of HIV/AIDS patients in Indonesia are intravenous drug users, and fewer than 10 percent of men use condoms, said Dr. Toha Muhaimin at the center. "Moral issues" are cited, he said, explaining people view use of condoms as promoting promiscuous sex.

About HIV and AIDS Human immunodeficiency virus (HIV) was identified in 1983 as the pathogen responsible for acquired immunodeficiency syndrome (AIDS). In infected individuals, the virus causes a reduction in T-cells -- a major component in the immune defense system -- that leaves patients susceptible to infections and other malignancies. » Numbers: About 33.2 million people were living with HIV in the last year. » New cases: HIV infections have dropped because of prevention efforts, yet 2.5 million people were newly infected last year, an average of more than 6,800 daily. » Deaths: 2.1 million died from AIDS last year. » Fastest growing: Indonesia has the fastest-growing epidemic in Asia. In Vietnam the estimated number of people with HIV more than doubled between 2000 and 2005. » In the U.S.: AIDS diagnoses are increasing among Asians and Pacific islanders, based on data from 33 states. They account for about 1 percent of the total number of HIV/AIDS cases in 33 states with confidential name-based HIV reporting. Sources: World Health Organization; U.S. Centers for Disease Control and Prevention

Professor S.S. Lee, with the School of Public Health, Chinese University of Hong Kong, said the HIV/AIDS partnership pattern has changed.

Where partners met before on beaches and in bars, connections are made now on the Internet across cities and countries, spreading the disease to more partners, said Lee, who pioneered needle exchange and methadone clinics in Hong Kong.

Hawaii is better off than most places to identify and treat HIV/AIDS because of needle exchanges, rapid testing programs and drug therapy, say Hawaii health officials and infected patients.

But visitors or travelers from epidemic regions who are infected and do not know it could pose a risk to public health through contacts in the islands.

Melanie Moore of the Life Foundation, Hawaii's oldest and largest HIV/AIDS organization, said prevention team workers do outreach on the Internet. "We have identified that as an issue for safe sex."

Vietnam is getting help from Hawaii through President Bush's Emergency Plan for AIDS Relief, funded by the U.S. Department of Defense.

Of 15 countries designated most in need of antiretroviral therapy and HIV assistance, Vietnam is the only one in Southeast Asia, said Dr. Cecilia Shikuma, director of the University of Hawaii AIDS Clinical Research Program.

She went to an infectious disease hospital in Hanoi last year and arranged for Vietnamese military physicians to come to Hawaii for training to initiate an HIV therapy program. An HIV therapy hospital is to open this year in Ho Chi Minh City with military physicians who already have been trained here, she said.

Shikuma's team also is participating in a Southeast Asia Research Collaboration with Lt. Col. Jerome Kim, formerly of Honolulu, chief, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences in Bangkok, and the Thai Red Cross AIDS Research Center. Kim's group is running the world's only large HIV vaccine trial, Shikuma said.

HIV AIDS Center 2 in Hanoi has provided tests and treatment since 1992 for drug addicts, prostitutes, children and orphans, and "opportunistic infection people." The epidemic is highly stigmatized, with little mention of males who have sex with males.

The director, Nguyen Thi Phuong, said the center's capacity has grown to 1,000 from 300. Antiretroviral therapy (ARV) drugs are received from the United States and international agencies, but there are not enough for every patient, she said, so many get only palliative care.

Dr. Masami Fujita, senior adviser for HIV/AIDS with the World Health Organization in Hanoi, said the virus is rapidly increasing among drug users, sex workers and partners. Cases more than doubled in Vietnam to 280,000 last year from 122,000 in 2000, he said.

He noted "a change of attitude" in Vietnam with a political commitment to HIV/AIDS, increased national services and "a new agenda" toward homosexuals. Studies are under way to monitor the virus in that population, he said.

In Ho Chi Minh City (formerly Saigon), the Sisters of St. Vincent de Paul created an HIV/AIDS Center in 2001 with specialized care for infected patients. Patients included 14 children ages 5 to 13 and 14 adults with advanced disease when health journalists visited from the U.S. and Asia.

"Our philosophy is as long as they live, they should have a normal life," said Sister Tue Linh. "The idea was to have home-based care. We tried our best at the beginning. They refuse children, so no choice. They must be here."

People connect the disease with drug addicts and prostitution, Sister Linh said. "We make a lot of effort to say it's not only that, but ordinary people."

Dr. Le Truong Giang, deputy director of Ho Chi Minh City's Health Service and an HIV expert, said the first case was detected there in 1990, and the epidemic developed primarily among opium users. It was quickly controlled "thanks to a lot of education and reduction campaigns," he said.

Since 1996, he said, HIV and tuberculosis have been increasing among young drug users. However, a monitoring program for infected people has reduced deaths and increased quality of life, he added.

Nobody knows how large the gay population is because homosexuality is not recognized in the Vietnamese culture, he said. "Some say 100,000; others, 150,000. We don't know."

Giang started a Blue Sky Club for homosexuals in Ho Chi Minh City that has 1,000 members. It provides outreach with a condom van and mobile clinic and offers free exams and treatment, peer education, clean needles, condoms and activities, he said.

A needle exchange program began in 1993, but people would not support it for several years, he said.

S.S. Lee of the Chinese University of Hong Kong said an estimated 650,000 people in China have HIV, and millions are expected to be infected by 2010. "China is facing a huge challenge," he said, adding that "it doesn't have a good, effective health system."

He said it took about 10 years to come up with a methadone policy for HIV treatment, and about 7,000 people a day are getting methadone in 20 clinics in the urban area.

Seven to eight years ago, he helped to set up condom vending machines in rail stations in China, but Hong Kong has none, he said. "Western people are conservative."

He said the budget for HIV/AIDS has gone from $20 million 10 years ago to $100 million, and it should be $200 million. With a budget increase, the country could fight HIV, TB and malaria, he said. "This is the time."

Transmission rate down in Hawaii

A needle exchange program starting in 1990 and availability of antiretroviral drugs in 1996 have made a big difference in Hawaii's HIV/AIDS population.

Needle exchanges have reduced transmission rates not only among drug users, but among male and female partners and babies, said Nancy Kern, the state Health Department's STD/HIV prevention coordinator.

People infected with HIV also are living longer without developing AIDS because of the drugs. The number of AIDS cases fell to 68 in 2005 from 106 in 2001.

As of June 30, 2,975 AIDS cases had been reported to the Department of Health's HIV/AIDS Surveillance Program since AIDS reporting began in 1983.

A total of 89 AIDS cases were reported from July 1, 2006, to June 30, 2007, with 80 male cases and nine women, according to the HIV/AIDS Surveillance Semi-Annual Report.

Men having sex with men is the leading risk factor for HIV/AIDS in Hawaii, the report said. No children were diagnosed with AIDS from 2003-2006.

The Health Department is changing administrative rules to require name-based HIV reporting, recommended by the U.S. Centers for Disease Control and Prevention across the country.