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AIDS epidemic set to escalate in Asia

July 12, 2004 By Apoorva Mandavilli This article courtesy of Nature News.

Leaders urged to take immediate action.

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Bangkok

A massive AIDS epidemic is spreading rapidly in Asia, and is sneaking below the radar of governments in the region, experts warned on 11 July.

Speaking at the XV International AIDS Conference in Bangkok, scientists urged Asian governments to scale up prevention and treatment efforts by providing sterile needles, condoms and antiretroviral drugs.

"This conference must be a wake-up call to Asian leaders," says Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS. "They're starting to respond, but sometimes too timidly."

An estimated 7.4 million people in Asia are already living with HIV. Unlike in Africa, where the disease has spread into the general population, the Asian epidemic is driven largely by intravenous drug users, sex workers and men who have sex with men, according to a new report released by the network known as Monitoring the AIDS Pandemic (MAP).

"That pattern has held in virtually every country in Asia," says Tim Brown, an epidemiologist at the East-West Center research organization in Bangkok, and a member of the MAP network.

Compared with Africa, Brown predicts that Asian nations will see a slow, steady rise in infections. "We are never going to see a generalized spread in the population as in Africa," he said.

But although many Asian countries have low infection rates, their large populations mean that millions of people are infected. For instance, the prevalence of HIV infection in India is 0.9%, one-twentieth that of South Africa. But with 5.1 million infected individuals, India is rapidly approaching South Africa's 5.3 million.

Escaping detection

The epidemic in Asia is, in some ways, more dangerous because the low infection rates mean the disease is "flying below the radar" of the governments involved, Brown says.

In some Asian countries, greater stigma is attached to AIDS and sex than in Africa. Many Asian countries also have poor public-health systems.

In Vietnam, for instance, there is only one doctor for every 11,250 HIV-infected people and China has fewer than 200 trained doctors for an estimated 840,000 infected individuals, according to a report released by the American Foundation for AIDS research.

Some 27 companies in Asia make generic versions of patented antiretroviral medications. But of 1.3 million Asians who need the drugs, only 7% have access to them, the report states.

Early intervention

Computer models predict that HIV will spread most rapidly in countries where more than 20% of men visit sex workers. Measures to delay the spread of the epidemic in these countries are urgently needed to buy governments more time to combat the disease itself, Brown says.

There is reason to believe that early intervention could stop the Asian epidemic in its tracks. Thailand, which saw an early and rapid rise in infections in the late 1980s, increased condom use among Thai sex-workers to nearly 90% and halved the number of men who visited them. As a result, the number of new people testing positive for HIV in the country fell from 142,819 in 1991 to 21,260 this year.

"There is no question about what needs to be done to fight AIDS in Asia," says Piot. "The only question is whether the governments and people of Asia will have the courage to do it."

This is the first time the conference, which has attracted 17,000 people from 160 countries, has been held in Asia. But the leaders of many Asian nations have been largely absent.

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