Sex and drugs fuel simmering AIDS crisis in Asia and Pacific
Countries in the Asia-Pacific region are being urged to combat the social exclusion of sex workers and of injecting drug users in order to prevent an explosive epidemic of HIV/ AIDS in a region which accounts for 60% of the world's population.
A new report by WHO, HIV/AIDS in Asia and the Pacific Region, says the epidemic is being driven mainly by sex work and drug abuse ¾ both of which are illegal and clandestine activities in just about all the countries throughout the region. But efforts to focus prevention on these groups are failing, the report says, because those spreading the infection are largely out of reach on the fringes of society or on the wrong side of the law.
Dr Neff Walker, an epidemiologist with UNAIDS, believes there is an urgent need to ensure that sex workers and injecting drug users have access to HIV prevention programmes. "We have to learn how to build bridges so that we can work with these populations," he told the Bulletin.
The report, issued in August, says HIV prevalence rates remain low in most Asia- Pacific countries ¾ due in part to social norms that discourage women from both premarital and extramarital sex. But it warns that there are now "major public health concerns" about the future growth potential of HIV/AIDS in the world's most populous region.
In Nepal, north-east India and Delhi, and in some provinces of southern China, at least 50% of injecting drug users, the report says, are now HIV positive, vs "a negligible number about a decade ago", according to Walker. Similar rates of infection have been reported among sex workers in some areas of Cambodia, Myanmar, and Thailand, and in some cities in India. In Asia, most commercial sex takes place without condoms, according to WHO's Western Pacific regional office. And needle exchange programmes are difficult to implement as long as drug- taking remains illegal.
The report ¾ produced jointly by WHO's South-East Asia and Western Pacific regional offices ¾ urges countries to follow the example of Thailand and Cambodia in implementing a 100% condom policy throughout the sex industry. In Thailand, where prostitution remains illegal, this has led to a dramatic fall in infection rates among sex workers ¾ from 33% in 1994 to 20% by 2000. WHO also calls on countries to "aggressively implement" HIV prevention programmes for injecting drug users, including the provision of clean needles to ensure safe injection practices.
Another report, Sex work in Asia, soon to be launched also by WHO's South-East Asia and Western Pacific regional offices, says changing social and economic trends ¾ including increased labour mobility, economic hardship, migration, and changing sexual attitudes ¾ have led to an increase in prostitution in many countries throughout the region. In some countries, commercial sex is already big business: in Indonesia, Malaysia, the Philippines, and Thailand, the sex industry now accounts for an estimated 2%¾14% of gross domestic product (GDP).
To make matters worse, the report says, prostitution is now spreading beyond the traditional "red light" areas to suburbs, highways, and international borders, where it is less visible ¾ posing additional challenges for HIV prevention efforts. The report, due to be published in October, was presented in August at a meeting in Hanoi, Viet Nam, on condom promotion in Asia. It says most sex workers are unable to insist on condom use, especially if they are young, victims of trafficking, or migrants.
It is estimated that over 500 000 people in the Asia-Pacific region died from AIDS- related illnesses in 2000 ¾ 17% of the global annual number of deaths from AIDS ¾ and that the annual death toll will rise in the coming years to about 800 000 in the region. Most of the deaths are expected to occur in China (see Box on next page), India Myanmar, and Thailand. An estimated 6 million people in the Asia-Pacific region are living with HIV/AIDS. 
Sheila Davey, Geneva, Switzerland
