BOOKS & ELECTRONIC MEDIA
AIDS in Asia: the challenge ahead
Beena VargheseI,1; Susan V. GeorgeII
ICentre for Health Economics Research, Bangalore, India (email: bvarghese@lycos.com)
IIBangalore, India
Editor: Jai. P. Narain
Publisher: Sage Publications India Pvt Ltd: New Delhi; 2004
ISBN: 0-7619-3225-9; softcover; 392 pages; price US$ 9
The 23 chapters of this book seek to throw light on the HIV/AIDS situation in Asia a continent where the HIV/AIDS scene is markedly varied, with very different levels of prevalence, different needs, and different challenges. The editor has succeeded in bringing these differences out and in producing a comprehensive volume that focuses on the epidemiological and programmatic issues of the epidemic in Asia. However, because of the large number and variety of topics, the book sometimes loses continuity and in many places is repetitive and laden with too much statistical information.
Practitioners and policy-makers will find the book useful as it provides sufficient details about the scale and magnitude of the HIV/AIDS problem in the region. A wide range of topics related to prevention, care and treatment are covered as are country-specific HIV reports, including lessons learned from the Asian and African responses to the epidemic.
Individual chapters highlight the issues, ranging from the importance of safer behaviour in sexual and injection practices to the different challenges and role of intravenous drug use in the HIV epidemic. However, the interventions on promoting safe sex practices focus on the "supply" of safe sex by sex workers, with insufficient coverage of potential interventions to increase their clients' "demand" for safe sex. Coverage of the differences and similarities between the African and Asian epidemics, the role of other sexually transmitted infections (STIs) in the spread of HIV/AIDS, and on scale-up of antiretrovirals (ARVs) (WHO's "3 by 5" strategy) is useful and informative.
The detailed country-specific accounts of the epidemiology of HIV/AIDS and of the response by government and nongovernmental organizations are very informative as is the in-depth analysis of the success of the HIV-prevention programme in Thailand. The importance of political buy-in and of decentralization and integration of STI services in primary and reproductive health services into this country are valuable lessons also for other Asian countries. Another important lesson is the acknowledgement that the 100% condom use strategy that resulted in significant reduction in HIV prevalence in Thailand is more suitable for structured/institutionalized brothel-based sex work than for casual sex or for a less structured setting.
HIV/AIDS care, an important area for both programme and research, receives sufficient coverage; details are provided of various opportunistic infections, especially the importance of TB prevention and treatment among HIV-infected persons. Similarly the role of ARVs is well covered with elaborate details provided on clinical issues selection of drugs, monitoring of patients, and drug resistance. However, the book could have benefited from some discussion of the economics of HIV care, especially the cost of ARV therapy and of the associated monitoring tests as well as the opportunity costs of such expenditures to public health budgets across the region. Even at a cost of US$ 5001000 per person per year for ARVs, AIDS care would impose a significant burden on public health budgets for most countries in South-east Asia, particularly for India and Indonesia. To meet these costs, countries will have to consider different financing mechanisms including national health insurance schemes, co-financing mechanisms, community insurance etc.
Overall, the authors make an important contribution to describing the HIV/AIDS epidemic in Asia, covering most aspects of the disease. The book is reasonably well organized and referenced and laid out in an easy-to-read style. Most importantly, unlike the general trend in the literature on HIV/AIDS issues, this book is not alarmist. 
1 Correspondence should be sent to this author.